The following is an edited version of a speech given by Stephen Lewis, UN Special Envoy for HIV/AIDS in Africa, at a Summit on Global Issues in Womens Health held in Philadelphia in April.
by Stephen Lewis
I have been an envoy for four years. Things regarding HIV/AIDS are changing in an incremental (gradvist stigende), if painfully glacial way. But one factor is largely impervious (umulig) to change: the situation of women.
Just a few weeks ago, I was in Zambia. We were taken to a rural village to see an income- generating project run by a group of women living with AIDS. They were standing proudly beside the project – a bountiful cabbage patch (frodig kålmark). After they had spoken about their needs and the needs of their children (as always, hunger led the litany), I asked about the cabbages.
I assumed it supplemented their diet? Yes, they chorused. And you sell the surplus at market? An energetic nodding of heads. And I take it you make a profit? Yes again. What do you do with the profit?
This time there was an almost quizzical response as if to say, what kind of ridiculous question is that – surely you know the answer:
“We buy coffins of course; we never have enough coffins.”
It is at moments like that when I feel the world has gone mad. I do not know how otherwise to characterize what we are doing to half of humankind.
It took until the Bangkok AIDS conference in 2004 before the definitive report from UNAIDS commented, extensively, upon the devastating vulnerability of women. The phrase “AIDS has a womans face” gained currency at the AIDS conference in Barcelona two years earlier. Even then it was years late.
The women of Africa have always known whose face it is that is withered and aching from the virus.
Maternal mortality has been haunting the lives of women for generations. In the late 90s, when I was overseeing the publication of “State of the World’s Children” for UNICEF, we realized that the same number of annual, maternal deaths, between 500.000 and 600.000, had not changed for 20 years.
And now it is 30 years. You can bet that if there was something called paternal mortality, the numbers would not be frozen in time for three decades.
The UN has a Task Force on Women and AIDS in Southern Africa, established after I and others travelled in 2003 to four African countries beset by a combination of famine and AIDS: Zimbabwe, Zambia, Malawi and Lesotho.
So distressed were we about the decimation of women, that we appealed to the U.N. Secretary-General to personally intervene.
And he did. He summoned a high-level meeting and after several agitated interventions, launched a Task Force on Gender and AIDS in Southern Africa, to be chaired by Carol Bellamy of UNICEF.
Studies were done and recommendations were made.
And here is what festers in the craw (er uendeligt svær at sluge): the funding for implementation is not yet available. The needs and rights of women never command singular urgency. And the Task Force findings are clearly not something the UN promotes with messianic fervor.
Prime Minister Tony Blair chaired and established the Commission on Africa. Its report has received nothing but accolades (hyldest), particularly for the recommendations on development assistance, trade and on debt. The tributes are deserved.
With one exception. The one aspect of this prestigious report which fails, lamentably, is the way in which it deals with women.
There is the occasional obligatory paragraph which signals that the commission recognizes that there are two sexes in the world, but by and large, given that women are absolutely central to the very integrity and survival of the African continent, they are dealt with as they are always dealt with in these auspicious studies: at the margins, in passing, pro forma.
And it is not just HIV/AIDS; it is everything, from trade to agriculture to conflict to peace-building. HIV/AIDS is the worst plague this world is facing; it wrecks havoc on women and girls, and we have absolutely no agency of power to promote womens development, to offer advice and technical assistance to governments on their behalf, and to oversee programs, as well as representing the rights of women.
We have only UNIFEM, the UN Development Fund for Women, with an annual core budget in the vicinity of 20 million US dollar (120 mio. DKR), to represent the women of the world. There are several UNICEF offices in developing countries where the annual budget is greater than that of UNIFEM.
What we have here is the most ferocious assault ever made by a communicable disease on womens health, and there is just no concerted coalition of forces to go to the barricades on womens behalf.
I was listening to the presentations at the dinner last night, and thinking, when in heavens name does it end? Obstetric fistula causes such awful misery, and isn’t it symptomatic that one of the largest – perhaps the largest – contributions to addressing this appalling condition has come not from a government but from Oprah Winfrey?
Fully half of the 300.000 child soldiers in the world are girls. And if that is not a maiming of health – in this case emotional and psychological health – then I do not know what is.
Women have achieved parity on the receiving end of conflict and AIDS, but nowhere else.
I see the evidence in the unremitting carnage of women and AIDS. God, it tears the heart from the body. I just do not know how to convey it.
These young young women, who crave so desperately to live, who suddenly face a pox, a scourge which tears their life from them before they have a life – who cannot even get treatment because the men are first in line, or the treatment rolls out at such a paralytic snails pace who carry the entire burden of care even while they are sick, tending to the family, carrying the water, tilling the fields, looking after the orphans – the women who lose their property, and have no inheritance rights, and no legal or jurisprudential infrastructure which will guarantee those rights – no criminal code which will stop the violence.
Because I have observed all of that, and have observed it for four years, and am driven to distraction by the recognition that it will continue, I want a kind of revolution in the worlds response.
Let me, therefore, put before the conference, two quite pragmatic responses which will make a world of difference to women, and then a much more fundamental proposal.
The Kingdom of Swaziland recently made history when it received from the Global Fund on AIDS, Tuberculosis and Malaria, money to pay a stipend to 10,000 caregivers, looking after orphans, the vast majority being women.
The Swaziland National AIDS Commission made the proposal for payment to the Global Fund, and it swept through the review process with nary a word. The amount is roughly 30 US dollar (180 DKR) a month, or a dollar a day, enough to make a great difference.
My recommendation is that this conference orchestrate the writing of a letter and have that letter sent to every African Head of State and Minister of Health, urging them to ask for compensation for caregivers, using the Swaziland precedent.
And the second pragmatic proposal? We need a combination of science and money. The head of UNAIDS, Dr. Peter Piot, recently suggested that the discovery of a microbicide may be only three to four years off. The prospect of a microbicide, in the form of a gel or cream or ring, which will prevent infection, while permitting conception —- the partner need not even know of its presence — can save the lives of millions of women.
I have heard the president of Botswana use the word extermination when he described what the country is battling. I have heard the prime minister of Lesotho use the word annihilation (tilintetgørelse). I sat with the president of Zambia not long ago, when he used the word holocaust to describe what the country is battling.
The words are true; there is no hyperbole (overdrivelse). But the words apply, overwhelmingly, to women.
African leadership, at the highest level, is not engaged when it comes to womens health. The political leadership of Africa has to be lobbied with an almost maniacal intensity (manisk intensitet) or nothing will change, Mr. Stephen Lewis concluded.
KIlde: The Push Journal
