KEEP YOUR PROMISE
END HIV AND VIOLENCE AGAINST WOMEN. NOW!

Around the world, women and girls are at an alarming and growing risk of HIV infection as a result of their persisting social, cultural and economic subordination, as well as pervasive violence in their homes, communities, schools, workplaces, streets, markets, police stations and hospitals.  HIV and violence against women and girls overlap in poisonous cycles. An HIV positive status may also increase the risk of violence as women and girls become all-too-easy targets for stigma, discrimination, neglect rights violations and violence.

Increasingly we are witnessing intersecting crises such as unprecedented food price rise, natural disasters, political unrest and social disruption. All of which disproportionately impact poor women and girls and increase their risk to impoverishment, violence and HIV.

In 2001 governments committed to promote and protect women’s human rights and reduce women’s vulnerability to HIV&AIDS by eliminating all forms of discrimination including violence against women. Seven years on, we are still waiting.

WOMEN CAN’T WAIT: MONITORING NATIONAL GOVERNMENTS’ COMMITMENT
Research in 16 countries to assess governments’ progress on their commitments to gender equality, women’s sexual and reproductive health and rights, violence against women, shows national governments have not strengthened a gender-sensitive national AIDS response, nor have they developed and accelerated national strategies for women’s empowerment and the promotion and protection of women’s full enjoyment of all human rights. We include key findings from this research:

Commitment to ensuring women’s participation:
Goal 37 – …address gender and age-based dimensions of the epidemic…involve partnerships with civil society and the business sector, and the full participation of people living with HIV/AIDS, those in most vulnerable groups and people at risk, particularly women and young people…”

1. The degree of women’s participation in national HIV programme policy, design and implementation varies greatly in the 16 countries. While in Uganda, efforts have been made to guarantee the formal participation of women in many decision making entities; in most other countries there is limited or no formal representation of women. 

Commitment to gender sensitive prevention programmes:
Goal 52 – “By 2005, ensure a wide range of prevention programs which take into account circumstances, ethical and cultural values…including information, education and communication in languages most understood by communities… expanded access to essential commodities; expanded access to voluntary and confidential counselling and testing,…and early and effective treatment of sexually transmittable diseases.”
Most countries do not have prevention programmes designed specifically for women, much less committed to promoting and protecting women’s human rights. In fact, in some countries there is evidence of prevention related campaigns reinforcing gender stereotypes rather than challenging them. Access to female condoms is found to be limited resulting from high production costs. It is important here to point out that unless distribution of female condoms is integrated in to national HIV prevention programmes and sexual and reproductive health programmes, their production costs will remain high. Even male condoms that should be freely available are not especially in rural areas, as distribution largely depends on the efficiency of health systems. In many countries health services are centralized, and resources are concentrated in urban centers, making it difficult for indigenous and rural women to access these services.

Commitment to reducing parent-to-child transmission:
Goal 54 – “By 2005, reduce the proportion of infants infected with HIV… by ensuring that… pregnant women accessing antenatal care have information, counselling and other HIV prevention services available to them, increasing the availability of and providing access for HIV infected women and babies to effective treatment to reduce the mother to child transmission of HIV, as well as through effective interventions for HIV-infected women, including voluntary and confidential counselling and testing, access to treatment, especially anti-retroviral therapy and, where appropriate, breast-milk substitutes and the provision of a continuum of care;”
In all countries, PMTCT policies exist, however, programme coverage is not satisfactory. Moreover, even when prophylactic ARVs are available, pregnant women reportedly are not counselled and/or confidentiality of test results or their sero status is not maintained. The research from India, for instance, shows that health care providers violate confidentiality and inform partners and/or family members thereby increasing HIV positive women’s risk of violence, discrimination, disinheritance and dispossession. In addition, there is limited continuity of treatment for HIV positive mothers and unavailability to milk substitutes. Many countries report HIV positive women experience severe discrimination and rights violations in health systems. These range from forced sterilisation and abortions to HIV positive women being denied access to information on safe sex practices and prevention products. The health providers’ disapproval of HIV positive women exercising their sexual and reproductive choices is also widespread. 

