Back in the UK after the International AIDS Conference. The drums are silent again, the bras have found new homes. Time to reflect and work out if and how our knowledge of the world in relation to HIV has changed or not.
From the main conference came the news of the microbicide breakthrough - a powerful scientific advance. Another highlight was a World Bank session highlighting research from Malawi and Tanzania, which clearly shows that giving girls and their parents small regular cash transfers of a few dollars monthly over two years significantly reduces their risk of acquiring HIV. This emphasises the poverty dimension to young women’s vulnerability to HIV, since there is consequently less need for these impoverished young women to engage in transactional sex. In both these findings of course, it is important to continue to remember that neither medical nor financial interventions alone are the Holy Grail cure that so many keep looking for. Our lives are far more complex than that. Nonetheless, such breakthroughs are highly important in filling in another two pieces of the jigsaw and deserve celebration.
Which brings us to the thorny subject of funding for women’s rights and HIV, an issue which is clearly so immense and central, and yet one for which there is - as yet - “no evidence base”. With the costs of medication to keep us alive spiralling, medical male circumcision has been hailed as a great breakthrough to stop HIV in its tracks by protecting men by 55%. It is being rolled out across Africa with huge surgical budgets by large donors. A colleague visiting Swaziland recently was amazed to see young men being bussed in from far and wide to have their foreskins surgically removed at the local clinic, with hardly any other health service available, as the circumcision campaign had literally taken grip. Strong concerns have been raised by many women in various countries about the wisdom of such a techno-fix campaign, with little educational follow-up, which men often interpret as akin to wearing a permanent “natural” condom. Negotiation of safer sexual practices is even further from women’s reach. And, when the 45% likelihood of a man still getting HIV becomes a reality, blame on women will increase, in this kingdom where its head of state has so many wives, girlfriends and children that even he may have forgotten their numbers.
Yet whilst the dollars roll big-time for medical male circumcision, I bet my bottom dollar that similar funds will not roll for the scientific findings of this conference – the evidence that gender violence doubles HIV risk for women, the evidence that microbicides can protect women from HIV by 39% and from herpes by 50%, the evidence that cash transfers to girls can reduce their risk of acquiring HIV from 12 to 9%. Curiouser and curiouser, as Alice said down the rabbit hole.....
Something I learnt at the conference, with my heart for a change rather than just with my head, is the enormity of the HIV challenge just on our doorsteps, in Eastern Europe and Central Asia. I was particularly struck by a powerful film from Ukraine, entitled “Returning Home” about a young Ukrainian woman who has lost her husband, her brother and her best friend through injecting drug use and related health conditions. She considers herself and her friends fortunate because they are part of a highly supportive substitution therapy programme which has given them their lives back. She and her friends can now get on with being parents and workers, with this medical support which is still so highly criticised in many countries.
Another great moment for me in the week was the launch of WECARe+, the first Europe - and central Asia -wide network of HIV-positive women, together with a survey of 165 HIV-positive women from across the region, conducted in four languages. As Angelina Namiba blogged, despite 70% of women in the UK with HIV having been born in Africa, and despite there being sizeable numbers of HIV-positive women in other parts of Western Europe born in Africa, it seems curious that UNAIDS holds no statistics on this. Another odd quirk of UN statistics is the grouping of Western and Central European statistics with those of North America, rather than with those for the rest of the European and Central Asia landmass. In the WECARe+ survey, it came as no surprise to us that 1/3 of the respondents had experienced gender-based violence. Yet – another odd quirk of institutional thinking – the recent European Commission Charter promoting gender equity and speaking out forcibly against gender violence, makes no mention whatsoever of its widely known links to HIV.
In this survey, depression and fear of the consequences of disclosure of one’s HIV status were very widespread. In Vienna, many of us were in a rare bubble, where to be open about one’s status both feels normal and widely accepted. Yet I remind myself repeatedly of the conferences I went to before I felt safe to be open myself and remember that there were, no doubt, many others there who are still yet to disclose their status, even to their professional colleagues. There are, of course, many other issues which one feels nervous speaking out about. It was particularly moving to hear one woman from south east Asia talking publicly for the first time, in a session in the Women’s Networking Zone, of her experiences as a sex worker . She received a warm round of applause. By contrast, one extraordinary young woman activist, who has been HIV-positive since birth, had her cover blown back at home during the conference, after one well-meaning but misguided colleague posted a video of her speaking on her facebook site. Speaking openly involves risk and stress. Thus many young HIV-positive women activists whom I know go “back into hiding” once they decide to reclaim their lives and start a family of their own.
One piece of news which I am thrilled about is that one of the two young graduate volunteers we took with us to help with Russian/English translation in the Zone has come back so inspired by the whole experience that she has decided to take a Masters’ degree in Human Rights. Both these young women were amazed and rightly shocked that this whole HIV world was so new to them – and that comprehensive sexuality education is still not a compulsory part of the UK’s National Curriculum.
To return to the money question: the WECARe+ network development and survey was conducted without any funding, like so many of the other women led projects represented at the conference. What is it about women’s rights work that makes it so systematically unfundable, despite all the rhetoric that has been played out in Vienna about the fundamental centrality of gender issues to an effective AIDS response? We are forever at the wrong end of a deeply entrenched uneven male playing field of traditions when it comes to gender, HIV - and funding.
In the words of one session which highlighted the lack of access to funding for women’s rights: “We hear the thunder but we see no rain”. This, to me, is the outstanding challenge to move forward from the Vienna conference. Meanwhile I am off to write yet another funding proposal.
To read our full coverage of the AIDS 2010 Right Here, Right Now conference in articles and the multi authored blog click here