Juliana Atieno volunteers in her local health facility as a mentor mother, providing advice and support to pregnant women newly diagnosed with HIV. She is also a passionate advocate for survivors of gender-based violence and works to ensure that they receive the support and care they deserve, including by linking them to HIV prevention and treatment services. 

Ms Atieno, who is 29 years old and a survivor of gender-based violence, was diagnosed with HIV as a teenager, in 2008, when she was already very ill. She was linked to treatment immediately and today she is healthy and the mother of two young boys, aged two years and nine years, both born free of HIV. Her partner is also HIV-negative. The family lives in the Kiambiu informal settlement, near Nairobi.

On the eve of the launch of UNAIDS’ new report, Power to the people, Ms Atieno told the UNAIDS Executive Director, Winnie Byanyima, how much her work means to her.

“I love my work encouraging young women and girls to get tested for HIV, to take treatment if they need to and to adhere to it so that they can stay healthy and give birth to babies free of HIV,” she says. “I tell them not to worry, that if I made it through, then they can too.”    

Women and girls like Ms Atieno are the backbone of care support in their families and communities, providing unpaid and often undervalued work in caring for children, the sick, the elderly and the disabled and underpinning fragile social support systems. The involvement and leadership of women like Ms Atieno is critical in the response to HIV.  

“Whenever I meet women like Juliana, I am moved and inspired by their courage and resilience,” said Ms Byanyima. “It’s clear that when women like Juliana have power and agency, real and positive change flows to their families and to their wider communities.”

Ms Byanyima’s meeting with Ms Atieno coincided with the beginning of the 16 days of activism campaign against gender-based violence.

Monique McDonald is an HIV peer educator who tells the story of her childhood with unflinching courage. “I was sexually abused by my uncle at the age of 12 and contracted HIV.”

Ms McDonald has written about her experiences in a book called I am now free. It uses her old diary entries to describe the abuse she suffered as a child and her journey to recovery. Today, she supports young women living with HIV, helping them to come to terms with their status and advising them on adhering to treatment. She has also founded the Ashley Fund to help other sexual abuse survivors to continue their education.

She admits that it’s been a long road.

“I was so depressed, I didn’t know who to trust,” she remembers. “How could this happen, and everybody turned their eyes?”

Rushell Gray reflects on her past with a similar mix of sorrow and disbelief.  

“As a young girl everybody turned a blind eye and blamed me. I was the AIDS girl walking around in the community. Nobody said, “this man needs to go to jail.” At one point I almost gave up because the stress was too high,” she said.  

Ms Gray now works as a Mentor Mom. The Mentor Mom programme enlists young mothers living with HIV to share their experiences and help other young women coping with similar situations. Mentor Moms answer questions and offer reassurance, accompany young women and girls on their health visits and reinforce clinical guidance on the importance of taking medicines regularly.  

Both Ms McDonald and Ms Gray are employees and past clients of Eve for Life, a Jamaican nongovernmental organization that helps to prevent new HIV infections and improve the quality of life of women and children living with or affected by HIV. Clients benefit from peer support groups, psychological care and empowerment programmes.  

Joy Crawford and Patricia Watson founded Eve for Life 11 years ago. While supporting young women and girls affected by HIV, they quickly learned that there was a clear link between HIV infection, adolescent pregnancy and child sexual abuse. According to Situation analysis of Jamaican children, a 2018 report by the United Nations Children’s Fund (UNICEF), more than one in five (21%) adolescent girls in Jamaica said that they had survived sexual violence.  

As a long-standing provider of technical support and capacity-building around sustainability for Eve for Life, UNICEF is keen not only on supporting girls, but addressing the cultural norms that make them vulnerable.  

“There is this pervasive idea that adult men should have some level of access to a girl’s body if they are in their life, supporting the family or something like that,” explains Novia Condell, UNICEF Jamaica’s Adolescent Health and Empowerment Specialist. “Of course, the girl has no power to negotiate any protection in a situation where she has been abused or exploited.”

