Forgotten women: UNAIDS, PEPFAR, and ‘keeping mothers alive’

Ann Starrs is president and co-founder of Family Care International. This article has been cross-posted on RH Reality Check, the Kaiser Daily Global Health Policy Report, and the Maternal Health Task Force blog.

Two years ago, in July 2011, UNAIDS  launched a joint initiative with PEPFAR, the U.S. President’s Emergency Plan for AIDS Relief, to help achieve the goal of an AIDS-free generation. The ambitious, if clumsily named, “Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive” included two global targets:

  • Reduce the number of new HIV infections among children by 90%
  • Reduce the number of AIDS-related maternal deaths by 50%

Today, UNAIDS and PEPFAR released a new report on progress in this important initiative. The report and accompanying press release highlight the very welcome news that seven countries (Botswana, Ethiopia, Ghana, Malawi, Namibia, South Africa and Zambia)have reduced mother-to-child-transmission of HIV by 50% or more, with two additional countries (Tanzania and Zimbabwe) close to achieving that rate of reduction.

UNAIDS, PEPFAR, and all of their global and country partners deserve sincere congratulations for this tremendous accomplishment, achieved in a relatively short span of time. Progress toward the Global Plan’s first target has been truly impressive.

But their report almost completely ignores the plan’s second target, and in fact the second part of its long title — “…and keeping their mothers alive.” Perhaps a more accurate title for the initiative, at least as reflected in this report, would have been “Global plan towards the elimination of new HIV infections among children, and keeping their mothers alive just as long as they are pregnant or breastfeeding  (but after that, not our concern…)”

Ok, maybe I’m being a bit too harsh. But in the report’s 15 pages of text, there is at best one glancing reference (being generous) to the fact that women with HIV who are eligible for treatment should receive antiretrovirals because they have a right to treatment for the sake of their own lives and health. And the target for reducing maternal deaths is not even mentioned in the report’s text (though, to be fair, it is included as an indicator in the country profiles that make up the second part of the report).

What gives?

Well, the report makes it clear. “Many more women,” it states, have access to antiretroviral medicines to reduce the risk of HIV transmission to their children  than four years ago [my emphasis, here and below].” And again, “Special attention is needed in all countries to ensure access to and retention on antiretroviral medicines for pregnant and breastfeeding women living with HIV to cut these numbers of children acquiring HIV infection.” The report betrays, alarmingly, a view of women exclusively as bearers and feeders of children.

It does, at a couple of points, vaguely acknowledge that women’s lives have value even when they are not carrying or breastfeeding babies.  “The number of women acquiring HIV infection has to be reduced,” the report states, “and all women living with HIV eligible for antiretroviral therapy must have access to it for their own health.” But this commitment, for which many advocates have fought long and hard, must be translated into concrete action to prioritize ARV treatment for HIV-positive women who are not pregnant, or who have finished breastfeeding. Too often, still, these women do not have access to the life-saving medicines they need, or are dropped from programs when they no longer qualify through their children.

The report does, thankfully, acknowledge the significance of access to family planning as a means of preventing unintended pregnancy, and thereby of preventing infants from being born with HIV:

Reducing unmet need for family planning will reduce new HIV infections among children and improve maternal health. Increasing access to voluntary and noncoercive family planning services for all women, including women living with HIV, can avoid unintended pregnancies. Family planning enables women to choose the number and spacing of their children, thereby improving their health and wellbeing.

Kudos to UNAIDS and PEPFAR for being forthright about this crucial element of PMTCT programs, even though family planning is still far too rarely included in HIV/AIDS prevention efforts.

But in other respects, the agencies need to do better, both in their programs and in the messages they send through reports like this one. Michel Sidibé and Eric Goosby, the heads of UNAIDS and PEPFAR, have both, in many speeches and statements, acknowledged the importance of women, and the right of women living with HIV to get ARV treatment for their own health. This report should have reflected that awareness, and that principle (as, for instance, this one in 2012 did). I hope and expect that the next progress report for the Global Plan will include a clear discussion of the link between HIV infection, maternal mortality, and women’s health more generally, and what the agencies are doing to address it.

