(From left): Michel Sidibé, UNAIDS Executive Director; Irene Khan, human rights activist; Michelle Bachelet, UN Women Executive Director; Babatunde Osotimehin, UNFPA Executive Director. 24 February 2011.
Credit: UNAIDS/B. Hamilton

HIV is the leading cause of death among women of reproductive age worldwide. For this to change, the global HIV response must fully recognize the significant role that gender inequality plays in increasing women and girls’ vulnerability to HIV.

At a high-level consultation, jointly organized by UNAIDS, UNFPA and UN Women, influential experts, leaders and advocates came together to discuss how sexual and reproductive health, and the rights of women and girls living with HIV can be enhanced and protected.

The event which took place on 24 February, was co-hosted by Michel Sidibé, Executive Director of UNAIDS, Michelle Bachelet, UN Women’s Executive Director, and UNFPA’s Executive Director, Babatunde Osotimehin.

Concerns were expressed about the reported violations of the sexual and reproductive rights of women and girls living with HIV, which impact on their desire to have children, as well as their access to prevention, treatment, care and support. Participants described the experience of some young women living with HIV who face stigma and discrimination when accessing HIV and sexual and reproductive health services. Examples were shared of HIV positive women who were advised not to engage in sexual relationships and scolded when seeking health care when pregnant, which presented a barrier to them accessing prevention of mother-to-child HIV transmission and safe delivery services.

Participants identified strategic opportunities to protect and promote sexual and reproductive health and rights, including through improved and sustained investment in women and girls living with HIV. There was consensus that a gender-sensitive AIDS response can help countries move towards universal access to HIV prevention, treatment, care and support services and the Millennium Development Goals. This approach is that recommended by UNAIDS and in line with the UNAIDS Agenda for Women and Girls , and the UNAIDS Strategy 2011-2015 .

Arguing for the better integration of HIV in development plans, Dr Nafsiah Mboi, Secretary of the National AIDS Commission, Indonesia emphasized, “HIV is not a health issue, it’s a development issue.”

During the consultation’s opening session, Michel Sidibé spoke of the UNAIDS Strategy and the Agenda for Women and Girls, reinforcing UNAIDS commitment to making gender equality and women’s health and rights a core part of the global AIDS response. He encouraged women and girls living with HIV to raise their voices for social change, despite the risk of stigma, discrimination and social exclusion:

"We must take AIDS out of isolation and provide young girls with opportunities to negotiate their sexual relationships and receive sexuality education so that they can protect themselves from infection,” said Mr Sidibé. “If we don't do this, our vision of zero new infections will remain a dream."

Sharing UN Women’s response to these fundamental issues of gender inequality, Michelle Bachelet contended, "we need to integrate not only services provided but also ongoing political and social movements, including the HIV and women's empowerment movements."

Ms Bachelet also argued that human rights alone is not a sufficient argument for investing in women and HIV, rather, “what is needed is a political, economic and social case.” She also stressed the importance of all involved working together in a coordinated way.

Dr Osotimehin commented on the importance of strengthening the rights of women and girls. “Empowering young people, particularly girls and women, living with HIV to defend their rights and have access to education, information, and services would be a major revolution,” he said.

The outcomes of the discussion will serve as input for the 55^th meeting of the Commission on the Status of Women as well as the 2011 High-Level Meeting on AIDS in June.

Commission on the Status of Women

The 55^th session of the CSW runs until 4 March 2011. Representatives from Member States, UN entities, and ECOSOC-accredited non-governmental organizations from all regions of the world are gathered to evaluate progress on gender equality, identify challenges, set global standards and formulate concrete policies to promote gender equality and advancement of women worldwide.

(from left) Mr Michel Sidibé, Executive Director of UNAIDS; Ms Yoka Brandt, Director-General, International Cooperation, Ministry of Foreign Affairs, The Netherlands
Credit: UNAIDS/F. Chironi

UNAIDS governing body, the Programme Coordinating Board (PCB) is holding its 26th Board meeting from 22-24 June 2010 in Geneva.

UNAIDS Executive Director Michel Sidibé addressed the Board on 23 June giving an overview of progress in last six months by the Secretariat, partners and Cosponsors. The UNAIDS Annual Report 2009 was also shared with the Board members.

