“It was hard for us before COVID-19, but it has become even harder now,” said Ayu Oktariani, the National Coordinator of the Indonesia Positive Network of Women Living with HIV (IPPI). For more than 10 years, she has been working with women and adolescents living with HIV who have been subjected to domestic violence in Indonesia, providing them with psychosocial support and counselling. Since the first COVID-19 outbreak, she has seen increased requests for help, as violence has escalated alarmingly.

Even before the COVID-19 pandemic, domestic violence was already one of the most significant human rights violations, but the pandemic has made a challenging situation even worse. Confinement is increasing the stress caused by security, health and money worries and is increasing the isolation of women with violent partners, separating them from the people and resources that can best help them.

According to a survey conducted by the International Community of Women Living with HIV in Asia and the Pacific (ICWAP) with support from the UNAIDS Regional Support Team for Asia and the Pacific, in June 2020 almost 30% of the respondents experienced some form of gender-based violence, including stigma and discrimination. In addition, more than 80% reported a lack of access to sexual and reproductive health services, including contraception.

In Indonesia, a report released by the National Commission on Violence against Women shows that the number of reported cases of violence against women living with HIV has significantly increased during the pandemic. “A few months ago, I was contacted by a woman living in a rural area, who was forced by her husband to have regular unprotected sex. She was unable to negotiate the use of condoms because of fear of violence,” said Ms Oktariani.

With other organizations in Indonesia, IPPI is developing a referral system that will guide women living with HIV who have been subjected to violence to women-led organization for legal advice and support. IPPI is also part of a national coalition that connects women and girls, including women living with HIV, to emergency services, including the police and justice and social services.

In Nepal, women living with HIV are faced with similar ordeals as a result of the COVID-19 pandemic. Sara Thapa Magar, the President of the National Federation of Women Living with HIV and AIDS (NFWLHA), Nepal, reflects on Lily’s (not her real name) story, a woman living with HIV who was beaten by her husband after she went to the local hospital to get refills of her antiretroviral therapy. The current circumstances, including limitations on access to helplines and disrupted public services, have made reporting of abuse and violence even harder.

NFWLHA has played a critical role in addressing these challenges by offering legal support to women like Lily subjected to domestic violence and providing relief packages to women and children living with HIV. “Despite these efforts, we are struggling to cope with the knock-on effects of the pandemic, and one of the main reasons is the lack of funds,” said Ms Magar. “Women-led organizations need to be continuously supported in our frontline role.”

Kousalya Periasamy, the founder of the Positive Women Network (PWN+), explains the multiple impacts of COVID-19 on the life of women living with HIV in India. “Many women and girls were afraid of going to the hospital to get their antiretroviral therapy refill and access general health services out of fear of COVID-19,” said Ms Periasamy. “Women living with HIV who had COVID-19 were not able to provide for and look after children if they had to be admitted into the hospital.” Given the need to communicate with local network partners and members, PWN+ established a WhatsApp group to ensure that women living with HIV had access to reliable information on HIV and COVID-19. PWN+ also mobilized support from different local organizations to donate food and supplies and handed out pamphlets containing HIV and COVID-19 information.

Sarah Feagan, a Board Member of ICWAP, works for a local agency in Australia, Living Positive Victoria (LPV). During the lockdown in Melbourne, “I worked to ensure women living with HIV remained connected and supported during COVID-19. Since I could not meet anyone in person, I kept in touch on the phone, linking them together via online workshops and other women living in similar areas to meet up without breaking the 5 km rule,” she said. She was able to offer financial support, food parcels and legal and emotional support thanks to LPV and other HIV organizations.

“On International Women’s Day, we commend all our sisters across Asia and the Pacific, who, like Ayu, Sara Thapa, Sarah and Kousalya, are establishing supportive mechanisms for women and girls living with HIV, even in the face of adversities,” said Sita Shahi, ICWAP Regional Coordinator.