Commitment to women’s empowerment and elimination of violence against women:
Goal 61 – “By 2005, ensure development and accelerated implementation of national strategies for women’s empowerment, the promotion and protection of women’s full enjoyment of all human rights and reduction of their vulnerability to HIV/AIDS through the elimination of all forms of discrimination, as well as all forms of violence against women and girls, including harmful traditional customary practices, abuse, rape and other forms of sexual violence, battering and trafficking of women and girls.”
Most countries have legal and policy frameworks to address violence against women; however, all countries report poor implementation of these policies and enforcement of laws that protect women and girls from violence. They also point to the lack of states’ ability and will to prevent and redress violence. Which is manifested in the under resourcing of anti-violence programmes including, the lack of specialised including medico-legal services for survivors of violence, poor coordination between different services, absence of safe houses, absence of accessible, affordable and appropriate criminal justice systems. In addition, they report a lack of systematic data gathering on the extent and impact of violence against women by the state. Most countries also report that this is exacerbated for women sex workers, women living with HIV, and lesbian and transgender women. 

As governments meet to monitor progress on the Declaration of Commitment, we ask them to keep their promise to women and girls.

Women Won’t Wait.

WE ASK ALL GOVERNMENTS TO KEEP THEIR PROMISE TO WOMEN AND GIRLS:  

1. Articulate or refine a clear policy framework that gives priority to violence against women and girls, HIV/AIDS and their inter-linkages.  This should ensure violence against women and girls is addressed across the HIV prevention, treatment and care spectrum and that these policies are translated into action plans and assessments and programming. 
2. Strengthen the evidence base on the intersection of violence against women and HIV&AIDS. Systematically collect data on prevalence, causes and impact of violence against women in itself, and when it intersects with HIV&AIDS. Collect data disaggregated by sex, ethnicity, residence location, age, and socio-economic status.  This data should be used to guide allocation of financial and human resources, the design of policies, programs and health services. This data must also serve as the baseline to monitor whether services and funds are being equitably allocated among diverse women and meeting their specific needs.
3. Develop specific means for measuring work that addresses violence against women and girls in HIV budgets, action plans, programming and monitoring and evaluation processes. The form of measurement may vary from institution to institution – a VAW “marker” in the funding database, a line item in budgets and reporting, etc.  This will allow for tracking, monitoring, evaluating and calculating the extent and impact of such integrated programming. HIV/AIDS programming plans, funding proposals and funding reports must contain a line or section for work on violence against women and girls.
4. Ensure that the voices and experience of people living with HIV&AIDS – especially women and girls whose voices are too often silenced – are given prominent position in designing and scaling up the global AIDS response.  Women’s groups and advocates should have a seat at the table when it comes to devising global, national and local AIDS strategies. Furthermore, within the participation of women and girls living with HIV&AIDS (and indeed relevant to the participation of any other groups), it is important to acknowledge the diversity of this group and to ensure that participation encompasses not only the easiest to reach or those with the strongest voice within this group but that it includes a cross-section of women and girls living with HIV&AIDS.
5. Strengthen the health and legal sector responses to violence and all human rights violations related to HIV&AIDS including but not limited to violence, stigma, and discrimination.  All prevention, treatment and care programs should include relevant programmatic responses to violence against women and girls, and all health care workers doing direct delivery should be trained in screening and referral for violence and abuse. 
6. Put together programs and services to prevent violence and to support survivors of violence.  This includes designing specific actions for each type of HIV&AIDS and sexual and reproductive health programmes such as:
7. Training of health care and service providers (with particular attention to those providing PMTCT, given the increased risk of intimate partner violence pregnant women face) to recognize and respond to the signs and symptoms of violence as a routine part of HIV&AIDS testing, treatment, care and support.
8. Education programs about and the provision of post-exposure prophylaxis (PEP) and emergency contraception to survivors of sexual violence.
9. Distribution of female controlled prevention methods, including the distribution of the female condom to women, men and transgender people. 
10. Anti-violence education programmes operating in all communities where gender-based violence occurs.
11. Budget effectively to address this driving force of the HIV&AIDS pandemic. This includes increasing current funding for programmes to prevent and redress violence against women and girls within AIDS funding per year, in addition to broader and increased investment in sexual and reproductive health and rights; and to promote empowerment of women and girls as an integral and indivisible part of any AIDS response, whether these be focused on prevention, treatment, or care. 

Core Targets and Indicators: Essential steps required of governments to grapple with the intersection of violence against women and HIV

Recommended targets and indicators: Interventions to be integrated into countries’ national AIDS and violence against women responses.