In his speech, “Delivering results in transformative times”, Mr Sidibé laid out a “reinvigorated mission” for the Joint Programme. Mr Sidibé also identified five challenges for UNAIDS and described approaches for a more focussed UNAIDS, acting more strategically, increased flexibility and responsiveness, a more efficient Secretariat and more accountability.

On 22 June a thematic session took place on “Linking Sexual and Reproductive Health (SRH) services with HIV/AIDS interventions in practice”. Issues related to gender and youth education were also discussed under this theme.

Stakeholders involved in the AIDS response have always been of the opinion that the Millennium Development Goals will not be achieved without ensuring universal access to sexual and reproductive health and HIV prevention, treatment, care and support.

The majority of HIV infections are sexually transmitted or are associated with pregnancy, childbirth and breastfeeding; and the risk of HIV transmission and acquisition can be further increased due to the presence of certain sexually transmitted infections (STI). HIV is the leading cause of death in women of reproductive age, particularly in Sub-Saharan Africa, and contributes significantly to maternal mortality.

UNAIDS Executive Director Michel Sidibé has maintained that, “If we integrate HIV into maternal health programmes, we can make huge progress on almost every global development goal. We can stop mothers from dying of HIV and dramatically reduce maternal mortality.” Most of UNAIDS cosponsors are also involved in improving this field, enhancing human rights and promoting HIV prevention services.

The thematic session of the Board meeting provided a platform for stakeholders and participants to review the challenges of integrating sexual and reproductive health services with HIV interventions and vice-versa, and share lessons and best practices.

Special attention was paid to young people and gender issues, where progress in involving men and boys in SRH services and programmes that address harmful gender norms were included. Young people tend to be more motivated to use condoms to prevent unintended pregnancy than HIV. Programmes that focus on both can broaden their appeal and have an important impact on preventing pregnancy and STIs.

Sexual violence, sexual diversity and sexuality education with due respect to human rights, gender issues and greater involvement of people living with HIV was also addressed.

Participants were invited to discuss opportunities for women to control or influence their own sexuality and reproduction and to become familiar with the female condom. For pregnant women living with HIV, the single most significant intervention that could reduce maternal mortality, and virtually eliminate vertical transmission -- namely the timely initiation of antiretroviral therapy for life -- remains largely underutilized.

Established in 1994 by a resolution of the UN Economic and Social Council and launched in January 1996, UNAIDS is guided by a Programme Coordinating Board (PCB) with representatives of 22 governments from all geographic regions, the UNAIDS Cosponsors, and five representatives of nongovernmental organizations, including associations of people living with HIV.

UNAIDS Deputy Executive Director for Management and External Relations, Jan Beagle, delivered the keynote speech at an event for Canadian Parliamentarians. 25 May 2010.

Canada will host the annual summit meeting of heads of government of the Group of Eight (G8) countries in Huntsville, Muskoka from 25 to 26 June 2010. The Muskoka Summit aims to deliver the ambitious commitments made at the G8 summits since 1997 related to health, development, the environment, security and good governance.

The G8, which is composed of governments of France, Germany, Italy, Japan, the United Kingdom, the United States, Canada and Russia, met last year in Italy and reaffirmed existing commitments on global health, including US$60 billion for health over 5 years, 100 million malaria bed nets by 2010, and universal access to HIV treatment by 2010. A Global Consensus on Maternal Health was also adopted, which includes support for free services for women and children where countries choose to provide it. The first G8 accountability framework was published, showing individual country progress against some key G8 commitments.

Reducing the number of children who die before the age of five is the fourth Millennium Development Goal (MDG 4), while doing the same for mothers during pregnancy or childbirth is the fifth goal (MDG 5). These two Goals are often referred to as the health related MDGs along with the response to AIDS, malaria and other diseases. These three MDGs are closely interlinked and recent data has shown how HIV has prevented further progress in improving maternal health and reducing child mortality.

According to a recent study to assess progress towards MDG4, mortality in children younger than 5 years has dropped from 11.9 million deaths in 1990 to 7.7 million deaths in 2010 worldwide. A similar study focusing on MDG 5 estimates that there were 342.900 maternal deaths worldwide in 2008, down from 526.300 in 1980. The study also highlights that there would have been 281.500 maternal deaths worldwide in 2008 in the abscence of HIV.