During the COVID-19 pandemic, the UNAIDS Regional Support Team for Asia and the Pacific has joined hands with ICWAP to raise awareness about the needs and challenges of women living with HIV and to support the implementation of small local relief projects in Nepal, Malaysia and India. “COVID-19 is already testing us in ways most of us have never previously experienced. We must emerge renewed, with women living with HIV as a powerful force at the centre of the recovery,” said Eamonn Murphy, Director of the UNAIDS Regional Support Team for Asia and the Pacific.

The Network of People Living with HIV in Senegal (RNP+) marked Zero Discrimination Day 2021 by hosting a dialogue on the extent and impacts of the stigma and discrimination faced by women and girls living with HIV in Senegal—a country in which the 2017 People Living with HIV Stigma Index showed one in two people living with HIV experienced stigma and/or discrimination from others.

“Discrimination continues to affect women and girls and this is the reason why they are often excluded from the labour market, are isolated in their communities or experience stigma in health centres. Key populations are also historically the target of discrimination in Senegal,” said Soukèye Ndiaye, the President of RNP+.

Various assessments undertaken in the country have revealed that women living with HIV face obstacles in accessing reproductive health services, that sex workers face high levels of stigma in health-care settings and that the economic and social vulnerability of women living with HIV is not sufficiently taken into account in HIV programmes.

This dialogue served as the spearhead for the advocacy strategy that RNP+ will develop this year on human rights and gender issues in order to better respond to the expectations of its members and communities affected by HIV. This strategy will be accompanied by communication tools such as videos in several local languages and dialogue and sensitization sessions with key actors in the regions most affected by HIV.

During the dialogue, the participants were invited to support the RNP+ in this process. In particular, they were asked to become “champions” committed to making a better use of journalists, community radio and social networks to sensitize the general public to the challenges of discrimination.

Abdoulaye Ka, in charge of human rights issues at the National AIDS Control Council (CNLS), recalled the importance of continued collaboration between the state and non-state sectors. “Community organizations and networks have long been essential in the fight against AIDS because of their central role in raising awareness, informing, dispelling myths and misinformation and providing services to marginalized, vulnerable and discriminated against populations.”

The dialogue, which was supported by UNAIDS, brought together about 30 participants, including people living with HIV, representatives of women’s movements and key populations, human rights advocates, policymakers and health service providers in a meeting held both virtually and physically.

“In Senegal, we know that discrimination against people living with HIV is still a major stumbling block in all aspects of the HIV response. The United Nations Joint Team on AIDS has always placed human rights and gender considerations at the centre of its work and support,” said Demba Kone, the UNAIDS Country Director for Senegal.

When Lineo Tsikoane gave birth to her daughter, she was inspired to intensify her advocacy for gender equality to give Nairasha a better life as a girl growing up in Lesotho.

“I think a big light went off in my head to say, “What if the world that I’m going to leave will not be as pure as I imagine?” I ask myself, “What kind of world do I want to leave my daughter in?”” she says.

As a result, Ms Tsikoane champions for women’s social, economic and legal empowerment at her firm, Nairasha Legal Support. It offers legal support for women in small and medium enterprises and women who are survivors of sexual and gender-based violence.

“Our main focus is gender-based violence, because this happens to be a country that has one of the highest incidences of rape and intimate partner crime in the world,” she says.

Even before the COVID-19 outbreak, violence against women and girls had reached epidemic proportions globally.

According to UN Women, 243 million women and girls worldwide were abused by an intimate partner in the past year. In Lesotho, it is one in three women and girls.

Less than 40% of women who experience violence report it or seek help.

As countries implemented lockdown measures to stop the spread of the coronavirus, violence against women, especially domestic violence, intensified—in some countries, calls to helplines increased fivefold.

In others, formal reports of domestic violence have decreased as survivors find it harder to seek help and access support through the regular channels. School closures and economic strains left women and girls poorer, out of school and out of jobs, and more vulnerable to exploitation, abuse, forced marriage and harassment.

The United Nations Population Fund (UNFPA) works together with UNAIDS, the United Nations Children’s Fund and the World Health Organization on 2gether4SRHR, a joint programme funded by the Swedish International Development Cooperation Agency, to address HIV and sexual and reproductive health in Lesotho.