High on UNICEF’s agenda is supporting the community engagement necessary to shift attitudes around child sexual abuse. Eve for Life has spearheaded the “Nuh guh deh” (don’t go there) campaign, which aims to stop sexual abuse. They use complementary strategies—everything from community meetings to music videos—to get the message out.

The UNAIDS country office in Jamaica also provides technical support to Eve for Life and has helped the organization build partnerships for resource mobilization. The UNAIDS Caribbean subregional office is also working with Eve for Life to create safe spaces for young survivors and leaders to raise awareness about the link between gender-based violence and HIV.

There is also a focus on meeting young women’s basic needs, including food, clothes and health care. But beyond these services, work continues to provide teenage girls and young women living with HIV with a deeper level of emotional support and mentorship.   

“Jamaica’s Ministry of Health has found a strong partner in Eve for Life—one that is able to focus on resilience and life skills-building. They get the girls’ lives on track so they can improve their lot and the lot of their children,” says Ms Condell.

Daniela de Barros, a Finance Assistant in the UNAIDS Country Office in Brazil, is also a UNAIDS Gender Focal Point for Latin America and the Caribbean.

She traces her interest and motivation to helping others and promoting equality back to a good deed in her childhood. “It was one of those dream-come-true situations. When my sister and I were younger, my parents couldn’t afford to pay for ballet classes. But their best friend’s sister ran a ballet studio and, one day, she invited us to start taking classes free of charge. From that point on, I never stopped dancing.” Ms de Barros says that dance has taught her to be disciplined, organized, focused and connected “body and soul” to her life and work.

“Besides all these important skills that I use all the time as a professional and as a mother of adolescent twins, I have also taken another important lesson from my ballet classes: I have learned how to connect with myself and meet my potential and my inner power,” she said. “Isn’t this what we want from such an important initiative like the UNAIDS Gender Action Plan? Empowerment and transformation for all women inside and outside this organization?”

From her role overseeing financial, administrative and operational aspects of the UNAIDS Country Office, Ms de Barros has seen that change management is crucial for maintaining staff motivation. “Although change generates some insecurity, in the end it can be a breath of fresh air. I have learned to recognize that change is important for organizations.”

Ms de Barros believes it is time that women were encouraged to be confident about achieving their goals. “The Gender Action Plan we have inside UNAIDS not only reinforces our self-confidence and courage, it also inspires men to support the women they work with,” she said.

Ms de Barros is sure that “UNAIDS chose her,” rather than the other way around. “I studied international relations and always wanted to work for the United Nations, but I confess I had never heard of UNAIDS until a friend of mine told me I should apply for the position,” she said. “I have grown a lot and learned so much from UNAIDS.”

She says that turning 40 years old has come with some significant changes for her and she now wants to engage in projects that can transform lives. For more than six months she’s been teaching ballet to other women and is just about to start what she describes as “a recently-born old wish”: teaching dance to young kids and adolescents from poor communities in Brasília, where she lives.

“I like to think of ballet as the realization of a Buddhist thought that says we see our external world from within, and that by working on our internal perspective, we can change the world outside. It is the power of dance and where it can take us. And this is what I want to teach children and women through the project.”

One year after the launch of the United Nations System-Wide Action Plan on Gender Equality and the Empowerment of Women 2018–2022 (UN-SWAP 2.0), UNAIDS has been rated as one of the best performing agencies in the United Nations system, meeting or exceeding all 17 of its performance indicators.

The updated and expanded action plan, implemented in 2018 across the United Nations system, was designed to accelerate progress on gender mainstreaming at all levels of the United Nations system and to provide the best overview of progress on gender equality work and the gender-related results of the Sustainable Development Goals.

The UN-SWAP reporting and accountability process is managed by UN Women, which receives annual reports on the implementation of the plan from all reporting United Nations organizations. In response to the annual report submitted earlier in 2019 by the UNAIDS Secretariat, UN Women, in a letter from its Executive Director, Phumzile Mlambo-Ngcuka, to Gunilla Carlsson, UNAIDS Executive Director, a.i., has commended the UNAIDS Secretariat on its results, in particular for its work to strengthen accountability mechanisms for gender equality and the empowerment of women through the development of its Gender Action Plan 2018–2023.

