Memorandum submitted by ActionAid
ABOUT ACTIONAID
Founded as a British charity in 1972 with a
mission to eradicate global poverty, ActionAid has been working
on HIV and AIDS since 1987. Since the launch of our strategy "Rights
to End Poverty" in 2005, Women's Rights has been our overarching
priority both in our programme and advocacy work.
ActionAid primarily supports poor and excluded
people living with HIV and AIDS and has been giving practical
support to people living with HIV in 23 countries, including,
Malawi, Kenya, Zimbabwe, India, Bangladesh, Nepal, Cambodia and
Guatemala. In addition, we designed Stepping Stones, a training
programme now used by 2,000 organisations in 100 countries worldwide
that helps people learn more about sexual health, discuss their
own behaviour and explore how to change risky practices.
In 1972, ActionAid had 88 supporters. Three
decades later we have expanded to more than 300,000 supporters
in Europe and have offices in more than 40 countries. In 2003
we became ActionAid International and moved our global headquarters
from the UK to South Africa. For more information about ActionAid's
work on HIV and AIDS please contact Fionnuala Murphy on 02075
617656/fionnuala.murphy@actionaid.org.
ActionAid welcomes the opportunity to input
into the IDC's enquiry on how DFID are tackling HIV and AIDS in
the developing world. We have chosen to focus on the question
on women's rights in line with our areas of expertise.
BACKGROUND ON
WOMEN'S
RIGHTS AND
HIV AND AIDS
Today more than 60% of all adults living with
HIV in Sub Saharan Africa are women and the numbers are rising.
Among young positive people, three quarters are female.
These statistics are inextricably linked to
the widespread and systematic denial of women's rights. In many
societies, women and girls are routinely denied their basic rights
to things like education, healthcare and a living wage. Many women
are economically dependent on men and have no say over who they
marry or have sex with, these decisions being made for them by
the men in their families. High levels of gender based violence
limit women's capacity to challenge rights violations.
All these factors make women vulnerable to HIV
infection. And once infected, low income and poor access to healthcare
mean many women don't get the care, treatment and support they
need.
WOMEN'S
RIGHTS IN
DFID'S HIV AND
AIDS STRATEGY
On World AIDS Day 2007, ActionAid and VSO launched
"Walking the talk: putting women's rights at the heart of
the HIV and AIDS response". This report analysed the barriers
faced by women in relation to HIV prevention, treatment, care
and support, and suggested areas for action. Off the back of this
research ActionAid launched Invisible Women, a campaign with the
aim of persuading DFID to put women's rights at the heart of its
new HIV and AIDS strategy.
ActionAid was broadly pleased with DFID's new
HIV and AIDS strategy Achieving Universal Access which included
a number of important first steps to meeting the needs of women
affected by HIV and AIDS. We were particularly pleased that it
included pledges to:
— Continue UK leadership in championing
evidence-based HIV prevention and the rights of vulnerable groups,
including women and young girls.
— Train DFID staff on women's rights
and HIV and AIDS.
— Take action to stop violence against
women.
— Integrate HIV, SRH and other health
services and ensure these services respond to the reality of women's
lives.
— Include a gender analysis in HIV
prevention strategies.
— Increase access to contraception
and female controlled HIV prevention, including female condoms
and microbicides.
— Improve the situation of women carrying
the burden of care associated with HIV and AIDS, including spending
£200 million in eight African countries over the next three
years on social protection for carers.
— Address structural inequalities
and women' economic disempowerment.
Moving forward, we particularly look forward
to seeing what action DFID will take to tackle violence against
women and girls, and to see a stronger commitment within DFID
to strengthening primary health care systems which meet all of
women's health needs.
However for Action Aid, implementation is the
real challenge. In order to bring real benefits for women, we
believe that DFID must build on the top line pledges included
in their strategy. This submission will set out the steps which
we believe are necessary in order to effect meaningful change
in the area of women's rights and HIV and AIDS.
AN IMPLEMENTATION
PLAN
Immediately after DFID's strategy was launched
on 2 June, ActionAid and a number of other NGOs began campaigning
for a plan of action to implement the pledges contained in the
strategy. Many of our supporters—who took part in the Invisible
Women campaign—have contacted the Parliamentary under Secretary
for International Development Gillian Merron to call for this
plan.