During Lesotho’s lockdowns, UNFPA worked with Gender Links, the Lesotho Mobile Police Service and others to support efforts to prevent and respond to incidences of gender-based violence.

“We are ensuring that a helpline, where people experiencing gender-based violence can call, is in place and is working and we are also providing relevant information through various platforms for people to access all the information they need on gender-based violence,” says Manthabeleng Mabetha, the UNFPA Country Director for Lesotho.

Mantau Kolisang, a local policeman from Quthing, Lesotho’s southernmost district, characterized by rolling hills and vast landscapes, says one reason why gender-based violence is prevalent in Lesotho is because the law is not heeded in the rural areas.

“It’s difficult to implement the law since these are remote areas,” he says, adding that while he has made arrests, he has no transport to access far-flung areas in the small mountainous region. 

Lesotho’s law states that a girl can marry at the age of 16 years. However, Mr Kolisang says cultural practices, coupled with contraventions of the law, has made some men believe a 13-year-old girl “can be a wife”, exposing Basotho girls to violence.

“Men don’t regard it as a crime,” he says, adding that girls have been abducted from the mountains for forced marriages.

Between 2013 and 2019, 35% of adolescent girls and young women in sub-Saharan Africa were married before the age of 18 years. Girls married before 18 years of age are more likely to experience intimate partner violence than those married after the age of 18.

Because of poverty, gender inequality, harmful practices (such as child, early or forced marriage), poor infrastructure and gender-based violence, girls are denied access to education, one of the strongest predictors of good health and well-being in women and their children.

In Lesotho’s legal system, women are regarded as perpetual minors. This categorization infantilizes women, Ms Tsikoane says. A man who abuses a woman can often walk away unscathed from the justice system if he says the woman in question is his “wife”, she adds.

“This makes women vulnerable to commodification because a child can be passed around,” she says.

Ms Tsikoane says there is a direct link between the minority status of women and HIV infection in Lesotho. In 2019, there were 190 000 women 15 years and older living with HIV in Lesotho, compared to 130 000 men. 

Adolescent girls and young women between the ages of 15 and 24 years are particularly vulnerable. They accounted for a quarter of the 11 000 new HIV infections in Lesotho in 2019.

“My hypothesis is women cannot negotiate safe sex,” says Ms Tsikoane.

The dangerous reality that Basotho women live in worries Mr Kolisang. But due to a lack of institutional support and resources, he feels his actions have limited effect.

“I feel for these children. I feel for these women. I do feel for them. I can help, but the problem is how?” he laments.

Ms Tsikoane says she finds “trinkets of opportunities” for her and her colleagues to help their clients and navigate a legal system that is not favourable towards women.

“So, if you are not being well assisted at a police station, if you feel like someone is dragging your case and you are struggling to get an audience, we are there. We will support you and we will fight with you,” she says. 

This story was first published by UN Women

On World AIDS Day, UN Women spoke to survivors and community changemakers in South Africa who as part of UN Women’s HeForShe community-based initiative and a joint UNAIDS programme are engaging men and women to reject violence against women and seek HIV testing and treatment. 

Until two years ago, Karabo Chabalala (28) and Sarah Baloyi (26), young women from Mamelodi — a township northeast of Pretoria in Gauteng, South Africa — were living very different lives.

“I was in a very dark place. I had multiple sexual partners and was part of a lifestyle that was not good or healthy for me,” says Baloyi. Her friend, Chabalala says, “I had many personal problems. I engaged in a transactional relationship with an abusive older man to fund my education and provide for my family.”

Their lives turned around following their involvement in UN Women’s HeforShe community-based initiative that aimed at improving attitudes and behaviours around gender-based violence (GBV) and HIV.

“Karabo introduced me to HeForShe, a community that cares for one another,” says Baloyi. “The dialogues showed me that I am not alone in my mistakes and could change my life. I have been inspired to promote safe and healthy living for young girls and to provide them with the same loving acceptance that was extended to me.”

