HIV: of bombs and banks and transformation...

Thirty years into the AIDS pandemic, an AIDS-free generation is in our grasp at last. Alice Welbourn asks whether we are really going to let it vanish, thanks to the aggressive traits of financiers and governments ?
Alice Welbourn
1 December 2011

The AIDS world is rocking in crisis. Last month Hillary Clinton laudably declared the US administration’s commitment to creating an “AIDS-free generation”, which, for the first time in the 30 years of this global pandemic, with the advancement of science, is actually a realistic possibility. Then this week the Board of the Global Fund for AIDS, TB and Malaria has dropped the bombshell : having to cancel Round 11 funds through lack of G8 donor commitment. It has kept millions of men, women and children alive around the world through providing bed nets to stop malaria, medication to cure TB and anti-retrovirals to keep people with HIV, like me, alive and make us productive once more. True, it’s had a poor track-record on gender to date. But at least it’s kept people alive. Critical as I am of the gender-blindness of a lot of science, without the medication to keep us alive and well and uncontagious, there would be millions more global AIDS-related deaths than there have already been. Yet, despite Clinton’s pronouncement, the powers that be in the US administration are clearly more interested in its daily military budget of $1.9 billion than committing to its annual Global Fund commitment of a paltry $1.33 billion, (that’s about the equivalent of teatime in war-speak), to keep women, men and children – largely in Africa - alive. Two prominent North Americans, Jeffrey Sachs and Stephen Lewis have just published rightfully excoriating articles about the position of the US as the lead donor in this global travesty of human rights and spending cuts we call US domestic policy. Hurray for truth.

What I find especially ironic is that last month I attended a hugely inspiring workshop which for me represented a historical breakthrough in terms of an “aha” moment for gender in this pandemic. In Istanbul there gathered 70 government, civil society and UN delegates, from 20 countries across the world. What better symbolic location, a historical meeting place of continents and cultures, visions and possibilities? A rare enough convergence in itself. The agenda made it even more special.

The Istanbul conference brought together three key strands of this pandemic that have been close to my heart for years: gender-based violence, the role of men and boys in gender equity and the meaningful involvement of women in decision-making in our lives. It is now widely recognized that internationally that gender-based violence and HIV are parallel epidemics. “Intimate partner” violence doubles women’s vulnerability to acquiring HIV globally. Likewise, when a woman learns she has HIV, she often experiences gender-based violence from her partner, in-laws, (often ill-trained, judgmental) health staff or the police. This violence is largely perpetrated by men, or by institutions led by men. Hence the need to develop ways of engaging men and boys collaboratively to help them realize their roles in all this.

As one man from the Stepping Stones programme conducted by the Fiji Network of People living with HIV wrote:

“My turning point was the Gender Violence session. It was such an eye opener for me. I finally realized how I have been mistreating my wife and how she must be broken hearted by the way I have treated her ever since we got married. I took her hands and gave her a very genuine apology straight from my heart for all the bad things I had done to her and that if I had hurt her feelings in any way for her to find it in her heart to forgive me. My wife cried…tears of joy for I know that that night was a new beginning in our relationship. Things have changed in my home… I believe that everything is linked – from community to parents and their children.” (Isimeli, Fiji)

Gender-based violence includes physical and sexual assaults, but can also be psychological, or financial: through limited access to proper jobs or money to feed the children. Or through limited legal rights to child custody, to the roof over your head or to your husband’s property when you have nursed him on his AIDS-related death bed and his relatives are baying at the door. As renowned prison psychiatrist and reformer James Gilligan explained, much violence stems from men feeling frustrated, ashamed or inadequate. (This is also why domestic violence always spikes when England is losing the football.) If men – and women - can be supported to deal with these feelings when they arise, through more self-awareness, more emotional literacy, learning to listen, and more assertive techniques of conversing, which are mutually respectful and conciliatory rather than combative, huge transformations can take place in relationships and in gender norms across entire communities. As Enita, a woman from the Stepping Stones programme conducted by the Coalition of Women living with HIV and AIDS in Malawi described:

“After being found HIV-positive, my husband left me. But after attending the Stepping Stones training, my husband decided to go for HIV testing and counselling, a thing that he vehemently refused to do in the past. His results revealed that he was HIV-positive. The training helped him to rediscover himself and he apologized for leaving me. My husband and I are now back together and happily married again with no incidents of violence because we are able to communicate better as a couple and respect each other’s rights.”