Halting the spread of HIV in Ecuador’s indigenous communities

Maritza Segura is FCI’s national coordinator in Ecuador.

On October 18 and 19, 2012, in Quito, Ecuador, in partnership with the Spanish NGO Interarts, FCI is organizing a national advocacy event — Our Life, Our Rights: HIV Prevention for the Good Life — to strengthen political commitment and support for implementation of specific HIV prevention and treatment strategies for indigenous peoples and communities. We have seen firsthand that access to accurate information is critically important for preventing the spread of HIV among indigenous populations, and especially among young people in indigenous communities. To be effective in helping young people embark on safe and healthy adult lives, this information must be provided in way that is culturally appropriate and relevant to their cultural context.

Much of FCI’s work in Ecuador in recent years has focused on preventing HIV among young people and women in indigenous communities. In the villages of the Amazon jungle, young people’s access to information about their reproductive health, including HIV and AIDS, is limited. Even though these communities are seeing more and more cases of HIV each year, national surveillance systems — which don’t record ethnicity — don’t reflect the magnitude of the problem among the indigenous population.

FCI and Interarts are working with indigenous organizations in Ecuador to train young indigenous people on HIV prevention. The training uses a participatory, youth-centered methodology, adapted to the local culture, to provide information on a range of critically important topics, including how HIV is transmitted, means of prevention, and correct use of a condom. Participants also learn about the importance of solidarity, about non-discrimination, and about their sexual and reproductive rights.

To date, FCI has trained more than 5,000 young people in five Ecuadorian provinces. In 2011, at the request of the Ministry of Public Health, we implemented a pilot project on sexuality and vulnerability to HIV among the indigenous Shuar and Achuar peoples; we also proposed the development and implementation of  a national strategy to respond to HIV and AIDS among the country’s indigenous populations. The October event in Quito will help to build support for this strategy.

This initiative is implemented with support from Interarts Foundation, through a grant from the Spanish Agency for International Development Cooperation (AECID).

You can directly support FCI’s work educating young people in Ecuador’s indigenous communities! Visit catapult.org to learn how.

La prevención del VIH en jóvenes y mujeres indígenas del Ecuador

 

Maritza Segura es la coordinadora nacional de FCI en Ecuador.

El 18 y 19 de octubre de 2012, a Quito, Ecuador, FCI y la ONG española Interarts están organizando un evento de incidencia nacional —  Nuestra Vida , Nuestros Derechos: Prevenir el VIH para el buen vivir — para fortalecer los compromisos políticos en respuesta al VIH, asegurando estrategias específicas para pueblos y nacionalidades indígenas.

FCI ha visto de primera mano la importancia del acceso a información verídica y completa en la prevención de la propagación de la epidemia del VIH en poblaciones indígenas, especialmente jóvenes, y la pertinencia de material culturalmente adecuado para fortalecer la construcción de un proyecto de vida saludable, en un contexto cultural diverso.

En los últimos años, FCI ha centrado sus esfuerzos en la prevención del VIH en jóvenes y mujeres indígenas del Ecuador. A menudo, en lugares remotos del país, adolescentes y jóvenes tienen acceso limitado a información y educación sobre salud reproductiva, incluido el VIH/SIDA. Trágicamente, aunque cada año se identifican más y más casos de VIH en estas mismas poblaciones, los sistemas nacionales de vigilancia no permiten un registro por pertenencia étnica por lo tanto las estadísticas no reflejan la magnitud de este problema. Como parte de un proyecto con Interarts, FCI trabaja con organizaciones indígenas de Ecuador para capacitar a jóvenes indígenas en la prevención del VIH utilizando una metodología participativa centrada en la juventud: El recorrido participativo para la prevención del VIH, que incluye los temas de formas de transmisión, el camino de la protección, el uso correcto del condón, solidaridad, no discriminación y derechos. Hasta la fecha, FCI ha capacitado a más de 5.000 jóvenes en cinco provincias. En 2011, y a solicitud del Ministerio de Salud Pública, FCI desarrolló un estudio en una provincia piloto sobre la sexualidad y la vulnerabilidad al VIH en población Shuar y Achuar y realizó una propuesta de estrategia para dar respuesta al problema del VIH/SIDA entre las poblaciones indígenas.