Maternal and child health and AIDS

Ahead of the G8 Summit and to highlight the important link between the 2010 G8 focus on maternal and child health and previous G8 commitments to the AIDS response, UNAIDS Deputy Executive Director for Management and External Relations, Jan Beagle, delivered the keynote speech at an event for Canadian Parliamentarians. The event, hosted by the Canadian Federation of Nurses Unions (CFNU) took place in Ottawa on 25 May and was attended by parliamentarians, health officials, civil society representatives and several African Ambassadors. CFNU represents 158.000 nurses and student nurses and regularly holds events for Members of Parliaments on health and public interest topics.

In her address, Ms Beagle stated that the Joint UN Programme on HIV/AIDS (UNAIDS) was encouraged by the sharp focus of the Canadian G8 Presidency on child and maternal health.

“As HIV is the leading cause of death among women of reproductive age, the global response to AIDS can and must be leveraged more effectively to meet women health needs,” said Ms Beagle.

She noted that the Muskoka initiative is in line with the UN Secretary-General’s global Joint Plan of Action focusing on the health of women and children which was launched in April 2010.

Ms Beagle called for an integrated approach to all the Millennium Development Goals and highlighted that MDG 4 and 5 cannot be accomplished without a strong commitment—and real action—on universal access to HIV prevention, treatment, care and support.

Prevention of mother-to-child transmission (PMTCT) programmes provide a platform for integrated service delivery. The recent scale up of mother-to-child HIV transmission programmes enables women to receive sexual and reproductive services at the facilities where they receive PMTCT services. Integrated services can maximize health system capacity by leveraging human resources for broader health gains.

“The focus on maternal and child health represents a unique opportunity for Canada to demonstrate to the G8 how well this ties in with G8 commitments on the AIDS response,” said Ms Beagle. “It also represents a unique opportunity to highlight to the G8 the importance of accountability and monitoring of progress on previous commitments”.

A version of this story is published at www.unfpa.org

During a high-level panel on the opening day of the 54th Commission on the Status of Women, UNFPA Executive Director Thoraya A. Obaid, speaking on behalf of the United Nations, called attention to the links between the right to sexual and reproductive health and women's empowerment, gender equality and the achievement of the Millennium Development Goals.

Throughout the first two weeks of March, the 54th Commission on the Status of Women will conduct a 15-year review of the Beijing Declaration and Platform for Action. This Platform, which emerged from the Fourth World Conference on Women in 1995, reinforced the importance of women's rights and empowerment as established a year earlier in Cairo. It called for action on 12 key issues: poverty, education and training, health, violence against women (one of UNAIDS nine priority areas), armed conflict, economy, power and decision-making, institutional mechanisms, human rights, media, environment and girls.

The commission will emphasise the sharing of best practices as well as discussion of obstacles and gaps, especially those related to achieving the Millennium Development Goals, whose tenth year review will take place in September. The synergy among the three development platforms has been articulated by UNFPA Executive Director in a statement she has issued to mark International Women’s Day 2010 (8 March).

“In 1994, at the International Conference on Population and Development (ICPD), leaders declared for the first time that reproductive health and rights are fundamental to women’s empowerment, gender equality and sustainable development. And fifteen years ago, at the Fourth World Conference on Women, world leaders agreed on a platform for action for equality, development and peace.

“Today many of these agreements are reflected in the Millennium Development Goals to which world leaders have agreed, to reduce poverty and put our world on a more sustainable path…With ideas spreading faster than ever, here is an idea whose time has come: We stand a better chance of solving the world’s problems if men and women join together as equal partners in finding innovative solutions.”

At the commission, UNFPA is participating in several side events on sexual and reproductive health rights, HIV, violence against women, peace and security, the role of men and boys as partners for gender equality, and female migration. The Fund is also releasing a review of its contributions to the Beijing commitments, Beijing at Fifteen: UNFPA and Partners Charting the Way Forward (2010).

