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AIDS 2012 Turning the Tide for Women and Girls

July 25, 2012
Washington, DC

The global effort to combat HIV/AIDS has been one of the great public health achievements of the past decades.  And today, as so many speakers this week have noted, we are closer to our goal of an AIDS-free world than ever before.

Around the world, new infections are falling.  The ranks of those on treatment are growing rapidly.  In countries where AIDS has taken its greatest toll, life expectancies are beginning to rise once again.

As we’ve fought the disease, one of the challenges we have seen is the evolving face of the epidemic. What was once a disease affecting mostly gay men, now also affects women in large numbers. Globally, AIDS is the leading cause of death for women of reproductive age. In sub-Saharan Africa, women and girls currently represent 60 percent of people living with HIV.  Right here in Washington DC, black women represent 92 percent of women living with HIV.

There are many reasons for these trends. We know that women are less likely to have the economic resources they need to get protection and care. Women often face greater stigma around HIV than men, and so are reluctant to come forward for care. If a couple has the disease, it’s often assumed – wrongly – that the woman is to blame. And women and girls are all too frequently victimized by domestic violence and sexual assault, which increases their risk of infection.

We can’t achieve our goal of an AIDS-free generation unless we also address the specific challenges that keep women from getting the support and care they need. 

And that’s exactly what we’ve done here in the US.

For example, we’ve launched a new Federal work group focused on HIV/AIDS, violence against women, and gender-related health disparities. And this spring, the President’s Advisory Council on AIDS passed a resolution on the needs of women at risk for and living with HIV. It calls on our Department to do more to focus our national efforts on reducing new infections among women and increasing access to care for women living with HIV.

We’re studying the best programs that address these challenges and are looking for ways to bring them to scale. We’re training domestic violence counselors to incorporate HIV/AIDS risk reduction strategies into their work. We’re giving HIV/AIDS service providers the tools to spot signs of abuse and violence. And we’re engaging men and boys in meaningful conversation about the prevention, treatment and care of women.

We’re also ending the systematic discrimination against women in the health insurance market, thanks to the historic health care law.  It will soon be illegal for the industry to lock people out of the market because you’re HIV positive, pregnant or a victim of domestic abuse. And most plans will be required to cover key preventive care and recommended screenings like HIV Testing.

Now, we’ve also put the same focus on women and girls in our work around the world.

One of our major priorities has been ending mother to child transmission. We know that by preventing new infant HIV infections and providing antiretroviral treatment to HIV-infected mothers, we can protect children from orphan-hood and help keep families together.

Altogether, we’ve invested more than $1 billion in the effort globally. And in the first half of this fiscal year, we reached more than 370,000 women with treatment, putting us on track to hit PEPFAR’s target of reaching an additional 1.5 million women by next year.

We have worked hard to make the health, safety and well-being of HIV positive mothers the centerpiece of our efforts. And this has had a cumulative effect.  As more mothers on treatment return to health, HIV becomes known as a manageable chronic condition and the stigma around the disease diminishes.  This increases people’s willingness to get tested and learn their HIV status – creating a virtuous cycle that helps reduce new infections.

Last year I visited a Coptic hospital in Kenya where I met an HIV-positive woman. She had transmitted the virus to her first child. But she got treatment and care during her second pregnancy. Her second child was born healthy. She is now healthy too. And as she told me her story, it was clear just how proud she was to have given her young daughter a healthy start.  We need to make sure more moms have that feeling.

We’re also working around the world to confront gender-based violence.

We know that when it comes to prevention, there is no single answer: a key intervention that helps prevent a woman from infection may be an education campaign that promotes gender equality.  It may be access to sexual and reproductive health services.  It may be protection from an abusive partner. And it might be economic empowerment that allows women to independently access HIV services. We need to take an all-of-the-above approach.

In South Africa, we’ve seen a microfinance program reduce gender-based violence and HIV risk by incorporating HIV education and gender equity into its mission. Now, we’ve brought that approach back to the United States to support similar microfinance programming and HIV risk reduction for African American women.

Too often gender-based violence is shrouded in silence, making it even harder for victims to reach out for help. By recognizing it and responding with support and care, we can begin to end the devastating cycle.

Part of what’s so exciting about this work and our commitment across the Global Health Initiative is the huge payoff we get when we invest in women’s health.

Women are gateways to their communities. Around the world, women are primarily responsible for managing water, nutrition, and household resources. They’re responsible for accessing health services for their families and educating their children. Many of them are closely involved in actually providing health care for those around them.   Healthy women often lead to healthy communities.

Not long after PEPFAR began, a pregnant woman named Stella joined a group for HIV-positive women supported by the program in Abuja, Nigeria. Thanks partly to the group, she was able to get the right antenatal care and have a healthy child.

Later, she had a second healthy child, and by this time, Stella had become a leader in the group.  She was able to educate many of her peers about the steps they needed to take to protect themselves and their children – advice that was much more effective coming from Stella than it would have been from an aid worker.

So by educating one woman about how to be healthy, we were able to improve the health of dozens of Nigerians.  That’s a return on investment that any business would envy.

There’s a Stella in every community in the world, in every village or neighborhood.

We need to reach them and break down the barriers preventing them from getting the care they need.  If we can do that, we’ll have taken a huge step toward our ultimate goal of an AIDS-free world.