Esta iniciativa es posible en coordinación con la fundación Interarts, y a través de fondos de la Agencia Española de Cooperación Internacional para el Desarrollo (AECID).

New publication fosters country accountability, supports Global Strategy

For the past five years, FCI has been a key partner in Countdown to 2015, a global coalition of academics, governments, international agencies, health-care professional associations, donors, and NGOs that uses country-specific data to stimulate and support country progress towards achieving the health-related MDGs. FCI shares (with the secretariat of the Partnership for Maternal, Newborn & Child Health—PMNCH) overall responsibility for Countdown’s advocacy and communications, working with partners to ensure that Countdown’s data, analysis, and key messages are seen and used by policy makers  to effect real change.

Accountability for Maternal, Newborn & Child Health: An update on progress in priority countriesThis week, Countdown released a new publication, Accountability for Maternal, Newborn & Child Survival: An update on progress in priority countries, which contains updated profiles on high-burden priority countries that account for over 95% of the world’s maternal and child deaths.  The report will be launched at the 126th Assembly of the Inter-Parliamentary Union, which takes place in Kampala, Uganda next week. These profiles highlight how well each country is doing in increasing coverage of high-impact interventions — key elements of the reproductive, maternal, newborn, and child health (RMNCH) continuum of care — that can save the lives of millions of women and children. The charts and graphs in each country profile provide an easy-to-read, attractive, and succinct portrait of whether these high-burden countries are making progress (or not) in increasing women’s and children’s access to essential services like antenatal care, skilled attendance during childbirth, immunization, and prevention of mother-to-child transmission of HIV.

This publication is one of the significant contributions that Countdown is making to the global accountability agenda around the Global Strategy for Women’s and Children’s Health, an unprecedented plan to save the lives of 16 million women and children by 2015, which was launched by UN Secretary-General Ban Ki-moon in September 2010. The country profiles in this publication, customized to showcase the core indicators selected by the Commission on Information and Accountability for Women’s and Children’s Health, are adapted from the full, two-page Countdown country profile, which Countdown produces on a roughly two-year cycle. Full country profiles will be included in Countdown’s 2012 Report, which will be published in June 2012.

Sample country profile from Countdown Accountability report: Burkina Faso
A Countdown country profile, from the Accountability report

FCI is also working on a number of other Countdown initiatives, including the launch of a new Countdown website and the development of a toolkit to assist high-burden countries in developing their own country-level Countdown conferences and publications.

Understanding cultures, improving reproductive health

In many developing countries, national health systems don’t always effectively reach certain groups of people with the information and services they need to stay healthy. Too often, the health services that are available are designed without sufficient regard for the cultures, beliefs, and traditions of those they  aim to reach, and the result is that essential information doesn’t get through to its intended audiences, and that urgently important health services don’t get utilized.  Many members of particularly marginalized groups — which can include teenagers who have left school or their home villages to seek work in the city, or indigenous populations living in poor, underserved rural communities — don’t know what they need to know about their sexual and reproductive health, and are particularly vulnerable to HIV infection.

Fatimata Kané of FCI-Mali and Aboubacar Dembélé of AEJT—the Association des Enfants et Jeunes Travailleurs

FCI works with our local partners to address this challenge by developing culturally-sensitive programs for reaching vulnerable groups with the information and services they need. Working with out-of-school young people in the port city of Mopti, on the Niger River in Mali, West Africa, and with women and young people in remote indigenous villages in Ecuador, we have partnered with Interarts, with support from the Spanish Agency for International Development Cooperation (AECID), to promote sexual and reproductive health and prevent HIV.