We are aware that a team within DFID is now
working on a plan of action, to be completed by 31 October. A
small number of civil society experts have been involved, but
are subject to Chatham House rules. ActionAid is eager to ensure
that this plan is as ambitious as possible. At the very least,
it should commit DFID to action in the following four areas:
1. Creating budget lines for work on the intersection
of women's rights and HIV and AIDS.
2. International leadership to tackle the feminisation
of HIV and AIDS.
3. Training of all DFID staff to understand and
act on the intersection of women's rights and HIV and AIDS.
4. Taking action to stop violence against women
and girls.
1. Creating budget lines for work on the intersection
of women's rights and HIV and AIDS
The DFID strategy pledges £6 billionn for
health up to 2010. However it does not set out how much of this
money will be allocated to improving the position of women, nor
whether additional money is available from other budget lines
such as education or gender and equity. As a starting point, DFID
need to establish how much money will be allocated to women's
rights and HIV, and should clarify which budgets this money will
come from.
In terms of how funding for women's rights is
allocated, ActionAid would particularly like to see:
— Sufficient long-term predictable
funding pledged for strengthening of health systems, in particular
to ensure female-friendly health systems that integrate HIV, sexual
and reproductive health and gender based violence services at
primary care level.
— Creation of budget lines for work
on the intersection of HIV and AIDS and violence against women
and girls.
DFID should also agree to disaggregate their
spending data by gender, and should commit time and money to strengthening
their own and their partners' capacity to do this. Funds should
also be allocated to improving Monitoring and Evaluation systems
so that funding can be tracked and its impact on women and girls
assessed.
2. International leadership to tackle the
feminisation of HIV and AIDS
Alongside increasing UK spending to tackle the
feminisation of HIV and AIDS, there is much DFID can do to encourage
other countries to take up the issue of women's rights and HIV
and AIDS.
In the new HIV and AIDS strategy, DFID makes
a number of pledges to take action at international level including:
— Continue UK leadership in championing
evidence-based HIV prevention and the rights of vulnerable groups,
including women and young girls.
— Work with donors, developing country
governments and multilateral bodies to scale up access to family
planning and SRHR services and to increase availability of female
condoms.
— Work with other countries towards
universal access to post exposure prophylaxis and emergency contraception
by 2010.
— Take action to stop violence against
women.
These pledges are all important steps forward,
but now require further development. In particular "leadership"
is difficult to measure. DFID should develop a long term global
advocacy plan on women's rights and HIV, which will set out how
they will implement this pledge. This plan should commit DFID
to strategic activities at international level on the following
issues; ending prevention strategies which ignore the needs and
rights of women (eg abstinence-only programmes, criminalisation
of HIV transmission and exposure laws, persecution of sex workers
etc), improving access to contraception, female controlled HIV
prevention and PEP, tackling violence against women and girls
and ensuring women's economic empowerment. Key outputs from this
global advocacy should include:
— DFID to continue visibly challenging
female-unfriendly prevention strategies at international level,
leading to decline of these strategies in practice.
— Increased global momentum towards
the target of universal access to sexual and reproductive healthcare
by 2015, and increased availability of female condoms and contraceptives.
— Significant investment in, and progress
on, microbicide development.
— Significant increase in funding for
and availability of PEP and emergency contraception.
— DFID championing the fight to stop
violence against women and girls and HIV in regional and international
forums working on HIV, education and health. This should lead
to the inclusion of a stronger women's rights component in these
forums.
— DFID working with donors, institutions
and developing country governments to improve the economic status
of women.
3. Training of all relevant DFID staff to
understand and act on the intersection of women's rights and HIV
and AIDS
The Gender Equality Action Plan commits DFID
to training and incentivising staff to increase their knowledge
of and commitment to gender equality. Given the rate at which
women are becoming infected with HIV, and the disproportionate
impact which the AIDS pandemic is having on them, training on
the specific interactions between gender inequality and HIV and
AIDS is particularly important and urgent. The DFID action plan
must:
— Commit to and allocate funding for
a programme of staff training on the intersections between women's
rights, gender based and HIV and AIDS.
— Set a timetable for development of
programmatic guidelines on women's rights, violence against women
and girls and HIV.
— Agree to include an indicator on
gender and VAWG in DFID's performance and incentive structure.