Another initiative to promote the idea of gender equality and empowerment of women during 2010 is a special radio/audio series on gender equality and the empowerment of women with a focus on young woman and adolescent girls. The programmes, being produced by UN Radio with support from UNFPA, will explore the challenges facing young adolescent girls, as well as their dreams for the future. Additional activities throughout the year will call attention to the Beijing Platform and its links to the International Conference on Population and Development and the Millennium Development Goals

(From L to R) Mark Richmond, UNESCO’s Global Coordinator on HIV and AIDS, Dr Mariangela Batista Galvao Simao, Director, Brazil National STD/AIDS Programme, Michel Sidibé, UNAIDS Executive Director, Elizabeth Mataka, member of the Global Advisory Group on Sexuality Education and the UN Secretary-General’s Special Envoy for AIDS in Africa and Marijke Wijnroks, the AIDS ambassador for the Netherlands
Credit: UNAIDS/D.Bregnard

In many parts of the world, a combination of social taboos, unavailability of sound information, lack of resources and infrastructure make it difficult for children and young people to access sexuality education aimed at improving knowledge and reducing risk. This leaves many young people vulnerable to coercion, abuse, exploitation, unintended pregnancy and sexually transmitted infections, including HIV.

According to the UNAIDS 2008 Global Report on the AIDS Epidemic, only 40% of young people aged 15-24 had accurate knowledge about HIV and transmission. It should come as no surprise that, against this background of insufficient levels of basic knowledge, young people aged 15-24 account for 40% of all new HIV infections (UNAIDS 2009 AIDS Epidemic Update).

In response to this challenge, the voluntary and non-mandatory International Technical Guidance on Sexuality Education developed by UNESCO in partnership with UNAIDS, UNFPA, UNICEF and WHO seeks to assist education, health and other relevant authorities to develop and implement school-based sexuality education materials and programmes. The International Technical Guidance on Sexuality Education is based on a rigorous review of evidence on sexuality education programmes and is aimed at education and health sector decision-makers and professionals.

Sexuality education can play a key role in improving knowledge and reducing sexual risk behaviours among young people. Equipped with better knowledge, information and skills, young people can be empowered to make informed decisions about sexual choices.

“If we are to make an impact on children and young people before they become sexually active, comprehensive sexuality education must become part of the formal school curriculum, delivered by well trained and supported teachers,” says Michel Sidibé, UNAIDS Executive Director. “Teachers remain trusted sources of knowledge and skills in all education systems and they are a highly valued resource in the education sector response to AIDS.”

The International Technical Guidance on Sexuality Education was co-authored by leading experts in the field of sexuality education and subjected to extensive review and comment by a global panel of experts and practitioners from civil society organizations, ministries of education and international agencies. Volume I of the International Technical Guidance on Sexuality Education focuses on the rationale for sexuality education and provides sound technical advice on characteristics of effective programmes. It is the outcome of a rigorous review of the literature on the impact of sexuality education and sexual behaviour, drawing upon 87 studies from around the world.

A companion document (Volume II) focuses on the topics and learning objectives to be covered in a ‘basic minimum package’ on sexuality education for children and young people from 5 to 18+ years of age and includes a bibliography of useful resources. It was informed by a review of curricula from 12 countries, as well as other international models.

“Numerous studies show that with the right information and skills, young people can change their behaviour to reduce the risk of acquiring HIV infection or passing it on to others,” says Mark Richmond, UNESCO’s Global Coordinator on HIV and AIDS and the Director for the Division for the Coordination of UN Priorities in Education. “At a minimum, HIV and AIDS education needs to include information on the HIV virus and its modes of transmission. At some point, HIV and AIDS education must introduce sex and relationships education - simply because over 75% of all HIV infections occur through sexual transmission.”

The UN organizations called on policy-makers to listen to young people, families, teachers and other practitioners, and use the International Technical Guidance to make sexuality education an integral part of the national response to the HIV pandemic.

UNESCO and its partners including UNAIDS, UNFPA, UNICEF and WHO, as well as a wide range of other partners, will support governments in operationalising the International Technical Guidance on Sexuality Education at regional and country level. The two volumes of the International Technical Guidance will be published in all the six UN languages (Arabic, Chinese, English, French, Russian and Spanish) as well as Portuguese.