Maritza Segura of FCI-Ecuador presents at Barcelona meeting

In mid-February, Fatimata Kané, FCI’s country director in Mali, and Maritza Segura, our national coordinator in Ecuador, together with representatives from our local partner organizations, presented this work at a conference in Barcelona, Spain. This meeting, entitled “Culture and Sexual and Reproductive Health—towards a new interconnection:  A day to think, discuss and act,” was organized by Interarts as an opportunity for 50 NGOs, development agencies, migrant organizations, health workers, anthropologists, and educational professionals to share best practices and exchange ideas on the links between cultural rights, sexual and reproductive rights, and health. Meeting participants emphasized that integrated programs must focus on community needs, guarantee health rights, and respect local cultures and cultural rights. Understanding a community’s culture is essential to any health project’s success and sustainability, and is particularly important in efforts to modify behaviors that may have a negative impact on sexual and reproductive health, enabling programmers to identify bottlenecks and address issues in a participatory way.

Carmen Inés Guaminga Muyulema of Ecuarunari—the Kichwa Confederation of Ecuador

For the Barcelona conference, the representatives from FCI-Mali and FCI-Ecuador were accompanied by youth leaders from FCI’s project partners: AEJT (the Association of Working Children and Youth) in Mopti, Mali, and Ecuarunari (the Kichwa Confederation  of Ecuador). The team from Mali described their work with young people in Mopti’s ‘informal sector’ (domestic workers, market vendors, artisanal apprentices, etc.), and with the traditional leaders, employers, and parents who can influence them, to raise awareness about the consequences of negative and high-risk practices and to encourage cultural change for better sexual and reproductive health. (At first, taboos about discussions of sexuality made it difficult to involve religious leaders in the project; by sensitively integrating culture and religion into our approach, however, FCI was able to facilitate constructive dialogue by showing that religious texts do not actually support female genital mutilation and other negative practices.) The team from Ecuador discussed their work with indigenous women’s and youth groups to identify the traditions, beliefs, and cultural factors that lead to increased vulnerability to HIV, and to strengthen cultural values that can help prevent HIV and its attached stigma in indigenous communities.

Mah Doumbia, a peer educator in Mopti, Mali, educates young women about contraceptive methods

 

Getting to Zero: World AIDS Day advocacy

Today, on World AIDS Day 2011, Family Care International has partnered with Save the Children to help policymakers across Africa understand and act on the urgent need to eliminate new HIV infections among children, and to provide comprehensive HIV services for their mothers.

Three decades into the AIDS pandemic, new HIV infections among children are virtually zero in high income countries. Yet in middle and low-income countries, an estimated 370,000 children were born with the HIV virus in 2009, while 60,000 pregnant women died because of HIV. “This is unacceptable. Urgent and exceptional efforts should be made to eliminate new infections among children and to keep their mothers alive,” said Thomas J. McCormack and Fatimata Kané, Country Directors in Mali for Save the Children and FCI, respectively, in a joint statement supporting the Getting to Zero campaign to eliminate new HIV infections. “Save the Children and FCI agree: Getting to zero is possible in Mali and in countries across Africa.”

Photo: UNAIDS/Getting to Zero

With over 2.5 million children and 1.4 million pregnant women living with HIV, action must be taken to ensure the survival of children and mothers. Weak health systems, insufficient numbers of health workers, limited health financing, and inadequate focus on health issues within national development frameworks all must be addressed urgently in order to save women’s lives, protect their health, and help them avoid passing on the virus to their children. This requires action by governments, in partnership with the private sector and development partners.

FCI and Save the Children are joining UNAIDS and a global coalition of NGOs in supporting the Global Plan Towards Elimination of New HIV Infections among Children by 2015 and Keeping their Mothers Alive.  The Global Plan has two important targets:

  • Reduce the number of new HIV infections among children by 90%
  • Reduce the number of AIDS-related maternal deaths by 50%.

