By Serra Sippel
Thursday, December 1, 2011
It's an odd question to ask Hillary Clinton, the Obama administration's champion for global women's reproductive rights. But where were the women in her "AIDS-free generation" speech two weeks ago? World AIDS Day is a good time to ask.
(WOMENSENEWS)--Two weeks ago, Secretary of State Hillary Clinton gave a speech that outlined a new course of action in the fight against HIV that sidelined women and reproductive health.
Have no doubt we will lose this fight if we follow the plan without considering the consequences.
Any complete, effective response to HIV is contingent upon woman-centered interventions and unfettered access to comprehensive sexual and reproductive health services. Women account for more than half of the world's population living with HIV, and sexual intercourse is still the No. 1 mode of transmission. Increasingly, women are the face of this pandemic, and our sexual and reproductive health and rights are the crux.
Clinton's "AIDS-free generation" theme was ambitious, along with her 2015 target date for ending vertical (mother-to-child) transmission. Her focus on evidence-based interventions was broadly welcomed, but anyone familiar with the demographics of the pandemic had reason to be disheartened. While references to women and gender inequality decorated her speech, nominal mention of gender-based violence and discrimination do not make a woman-centered policy.
On World AIDS Day, meant to raise collective awareness and concern about the pandemic, there's no better time to focus on what Clinton should have emphasized, but didn't.
Clinton instead identified three interventions as the new focal points of U.S. HIV policy: male circumcision, treatment as prevention and prevention of vertical transmission. Each intervention is critical, but without integrated reproductive health services and an emphasis on women's rights, they are nowhere near enough.
Male circumcision is a one-time intervention that can decrease a man's risk of contracting HIV during heterosexual sex from anywhere between 44 and 71 percent. Eventually, if fewer men contract HIV, fewer women will contract it as well. But "eventually" isn't good enough, and a decreased risk of 71 percent at best isn't good enough, either.
Women are the majority of this pandemic and we need our own protection now. Any and all male circumcision efforts need to be integrated with female and male condom programs, so women can initiate their own protection and men can understand that circumcision's partial protection requires backup -- and is not a license to go condom-free and have sex without consent.
"Treatment as prevention" is based on evidence showing that when people with HIV are receiving treatment, their viral load decreases. This lowers their risk of transmitting the virus to others. It's essential, but it's not enough. HIV was responsible for approximately 60,000 maternal deaths in 2009, and pregnancy alone can further compromise the immune system of a woman living with HIV. We must integrate voluntary family planning and other reproductive health interventions so women living with HIV can maintain their health.
Prevention of vertical transmission protects infants and is key, of course. But the first opportunity to prevent infections in children is preventing infections in women. And the second opportunity is to provide women living with HIV who don't wish to have children access to contraception. In fact, prevention for women and voluntary family planning programs are two of the four core components of comprehensive vertical transmission prevention. Yet these critical components are not typically the focus of U.S.-funded programming.
And what about women who are not infected? What tools does the new course of action offer them? When did protecting women from infection in the first place become an afterthought?
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