Chabalala adds, “Many young women don’t open up at home about problems they are facing. These dialogues give us a space to express our thoughts and feelings and to ask any questions that we have about life.”

Led by UN Women’s partner, Southern Africa Catholic Bishops Conference (SACBC), and funded through the Joint United Nations Programme on HIV/AIDS (UNAIDS), the HeforShe dialogues have since 2018 engaged 115,000 men and women across seven districts (Mamelodi, Klerksdorp, Bojanela, Sedibeng, city of Johannesburg, Ehlanzeni and CapeTown) in South Africa’s five provinces.

“The dialogues are coordinated by 151 trained women and men ‘changemakers’, including young women like Baloyi and Chabalala, equipped with knowledge on HIV and violence prevention, unequal gender norms, the importance of HIV testing and adhering to treatment, responsible sexual behavior, and how socio-economic factors can drive HIV infections among men and women,” explains UN Women's South Africa Multi-Country Office Representative, Anne Githuku-Shongwe.

“Many women in Mamelodi have been victims of abuse or witnessed femicide in their homes, often at the hands of men who [are alcoholic].” says Baloyi.

“All I feel is anger,” says Chabalala. “These men don’t respect us. Women in our community are being raped and killed. Some men who perpetrate these crimes are out on bail the following day.”

“There has been a rise in GBV since the COVID-19 lockdown,” says Baloyi. “Abusive partners have been stuck at home and they are frustrated. They are no longer able to spend their time working or drinking with friends, and take it out on their partners and children. This is especially the case in informal settlements, where families live in one- or two-room shacks.”

South Africa is home to almost one-fifth of people living with HIV worldwide and has an HIV prevalence rate of 20.4 per cent among adults (15-19 years). In line with trends across Sub-Saharan Africa, in 2019, women accounted for the majority of new infections in the country. Structural gender inequalities, discrimination, violence against women and girls, and unequal gender norms continue to undermine efforts by women and girls to prevent HIV and use HIV/AIDS services.

“The stigma around HIV prevents people from seeking treatment. I have met some older patients who still fear going to the clinics because they feel judged or embarrassed,” says Chabalala.

To increase the uptake of HIV testing, the changemakers partnered with 20 local HIV counselling and testing clinics across participating districts. They also facilitated outreach for HIV testing at community and church events and developed a referral system. In two years, the HeforShe initiatives have resulted in 62 per cent of those engaged testing for HIV, and 36 per cent returning and adhering to their antiretroviral treatment. However, because of the COVID-19 pandemic, people living with HIV and people at higher risk of HIV infection are facing life-threatening disruptions to health services.

Inspired by the positive impact of UN Women initiatives in communities and empowered by the change makers, Mamelodi community members founded the national ‘Young Women for Life Movement (YWfLM)’, which has grown to 2,035 members. With support from the SACBC, the group is currently monitoring the proceeding of 30 cases of sexual and gender-based violence and 17 cases of femicide in the justice system, as well as supporting the families of survivors. They also played a crucial role in organizing food supply drives to the most vulnerable households in their communities during the COVID-19 lockdown.

“I started the Mamelodi chapter of the Young Women for Life Movement,” says Chabalala. “Being part of this community of 200 powerful young women has taught me so many things and helped me grow. It has changed my life”.

“As a YWfLM member, I work with our local clinic and visit people living with HIV in our community to confirm that they are taking their medication and to ask if they need any assistance or additional supplements,” says Baloyi. “We also have an HIV-positive support group that now mainly connects online due to the pandemic.”

Both Baloyi and Chabalala believe that men need to be more involved in initiatives to improve attitudes and behaviours to prevent GBV and HIV. “Young men need to not only be part of this conversation, they must have their own dialogues where they focus on how to change their mindset,” says Chabalala.

Baloyi adds, “Many more men need to join women in our fight. Men must join us in court and in the streets. They must fight with us.”

Like HIV, the COVID-19 pandemic thrives on inequalities and inequities. In addition to its impact on people’s health, the COVID-19 pandemic has resulted in significant increases in gender-based violence around the globe, including in the Middle East and North Africa.

