HIV – the (almost) missing link SRHR, Gender and HIV/AIDS – parallel session at the “Gender and SRHR at the heart of the MDGs” Conference, 8/9 November 2010 Lydia Mungherera MD: Policy/Advocacy Officer, TASO; & Founding Director, Mama’s Club; Alice Welbourn PhD: Founding Director Salamander Trust; Author Stepping Stones HIV – the (almost) missing link SRHR, Gender and HIV/AIDS – parallel session at the “Gender and SRHR at the heart of the MDGs” Conference, 8/9 November 2010 Lydia Mungherera MD: Policy/Advocacy Officer, TASO; & Founding Director, Mama’s Club; Alice Welbourn PhD: Founding Director Salamander Trust; Author Stepping Stones

HIV and AIDS form an integral part of the landscape of SRHR and gender globally 2

IN AFRICA ALSO… HIV and AIDS bear a female face Cultural, social, economic status of women… Community determines a girl’s and woman’s destiny Men are seen just as the problem… Huge access issues in rural areas: EOC etc… 3

HEALTH STAFF CRISIS Lack of support for health staff with HIV… Annual drop-outs (Shisana, Odetoyinbo et al) Max. 10% HIV work-place-related (WHO) Female health staff no PEP (LVCT Kenya) Health staff 80% female (WHO) Lack of WHO GRC acceptance of TREAT… Lack of WHO awareness of HIV/SRH linkages for health staff…. MMC investments….. (WHiPT) 4

Therefore….. Entire public health service under strain because of lack of attention to comprehensive SRHR, gender and HIV linkages within the health care setting Other female-staffed public sector services, eg education, equally affected by HIV Without sufficient staff in place, with full access to integrated SRH & HIV care in their own right, no MDGs will be achieved 5

HIV and institutionalised violence Violence in ANC settings Coerced sterilisations (Namibia, PNG, Chile, Romania) Avoidance of ANC or travelling out of area Thus MDGs 4 and 5 undermined 6

CRIMINALISATION OF HIV TRANSMISSION Increasing numbers of countries rolling this out Including vertical transmission 10 reasons why (ATHENA Network) Increases fear of accessing health services Undermines MDGs 3, 4, 5, and 6 7

RESOURCES….. Active community responses but… No grassroots resources, no support….. Who is best placed to talk to a grassroots woman? 8

CONCLUSIONS SRHR and gender should be viewed holistically with HIV, not with HIV as an add-on Addressing HIV in relation to vertical transmission is the entry point to reaching MDGs 4 and 5 Legal, medical, social, economic, educational and political dimensions all inter-related, not separate Good programmes include those most affected at their core: eg Mama’s Club, From Pregnancy to Baby and Beyond, Stepping Stones, working with men..… RESOURCES, RESOURCES, RESOURCES The WHO should take the lead in upholding health workers’ SRH, HIV and related rights 9

CONCLUSIONS contd…... PCB and Agenda for Accelerated Action on Women, Girls and Gender Equality Cochrane Review on linking SRH/HIV Sex worker rights, drug user rights, LGBT rights….. Criminalisation issues Violence  HIV  Violence Sex-disaggregated data does NOT equal gender-disaggregated data MIWA, MIWA, MIWA….. 10

USEFUL LINKS Athena Network Mama’s Club Salamander Trust Stepping Stones TASO UNAIDS Agenda for Action WNZ 2010 resources: 11

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