The letter also commended UNAIDS for promoting a culture of inclusion. A noteworthy example in 2018 was the introduction of a single parental leave policy that extends adoption and paternity to 16–18 weeks, depending on the number of children, and introduces surrogacy leave of the same duration. UN Women noted that “this more equitable policy framework supports caregiving by men and women and can help in overturning perceptions that women of childbearing age are potentially too expensive or an absentee risk when compared with similarly qualified men.”

In terms of progress to be made, UNAIDS was encouraged by UN Women to sustain and strengthen efforts to achieve the equal representation of women at all levels and to continue to promote an inclusive work culture, particularly through the implementation of its Management Action Plan.

“The UNAIDS Secretariat continues to be fully compliant with the UN-SWAP framework. Yet, as UN Women points out, progress is fragile and the gains made can quickly be reversed. We must do more and better to achieve the equal representation of women at all levels and continue to improve our organizational culture. These are not just boxes to tick but issues that require continuous consideration and attention,” said Gunilla Carlsson, UNAIDS Executive Director, a.i.

Along with the letter, UN Women shared a set of infographics summarizing UNAIDS’ progress against the UN-SWAP performance indicators, all of which have been compiled into a report. UN Women’s assessment is made on the basis of self-reporting and evidence submitted by each organization and validated by UN Women. For strengthened accountability, UNAIDS conducted a peer review with the Office of the United Nations High Commissioner for Refugees, which confirmed the accuracy of UNAIDS’ self-assessment.

One of the 11 UNAIDS Cosponsors, UN Women is working closely with UNAIDS to improve the lives of women and girls worldwide. In Malawi, for example, UNAIDS and UN Women have partnered to reduce the impact of gender-based violence and mitigate the risk of HIV infection among women and girls.

“UN Women is the youngest of the UNAIDS Cosponsors, and we are delighted to work closely with UNAIDS and other partners under the UNAIDS Unified Budget, Results and Accountability Framework 2016–2021,” says Clara M.W. Anyangwe, the representative of UN Women in Malawi. The Unified Budget, Results and Accountability Framework (UBRAF) is a UNAIDS instrument that maximizes the coherence, coordination and impact of the United Nations response to HIV by combining the efforts of the UNAIDS Cosponsors and UNAIDS Secretariat. Its principal aim is to allocate financial resources to catalyse country-level action in the AIDS response.

With UBRAF funding, UN Women in Malawi has teamed up with an impressive number of partners, including UNAIDS, the Ministry of Gender, Children, Disability and Social Welfare, the National AIDS Commission, the National Law Commission, the United Nations Development Programme, the Malawi Network of AIDS Service Organizations and civil society to implement a project that aims to enhance the national response to sexual and gender-based violence, harmful practices, sexual and reproductive health and rights and HIV.

“Working together as UNAIDS Cosponsors is just a better approach,” says Ms Anyangwe. “There is no single agency that can help the country to achieve the UNAIDS 90–90–90 targets. Instead, each agency has a comparative advantage that they bring to the table. In this case, UN Women brings in the gender dimension and UNAIDS its expertise in the HIV response.”

Malawi has made great progress in reducing new HIV infections. In 2017, there were 39 000 new HIV infections, a 40% reduction since 2010, but 9500 of those were among adolescent girls and young women between the ages of 15 and 24 years. That is more than double the number among men of the same age group.

The project has produced a perception study on the prevailing gender norms that increase violence against women and girls and their risk of HIV infection in Malawi, such as rite of passage practices, sexual cleansing, child marriage, marriage by proxy and transactional sex. An indicator framework has been developed from the findings that will be used to track progress of Malawi’s National Strategic Plan for HIV and AIDS.

An important part of the project is to engage with traditional leaders, including those who facilitate rite of passage practices, and mother and father groups. As a result of the engagements, a framework has been developed that links partners in the local HIV, sexual and reproductive health and rights and sexual and gender-based violence response to monitor and address harmful cultural practices that occur during local rites of passage ceremonies.

A series of intergenerational dialogues that brought together young people, people living with HIV and traditional and faith-based leaders revealed that issues such as lack of access to youth-friendly HIV and sexual and reproductive health and rights services, peer pressure, stigma and discrimination and gender-based violence need to be addressed in order to increase young people’s resilience and empower them to protect themselves against HIV infection.