Some countries in the region lack essential services for survivors of violence, especially in, for example, rural areas, conflict zones or humanitarian settings. Where services do exist, they do not always reach marginalized women and girls, and in many cases have been reduced or de-prioritized during the pandemic. Gender-based violence in the Middle East and North Africa is also sometimes not prioritized by the police and justice systems and many countries do not criminalize domestic violence, marital rape and other forms of gender-based violence that are particularly relevant in the region, such as female genital mutilation.

The United Nations Issue-Based Coalition on Gender, Justice and Equality is taking a twin-track approach to gender-based violence in the region, combining a programmatic response that prevents gender-based violence and supports survivors with the launch of a region-wide awareness campaign. The campaign uses the regional goodwill ambassadors of the coalition United Nations agencies to shed light on the risks that women and girls face as a result of the health crisis and to raise people’s awareness on how to counter gender-based violence and support survivors.

“Any form of violence against women and girls is a direct violation of human rights. I want to assure every violated woman and girl through this campaign that we are all with you,” said Yousra, UNAIDS Goodwill Ambassador for the Middle East and North Africa.

The joint campaign is an illustration of the strength of collaboration among United Nations agencies and what partnerships can do in building and empowering the global appeals and calls to action of the United Nations Secretary-General and the Spotlight Initiative, a global, partnership between the European Union and the United Nations to eliminate all forms of violence against women. The campaign leverages the ability of regional celebrities to reach local communities to raise awareness on the compounding impact of COVID-19 on gender-based violence and the vulnerabilities of marginalized and vulnerable groups.

“The response to COVID-19 in this region, and globally, has shown us that when we act in solidarity, in true partnerships and with a sense of shared responsibility, we can win against the intertwining health threats of COVID-19, HIV and the shadow pandemic of gender-based violence,” said Rangayian Gurumurthy, Director, a.i., of the UNAIDS Regional Support Team for the Middle East and North Africa.

“During COVID-19, most of us are confined in our homes with our partners. This has increased relationship problems, as well as social and economic problems. Many are subjected to violence from our close family or our intimate partner. That is why our nongovernment organization dedicated a hotline for psychological support,” said a woman living with HIV in the Islamic Republic of Iran.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

The AIDS response has taught the world the importance of protecting human rights and promoting gender equality when fighting a disease. COVID-19 has amplified that lesson.

Since the start of the COVID-19 pandemic, UNAIDS has repeated the call that governments must protect human rights and prevent and address gender-based violence—an issue that is even more vital now that lockdowns are putting women and girls at an even higher risk of intimate partner and sexual violence. Equally, UNAIDS has made it clear that sexual and reproductive health services should be recognized as the essential services they are. 

To drive those messages to decision-making tables and to the front lines of the response, a new UNAIDS report shows how governments can confront the gendered and discriminatory impacts of COVID-19. Presenting six areas as imperatives to address the needs, and protect the rights, of women and girls during the pandemic, the report highlights the needs of women and girls in all their diversity, particularly the most marginalized, and the importance of access to essential health services. The neglected epidemic of gender-based violence, the misuse of criminal and punitive laws, the importance of education, health and well-being and the value of women’s work and making unpaid care work everybody’s work are also showcased.

“Just as HIV has held up a mirror to inequalities and injustices, the COVID-19 pandemic has put a spotlight on the discrimination that women and girls battle against every day of their lives,” said Winnie Byanyima, Executive Director of UNAIDS. “Many of the drivers of inequality in the HIV epidemic are the same as those driving inequality and injustice in the COVID-19 pandemic—both epidemics can only be successfully fought by putting gender equality at the centre of the response.” 

The report underscores that sexual and reproductive health and rights are often the first to be sacrificed during epidemics and that the gains of the past decade must be protected. The report also makes it clear that scarce resources must be focused on the most marginalized women and girls, including sex workers, gender diverse people, women in prison and migrants and others without proof of employment or residence.

