Hillary's AIDS Plan Missed a Key Idea: Women

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.

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Women Needed to Turn Tide

We cannot turn the tide against HIV without women. Women and our reproductive health compose the fulcrum on which the fight against HIV rests. As long as we treat the former as secondary and the latter as the plague, we are losing.

There's no argument against that, but as we've seen this year, there is plenty of well-organized political opposition. Many members of Congress are still bent on defunding family planning programs in the U.S. and overseas and thereby trampling women's access to contraception, maternal health care, cancer screenings and basic wellness exams. Some have expressed fervent opposition to any global AIDS money paying for contraception. As long as Congress insists on flooding the floor with these anti-woman, anti-reproductive health bills, the fight against HIV is a losing battle.

Clinton's speech was the first in a series of speeches that administration officials will give before the July 2012 International AIDS Conference. There scientists, medical professionals, policymakers, advocates and persons living with HIV will gather in Washington, D.C., to decide on future action against HIV.

We have less than six months to decide if we're going to fight HIV in a way that works, or let propaganda guide our policy.

This week, our organization, CHANGE, the Center for Health and Gender Equity, will deliver 2,000 postcards from concerned individuals around the world to the Obama administration, calling on decision-makers to put women at the center of U.S. global AIDS policy.

We have to start now.


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Serra Sippel is the president of the Center for Health and Gender Equity (CHANGE) in Washington, D.C.

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The analysis is very helpful where it says we need to have a focus on women, family planning and sexual and reproductive rights, program integration, and male and female condoms; it's less helpful in its implied criticisms of treatment as prevention, prevention of vertical transmission, and male circumcision:

-Treatment-as-prevention treats women equally meaning it specifically reaches the disproportionate number of women infected in Africa (60+%)
-Treatment-as-prevention reduces women's risk of infection by 96%, equal to or better than consistent and correct use of condoms
-Prevention of vertical transmission is to be promoted primarily based on Option B or Option B+ which means that long-term maternal health and survival are prioritized not just infant health
-Prevention of vertical transmission is pro-women – women don't want their babies to be infected with a life-threatening disease or to bear the psychological scars of not having taken measures to reduce the risk of transmission
-Prevention of vertical transmission reaches infant girls (and of course we are not only concerned about adult women)
-Male circumcision provides primary protection for men, but secondary protection for women which is equally important (fewer infected male partners, fewer exposures for women, though we do, as the article says have to guard against disinhibition)
-No one argues that microbicides, which will provide primary protection for women, shouldn't be emphasized because they don't address primary protection for men (there is a secondary benefit for men just like circumcision has secondary benefits women)

I hope our collective advocacy for the importance to woman-centered advocacy and for sexual and reproductive health can support both/and thinking. Secretary of State Clinton's speech was mostly about the US finally responding to the new science of treatment-as-prevention both for horizontal and vertical transmission. The speech would have been better, more balanced, and more scientifically accurate if it had included more on programming for women and girls and SRH. And the author may well be right that Clinton's retreat from discussing those issues is because of an anti-SRH backlash in Congress. But when the article asks "what about women who are not infected?" and "what tools does the new course of action offer?" it seems to trivialize the important implications of treatment-as-prevention and other synergistic prevention activities.