“We also leveraged UN Women’s global He for She campaign to engage men and boys as partners of women and girls. We were looking particularly to foster a positive masculinity. How can we use masculinity to protect women and girls against harmful practices?” said Ms Anyangwe.

During the dialogues, more than 100 men and boys took the pledge to be He for She champions to promote gender equality and reduce HIV and sexual and gender-based violence. The human rights approach embedded in the project has seen laws and policies that relate to HIV and gender translated into local languages and widely disseminated in affected communities.  

Ms Anyangwe insists that leveraging the specific expertise of partners under the UBRAF umbrella is reaping rewards in Malawi.

“It has also been great to have UNAIDS as a member of the Country Coordinating Mechanism of the Global Fund to Fight AIDS, Tuberculosis and Malaria. UNAIDS’ involvement in these mechanisms benefits us all,” she says.

“We really value UN Women’s continued support and partnership in ending HIV and gender-based violence in Malawi,” says Thérèse Poirier, UNAIDS Country Director for Malawi. “It has been beneficial to work as One UN so we don’t confuse our national counterparts by coming in and working separately on different areas of these interconnected and multilayered epidemics,” she said.

According to the World Health Organization, about one third of women worldwide have experienced violence. In some regions, women who have experienced physical or sexual intimate partner violence are 1.5 times more likely to acquire HIV than women who have not experienced such violence. Among marginalized populations, such as sex workers or transgender women, a high prevalence of violence is linked with higher rates of HIV infection.

In the Middle East and North Africa (MENA) region, UNAIDS estimates that around 220 000 people are living with HIV. New infections were up by 12% between 2010 and 2017 and AIDS-related deaths increased by 11% over the same period. The stigma and discrimination associated with HIV as well as high levels of gender-based violence are preventing several countries from making progress against the epidemic. Gender-based violence in the region is strongly associated with harmful gender norms and stereotypes.

In 2018, the LEARN MENA project was launched to provide women with a platform to share experiences and explore the linkages between gender-based violence and HIV in the region. Underpinning the project is the Action Linking Initiatives in Violence against Women and HIV Everywhere (ALIV(H)E) framework, a research project that collates evidence on what works to prevent violence and builds women’s awareness to understand and address linkages between violence against women and HIV.

Through community dialogues led by MENA-Rosa, a regional network of women living with or affected by HIV, women are strengthening their own understanding of the root causes of violence and the links with HIV. The dialogues have highlighted the fact that gender inequality is at the centre of violence against women and an increased risk of HIV infection. For example, through the dialogues it was revealed that some women had never been to school. Many had experienced early or forced marriage. Many women acquire HIV from sexual violence, including within their own marriage.

“Violence is everywhere. Over time, and as you get older, you get to see it as normal,” said an Algerian woman participating in one of the dialogues. 

The participants described multiple forms of violence across different settings, including in health-care settings, which impede their access to health care, including to HIV prevention and treatment services.

So far, the project has been implemented in seven countries―Algeria, Egypt, Jordan, Lebanon, Morocco, Sudan and Tunisia.

Findings from the project are helping women living with and affected by HIV to advocate for an improved response to the epidemic in the region and for measures to reduce the impact of violence against women. The dialogues have amplified the voices of marginalized women living with and affected by HIV, encouraging decision-makers and partners to build strengthened national community responses. UNAIDS is supporting countries to implement the recommendations and action plans developed from the project.

“MENA-Rosa leaders have learned through this painful process that violence against us should be denounced and not brushed under the carpet,” said Rita Wahab, Regional Coordinator of MENA-Rosa. “Empowerment will help women in all their diversity to know and understand their rights. Our advocates will move forward to expose the links between violence against women and HIV. Gender equality starts at home, grows in society and blossoms in the legal environment.”

LEARN MENA is implemented by UNAIDS, Frontline AIDS and MENA-Rosa, with funding support from USAID. Additional technical support is provided by the Salamander Trust, the lead author of the ALIV(H)E framework.