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Statement by Dr. Nafis Sadik Special Adviser to the United Nations Secretary-General HIV/AIDS – A Threat to Women and Girls in the Asia-Pacific Region Hanoi, Viet Nam Thank you for asking me to be part of this panel. I am very pleased to see this recognition, by APEC Women Leaders, that HIV is not just a health issue – it is an economic issue, a development issue and a gender issue. I would like to record that the UN system stands ready to assist the APEC Women Leaders Network in developing a programme for cooperation that will protect women from HIV infection and its impacts, through addressing women’s economic and social empowerment. We have several speakers and a limited time, so I will make only three points.
Every APEC member economy is affected by HIV. To give some idea of the exceptional scale of the threat, UNAIDS has estimated that, by 2010, 10 million adults and children in Asia-Pacific would be newly infected; three million would have died; and the economic cost would be a staggering $17.5 billion. Some economies have widespread epidemics; some countries have severe localised epidemics among high-risk groups; a few are managing, with considerable effort, to contain it. It may seem like an invisible problem, but the impacts are real. Worldwide, HIV is the leading cause of death of people in what should be their most productive years – age 15-59. In Thailand, UNDP estimates that income foregone between 1996-2000 because of ill-heath and early death due to HIV at around USD1 Billion! In Cambodia, where HIV prevalence reached around 3%, HIV has had a dramatic effect on poverty reduction, slowing it almost to a halt, until prevention efforts became effective. Men who have sex with men; injecting drug users and people exposed to infected blood products are at heightened risk; but the disease spreads mainly by sexual contact between men and women. Women and men who have several partners – including sex workers and their clients – are at special risk. One of the biggest risks in this region is refusal to respond to realities, whether it is drug use, prostitution, extra-marital sex or sex between men. Asia-Pacific countries can remove the threat of a widespread HIV/AIDS epidemic in the next ten years; but only if they are willing to face facts and respond to them.
Women in APEC are at increasing risk of HIV, and especially young women. The physiological fact is that women are more than twice as vulnerable to HIV/AIDS infection as men. The sociological fact is that women’s subordinate status – in their level of education; in economic power; in marriage, and in society at large, makes them many times more vulnerable. Viet Nam and other countries of the region have worked to promote legal equality of women. But traditional values are still strong and limit women’s equality, especially around reproductive and sexual decisions. Marriage offers young women no protection against HIV/AIDS; sometimes quite the opposite. Young women tend to marry older men, and their upbringing encourages them to trust their husbands. Yet, studies in antenatal clinics in several countries have shown that eight or nine out of ten HIV-infected women have had no partners outside marriage. There is a close connection between sexual violence and HIV/AIDS. There is research showing that women in violent or coercive relationships are 50 per cent more likely to contract an HIV infection. Recent research in Asia-Pacific shows a high incidence of sexual violence and coerced sex on the part of husbands towards their wives. Cultural norms across the region, especially in the rural areas and among the urban poor, give no encouragement or support to a wife who resists her husband for any reason. Women, especially young married women, need the full weight of the law to safeguard their health and protect them from violence. I hope you will introduce and support the necessary legislation and insist on its vigorous enforcement. The burdens of HIV care fall mostly on women; they are often last in line for treatment and are far more likely to bear the stigma of living with HIV/AIDS. Women in fact are often blamed for their husbands’ infection—a bitter comment on the value that Asia-Pacific cultures place on women. At the same time, women’s work underpins the region’s economy; and your many other daily roles – as housekeeper, cook, health aide, educator, child-care specialist, or nutritionist, for example – hold the family and community together. As a matter of human rights and simple justice, it is intolerable to expose Asia-Pacific’s women unnecessarily to the burdens of HIV/AIDS; as a matter of practical economics, it is insupportable.
The answer to the exposure of women to HIV/AIDS infection lies first in empowering all women with health care, education, rights in marriage and inheritance, and the power of the purse; and second, in changing the behaviour and underlying attitudes of men. Both of these aims should claim the close attention of government and civil society. Health care overall, and sexual and reproductive health care in particular, is of vital interest to women. Women in the Asia-Pacific region need new prevention methods they can use themselves, such as microbicides: but these are still some years away. In the meantime, women leaders should press for more attention to the existing range of prevention possibilities, such as male and female condoms; for their availability to all women throughout the region; and for the necessary support to women who wish to use them. For example, the Viet Nam Women’s Union has its own brand of condom and distributed over 10 million condoms last year. And Madam Khiet has strongly advocated that “condoms promote equality in the family”. A practical step will be to integrate reproductive health and HIV/AIDS prevention services. Many parts of the region still offer separate stand-alone facilities – but epidemiology and economy alike call for integration. I hope you will press for this necessary and obvious reform. One possibility would be to introduce integrated services in the workplace, so that women workers could avail themselves of two necessary services in one visit. Education is equally important for married and unmarried women, both for the confidence and self-esteem it brings, and for their access to health information and services. Education and empowerment is especially important for young women, who are at heightened risk of infection, whether they are married or not. A practical step towards keeping more girls in school would be to eliminate school fees. Trafficking of women for sexual purposes is unfortunately a major problem in parts of our region. There is another speaker on this issue later in this panel, so I only want to remind you of the important link between trafficking and HIV, and note that it is poverty that makes women available for trafficking. Working with the ILO to protect the rights of female workers, including labour migrants, represents a critical opportunity. Business leaders and women entrepreneurs can ensure adoption of and adherence to the ILO Code of Practice on HIV/AIDS and the World of Work Conclusion Finally, allow me to draw to your attention the Declaration from the recent UN General Assembly High Level Meeting, point 31 (one among many important points that I hope you will take time to study): Your governments agreed the following: There is no cure for HIV/AIDS and none is on the horizon. We can only stop HIV/AIDS by preventing its spread. Women stand to lose most from the disease: women leaders must act together to stop it. Thank you. |
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