GENEVA, 4 October 2011— The Joint United Nations Programme on HIV/AIDS (UNAIDS) is following with concern data from recent studies suggesting that women using hormonal contraceptives are at increased risk of acquiring HIV infection from their partners and transmitting HIV to them. The benefits of quality hormonal contraception have been repeatedly demonstrated and must be considered while evaluating the potential for increased risk of HIV infection.

All women should have access to safe family planning methods to meet their sexual and reproductive health needs. Access to safe contraception is also vital to reducing maternal and infant mortality and contributes to decreasing new HIV infections in children.

There have been a number of studies on the impact that hormonal contraceptives may have on the risk of HIV infection. Some have shown increased risk while others have shown no significant increase in risk of HIV infection. The studies must be further analyzed to guide policy decisions and to determine the programmatic implications.

The World Health Organization will bring together experts and researchers in January 2012 to discuss the findings in preparation to update global guidance on HIV and contraception use. UNAIDS is working closely with partners to provide the best possible guidance to countries on safe contraception and HIV prevention options.

Young women have increased risk of unwanted pregnancies and HIV infection across the world. This is particularly true of countries in sub-Saharan Africa. Reaching young women with HIV services is a high priority, particularly in sub-Saharan Africa where women are more likely to become infected with HIV than men.

The most recent HIV prevalence data from 2009 shows that in sub-Saharan Africa, 13 women become infected for every 10 men infected. One half of people living with HIV globally are women and 76% of all HIV-positive women live in sub-Saharan Africa. For example, recent research in rural Vulindlela, South Africa shows that from 2005–2008, HIV prevalence in young women ages 19-20 was 33%, ages 21-22 it was 44% and ages 23-24 it was 51%.

AMSTERDAM / BALI / GENEVA / LONDON / NEW YORK, 11 August 2009 – People living with HIV and their advocates today launched a groundbreaking guidance package, “Advancing the Sexual and Reproductive Health and Human Rights of People Living with HIV”. Now, policy makers, programme managers, health professionals, donors and advocates have an important tool to better support the sexual and reproductive health and rights of people living with HIV.

With input from networks of people with HIV worldwide, the Guidance Package explains what global stakeholders in the areas of advocacy, health systems, policy making and law can do to support and advance the sexual and reproductive health of people living with HIV, and why these issues matter.

Working together legislators, the law courts, government ministries, international organizations, donors, community- and faith-based organizations, and people living with HIV can provide services and legal support that will contribute to improved sexual and reproductive health for everyone.

“From a public health perspective, decision-makers and service providers must recognize that people living with HIV do enter into relationships, have sex, and bear children,” says Dr Kevin Moody, International Coordinator and CEO of GNP+. “Ensuring that we can enjoy these normal aspects of a productive and fulfilling life is key to maintaining our own health, and that of our partners and families.”

For a person living with HIV, dealing with sex means dealing with difficult issues at vulnerable moments and in vulnerable settings. People living with HIV are expected to disclose their HIV status before engaging in sexual relations – in some countries it is even a legal obligation, even though this may lead to gender-based violence.

In order to meet the Millennium Development Goals (MDGs), sexual and reproductive health must be addressed adequately and a supportive legal framework is essential. “Stigma, discrimination and punitive laws prevent people living with HIV from accessing services and making informed decisions about their sexual and reproductive futures,” said Michel Sidibé, Executive Director of UNAIDS. “This Guidance Package will help to ensure that the human rights of all people living with HIV, irrespective of their lifestyles, are respected and that they obtain access to the services and information they need to protect themselves and their loved ones.”

Advancing the Sexual and Reproductive Health and Human Rights of People Living with HIV is the outcome of a comprehensive, two-year process of research and analysis led by the Global Network of People Living with HIV (GNP+), the International Community of Women Living with HIV/AIDS (ICW) and Young Positives in collaboration with EngenderHealth, International Planned Parenthood Federation (IPPF), the Joint United Nations Programme on HIV/AIDS (UNAIDS), United Nations Population Fund (UNFPA) and the World Health Organization (WHO). Consultations were held in Addis Ababa (March 2006), Amsterdam (December 2007) and at LIVING 2008: The Positive Leadership Summit (August 2008) prior to the XVII International AIDS Conference in Mexico City, as well as through an interactive internet discussion forum.