1. HIV/AIDS Control in resource- poor settings, or why the ABCs are failing the African Woman: HIV/AIDS Control in resource- poor settings, or why the ABCs are failing the African Woman: Francoise Welter Policy Coordinator, GNP+ In grateful acknowledgement to Dr. Paul Pronyk of the Department of Infectious and Tropical Diseases London School of Hygiene & Tropical Medicine

2. HIV and development Western Europe 680 000 North Africa & Middle East 730 000 Sub-Saharan Africa 28.2 million Eastern Europe & Central Asia 1.8 million South & South-East Asia 8.2 million Australia & New Zealand 18 000 North America 1.2 million Caribbean 590 000 Latin America 1.9 million 2003 Total : 35-45 million 99000-E-1 – 1 December 1999 East Asia & Pacific 1.3 million

3. Structural factors driving the HIV epidemic: (Parker, 2000) Sexual Behaviour HIV infection Poverty and underdevelopment Mobility and migration Gender Inequalities

5. In sub-Saharan Africa, there are 13 women infected for every 10 men. Among teens, rates among girls 5 times higher than boys (UNAIDS 2000) HIV prevalence in women attending antenatal clinics by age, South Africa, 2000 Women’s economic vulnerability and dependence on men increases their vulnerability to HIV by constraining their ability to negotiate condom use, discuss fidelity, or leave risky relationships (Gupta, BMJ 2002) Men Women

6. Putting and Keeping YP in School Streets are unsafe for YP Streets are unsafe for YP YP are safer in schools. That said, being in school does not automatically reduce risk and vulnerability because sex –consenting or coercive- is taking place in schools. YP are safer in schools. That said, being in school does not automatically reduce risk and vulnerability because sex –consenting or coercive- is taking place in schools. Therefore, urgent need for comprehensive sex ed. Therefore, urgent need for comprehensive sex ed. Higher educational levels associated with higher rates of condom use Higher educational levels associated with higher rates of condom use YP are not in school 24 hours a day, there is urgent need for measures from schools and other authorities to address the needs of YP outside the classroom YP are not in school 24 hours a day, there is urgent need for measures from schools and other authorities to address the needs of YP outside the classroom According to UNFPA, each additional s/y results in 5-10% drop in child deaths; & each 1% increase in female schooling, with a 0.3% increase in national economic growth. According to UNFPA, each additional s/y results in 5-10% drop in child deaths; & each 1% increase in female schooling, with a 0.3% increase in national economic growth.

7. Finally,  Until a fully woman-controlled prevention method is available, many women will be unable to take control of prevention.  Microbicides are a heaven sent opportunity, but only if they challenge the gender inequality and are available to every woman who needs them. We, the stakeholders, must make sure that every woman living on the streets of Kampala, every commercial sex worker in Nairobi, every female trader in Lilongwe, every illiterate woman in Kigali, every domestic in Johannesburg has free access to microbicides.  It is also my personal plea that research into microbicides actively considers the HIV positive woman. We all know the importance of positive prevention, especially in settings with poor access to treatment. Microbicides would allow HIV positive women in developing countries to prevent both repeated re- infections, but also transmissions to others.  My heartfelt thanks to Dr. Paul Pronyk of the London School of Hygiene & Tropical Medicine for the slides and the inspiration  Thank you.