A selection of practical steps that UNAIDS has been taking with partners in countries to maintain essential health-care services, mobilize emergency legal protection and support populations facing human rights violations during the COVID-19 outbreak are presented.

For example, in Nigeria and Côte d’Ivoire UNAIDS is partnering with the International Community of Women Living with HIV to facilitate women living with HIV to work as community pharmacists, who help with the collection and home delivery of antiretroviral therapy and other medicines for people who were unable to access their treatment owing to COVID-19 restrictions.

In Latin America, the United Nations Population Fund and UNAIDS are offering contraceptives and HIV testing, as well as hygiene kits and information on gender-based violence and HIV, to women who are in compulsory quarantine after fleeing the Bolivarian Republic of Venezuela because of COVID-19. 

In Morocco, UNAIDS, in partnership with the Ministry of Health, the Global Fund to Fight AIDS, Tuberculosis and Malaria and civil society, is mobilizing self-help groups, medical and psychosocial support and family mediation services for populations at higher risk of HIV. Collaborations between the government and civil society have helped to ensure continued access to antiretroviral therapy, opioid substitution therapy and food aid during the pandemic. 

Above all, the report has the message that health, safety, dignity and rights, especially for women and girls, in all their diversity, must not be compromised and women should lead the call for change. 

“Get out there and fight, use your voice to demand and take action for your communities,” added Ms Byanyima.

Globally, among people living with HIV aged 15 years and older, coverage of antiretroviral therapy in 2018 was higher for women than for men. Numerous studies have shown that men are less likely than women to take an HIV test and to initiate and adhere to HIV treatment, which results in poorer clinical outcomes and a greater likelihood that they will die of AIDS-related causes. The low utilization of HIV services among men reflects general patterns of male health-seeking behaviour, which have been attributed to prevailing norms of masculinity, stigma, opportunity and other costs of attending health facilities, and inconveniently designed services (among other factors).

The disparity is seen across a range of geographic and epidemic settings. Regional estimates indicate that coverage of antiretroviral therapy was higher among women than men in all but one region with sex-disaggregated data. The disparity was most pronounced in western and central Africa, where an estimated 61% [32–67%] of women living with HIV were receiving HIV treatment in 2018, compared with 40% [18–41%] of their male peers. Treatment coverage for men and women differed by at least 10% in Asia and the Pacific, the Caribbean, eastern and central Africa, and eastern Europe and central Asia—trends that may reflect the fact that antenatal services have been a key entry point for HIV testing and treatment services in many regions.

A report on the progress made over the past 12 months by organizations active in the health sector to implement policies that promote gender equality, non-discrimination and inclusion in the workplace has once again rated UNAIDS as a “very high scoring” organization.

UNAIDS is one of only 13 out of the top 200 global health bodies—funders, nongovernmental organizations, corporate organizations and others with a presence in at least three countries—to be designated as very high scoring. A further 27 organizations were “high scorers”.

“I’m proud that UNAIDS is seen as gender-responsive and inclusive,” said Winnie Byanyima, Executive Director of UNAIDS. “But we must continue to build on these results—we’ve still got a long way to go.”

Researchers assessed the gender and geography of global health leadership, and the availability of gender and diversity policies in the workplace. The report also assessed whether organizations address the crucial role of gender in their health investment programmes and the health priorities they address.

While identifying some progress towards gender equality across the 200 organizations surveyed, the report warns that the pace of change is too slow, estimating that it will take more than 50 years to reach parity at the senior levels of global health organizations.

“Many of the 200 organizations we reviewed are falling short on the equality measures that they purport to uphold. More than 70% of the chief executives and chairs of boards are men, while only 5% are women from low- and middle-income countries,” said Sarah Hawkes, co-founder of Global Health 50/50 and Professor of Global Public Health at University College London.

Power, privilege and priorities is the third Global Health 50/50 report. Previous Global Health 50/50 reports have also found UNAIDS to be a gender leader, being rated in the top nine out of 140 organizations in 2018 and in the top 14 out of almost 200 organizations in 2019.