Such “gender transformations” are happening in inspirational pockets globally. But they are only in pockets and not widespread because of funding. Such programmes take time for attitudes and practices to change, for past experiences to fade and for new trust to grow. Bio-medical techno-fixes don’t produce these solutions, and the evidence for such transformations is really costly and doesn’t turn green overnight in a test tube. The answers lie instead in how we all relate to one another, word by word, action by action, across society. A young man, Julius, in Uganda, at the end of their Stepping Stones programme declared:

“Through the workshops I have plucked up the courage to face the elders. Before I couldn’t even mention the word ‘condom’ in front of them.”

Poverty is a major driver of men’s sense of inadequacy. Everywhere, if a man is badly treated by his boss or unemployed, domestic violence frequently follows. Yet funds for these social programmes, the effectiveness of which takes much longer and more complex, qualitative approaches to measure, over years, is really limited. So my organization is really struggling to fund our support and information hub for 900 grassroots organizations using Stepping Stones (which I wrote in the mid-1990s, when I was first struggling with my own new HIV diagnosis), in 100 countries across the world, despite there being an evidence base of its success in reducing gender-based violence.

What about the third strand of our workshop, the meaningful involvement of women with HIV in all this work? 51% of people with HIV globally are now female. Men with HIV around the world have done great things over the years, but one thing they haven’t managed is to stop us getting it. Just like any other problem, those most damaged by it have particular insights based on their own experiences, which can protect others in future. But globally the HIV activists with the funds, the jobs, the invitations to meet ministers and celebrities, the conference invitations, the plane tickets – and with their issues on the agenda are – men. True for sure, when it comes to having babies the funds pour in – the world colonizes us women with HIV to stop us having sex (though with zero advice about how to deal with a husband’s response); stop getting pregnant (remember the sterilizations court case which the Namibian government is still dragging out?); GPs in London, with no excuse, still think that women with HIV, even on medication, are 50% likely to give it to our babies, when the scientific reality is now closer to 0.1%. We women certainly know about having our bodies controlled. In many countries, despite UN guidelines which recommend voluntary HIV testing in pregnancy, women face mandatory ante-natal HIV testing (and consequent abuse if HIV positive) as a condition of receiving care. But, as a recent study of the Global Fund clearly shows, the great majority of decision-makers around the world are male. So meaningful involvement of women living with HIV – through funds for us to conduct research pertinent to us, support for us to raise awareness, or solidarity with us to train those supposed to be providing our care – is globally virtually non-existent.

But what made this workshop different was an amazing “aha” moment when suddenly all the delegations found themselves hearing from a woman living with HIV from their region, sitting with them at their table and telling them personally about these challenges. Quiet stories from the women with HIV, also speaking truth to power, reverberated around the room as those listening to them absorbed their profundity. We all then studied a policy brief manifesto, highlighting funding, capacity building and our democratic involvement, signed by 60 networks of positive women worldwide, which clearly declares our needs.

On the final workshop day, to our joy, we heard each country delegation in turn announce that they wanted to incorporate our requests into their national strategic plans, alongside work on gender-based violence and engagement of men to promote gender equity. At last we sensed a glimpse of light, a tiny but critical tipping point in this world of activism in which I have now been involved for nearly 20 years.

Yet I and my NGO colleagues have still flown home to empty purses, those bankers are still occupying our City - and now we have the grim news of this Global Fund fiasco to boot. I guess making money for personal gain and funding wars are addictions as strong and competitive as any other. As Ghandi said, poverty is the worst form of violence….

So how do we get these bankers and war-mongers to wake up? Keeping people alive and productive isn’t “just” a rights-based issue. It affects the world economy. Gender equity isn’t “just” good for women. It makes the world a better place for us all. That AIDS-free generation is in our grasp at last. Are we really going to let it vanish, thanks to the aggressive traits of financiers and governments? Or do we want to usher in a new way of being male? Ghandi also said “the fragrance remains on the hand that gives the rose”. Do the political and financial giants want fragrance or blood on their hands? Who knows? Maybe miracles can happen: maybe even bankers and war-mongers can transform their way of being in the world. Which of them is going to be the first to lead the way?

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