African leaders have made a number of commitments to address HIV/AIDS among women and children, most recently at the United Nations High Level Meeting on AIDS in June, 2011, when the Global Plan was launched.

In Mali, Burkina Faso, and Kenya, FCI is working, in collaboration with many partners, to hold policymakers accountable for keeping these promises.  Increased efforts to eliminate new infections for children and keep their mothers alive are crucial to improving child survival and maternal health, and to achieving Millennium Development Goals 4, 5 and 6. FCI is proud to partner with Save the Children and other advocates around the world on World AIDS Day to urge policy makers and donors to help us “get to zero.”

FCI co-sponsors UN event on girls, women, AIDS

The International Peace Institute, in collaboration with FCI, the Permanent Mission of Norway to the United Nations, and Women Deliver, hosted a policy forum entitled Prevention and Protection Save Lives: Girls, Women, and HIV on the sidelines of the 2011 UN General Assembly High Level Meeting on AIDS on June 8th. This description of the event is cross-posted from the UNAIDS website.

HIV is now recognized as the leading cause of death among women of reproductive age. The forum aimed to identify and strengthen the response to HIV, and to raise awareness about the interconnectedness of women’s health issues in relation to the broader development agenda.

In this light, the high level panel brought together Michelle Bachelet, Executive Director, UN Women; Purnima Mane, Deputy Executive Director (Programs), UNFPA; Carmen Barroso, Regional Director, IPPF/WHR; Jan Beagle Deputy Executive Director, Management and External Relations, UNAIDS; and Ms Lindsay Menard-Freeman, programme officer at Global Youth Coalition on HIV/AIDS, to discuss lessons learned, current challenges, and the path forward.

“Young people are now the actors, mobilising for prevention, taking ownership of the AIDS response and shaping the attitudes of future leaders,” said UNAIDS International Goodwill Ambassadors Her Royal Highness the Crown Princess of Norway Mette-Marit who opened the forum. “We have to make sure that the next wave of leadership is equipped, engaged and sufficiently supported to maintain and develop the response.”

Photo credit: Women Deliver

Also participating in the discussion was UNAIDS International Goodwill Ambassador Annie Lennox, a strong women’s rights activist: “We have the knowledge, we have the treatment,” said Ms Annie Lennox and urged world leaders gathering at the High Level Meeting on AIDS to take action on women and girls: “This is our moment: Don’t let us down.”

The Executive Director of UN Women called for leadership on this: “We know what has to be done and we know what works. And we can do better to stop this epidemic. With political will we can create the fiscal space to make women and girls a priority,” said Ms Bachelet.

The discussion, moderated by James Chau, Goodwill Ambassador, UNAIDS and a journalist with China CCTV, highlighted that young women in particular are vulnerable to HIV.  As a result of a combination of biological and socio-cultural factors, nearly a quarter of all new global HIV infections are among young women aged 15-24. “Knowing your epidemic in gender terms is critical. Human rights, including the sexual and reproductive rights of all women and girls – in particular women and girls living with HIV – must be protected and promoted in all HIV and global health programmes.”

However, progress has been made. More than 60 countries have shown their commitment to gender equality by implementing the UNAIDS Agenda for Women and Girls and HIV, engaging over 400 civil society organizations.

“It’s important to remember that young people are actors, and young people are asking for what they need,” said Ms Menard-Freeman. “Now that we are here [at the High Level Meeting on AIDS], we need the voices of young people to be heard.”

One of the critical examples raised as a model for a consolidated approach to women’s health was the United Nation’s Every Woman Every Child campaign. The campaign, launched during the United Nations Millennium Development Goals Summit, has so far seen a US$ 40 billion commitment by countries to improve the health of women and children. If implemented, it is estimated that the strategy could save up to 10 million lives of women and children by 2015.

The new UNAIDS Strategy 2011 – 2015: Getting to Zero [pdf] has made advancing human rights and gender equality for the HIV response one of its three key strategic directions, and is committed to ensure that the rights of women and girls in the context of HIV.