4. Take action to stop violence against women
and girls
The DFID HIV strategy recognises that widespread
violence against women and girls substantially increases their
risk of HIV infection and can stop them from accessing HIV counselling,
testing and other services. In ActionAid's programmatic experience,
we have learned that the links between HIV and violence are multi
faceted:
— Violence against women and girls
in the home prevents women from making their own choices to protect
themselves from HIV. Women in Nigeria tell us that domestic violence,
or the threat of it, deters them from refusing to have sex or
resisting an arranged marriage.
— Violence decreases women's chances
of getting HIV treatment. In Zambia, women say that they are afraid
to discuss AIDS with their husbands, even when they suspect the
men are the source of their own infection. Many attend clinics
and take HIV medicines in secret.
— Sexual violence in schools is common
in some countries, and many girls contract HIV as a result. In
South Africa, a country with the highest number of people living
with HIV in the world, a girl has a higher chance of being raped
than of getting a decent education.
— During war and conflict situations
women's bodies often become a battleground. During the 1994 genocide,
Rwandan women and girls were subjected to sexual violence on a
massive and systematic scale. An estimated two thirds of women
who were raped contracted HIV.
As set out above, as a first step DFID should
ensure that significant funding is available from their budget
to address the intersection between violence against women and
HIV. They can do this by creating budget lines for work on violence
against women and girls and HIV.
Leadership at international level on VAWG is
crucially important. DFID should work to ensure inclusion of a
stronger women's rights component in all regional and international
forums working on HIV, health and education (eg GFATM, IHP+ and
EFA Fast Track Initiative). DFID should also push for national
education sector plans to explicitly address violence against
girls in schools and for national AIDS plans and health strategies
to include a gender analysis.
Working with the FCO, there is also much that
DFID can do to combat violence (including violence against girls
in schools) and increase women's access to justice. Working together,
DFID and the FCO can help to promote political and legislative
reform in-country and can support legal action against perpetrators
of violence (particularly violence in schools) to ensure an end
to impunity. In committing to this, DFID should aim to increase
prosecutions for VAWG in at least 10 countries.
ActionAid believes that unless DFID takes action
in these four key areas the new strategy is unlikely to deliver
significant benefits for women.
Furthermore, practical action will be required
on the specifics of the pledges included in the strategy (listed
above). Below we have proposed a series of indicators in relation
to these pledges, and on two additional areas; women's access
and adherence to HIV treatment and increased involvement of women
living with HIV and AIDS in policy making.
INTEGRATE HIV, SRH
AND OTHER
HEALTH SERVICES
AND ENSURE
THESE SERVICES
RESPOND TO
THE REALITY
OF WOMEN'S
LIVES
— Funding allocated to training health
workers on women and girls' rights, gender based violence and
how to meet the needs of women and girls living with or affected
by HIV and violence as a routine part of HIV related care.
— An increased number of health workers
trained accordingly.
— DFID recognises role of strengthened
primary health care in rolling out HIV, sexual and reproductive
health care and gender based violence services which are accessible
to women.
— Funding allocated to expand and support
services for survivors of gender based violence and rape which
integrate SRHR, gender-based violence and HIV and AIDS.
— An increase in these services at
primary care level.
— An increased number of women receiving
accurate information and appropriate care, including ART, PMTCT
and treatment of opportunistic infections, including at primary
care level.
— Agreement to work with other countries
towards UA to PEP and emergency contraception by 2010, leading
to an increased percentage of emergency care facilities offering
emergency contraception and PEP.
INCLUDE A
GENDER ANALYSIS
IN HIV PREVENTION
STRATEGIES
— Allocation of funding for HIV awareness
campaigns and prevention programmes which challenge gender norms
in 10 countries.
— Development of long term global advocacy
strategy on female-unfriendly HIV prevention.
— DFID visibly challenging female unfriendly
prevention strategies at international level and decline of these
strategies in practice.
— Increased DFID investment in promoting
gender parity in schools.
INCREASE ACCESS
TO CONTRACEPTION
AND FEMALE
CONTROLLED HIV PREVENTION,
INCLUDING FEMALE
CONDOMS AND
MICROBICIDES
— Development of long term global advocacy
strategy on access to family planning and female controlled HIV
prevention.
— DFID begins working with donors,
developing country governments and multilateral bodies to scale
up access to family planning and SRHR services and increase availability
of female condoms.
— Increased global momentum towards
meeting the target of universal access to sexual and reproductive
healthcare by 2015.
— Increased availability of female
condoms and family planning.
— Significant investment in, and progress
on, microbicide development.
IMPROVE THE
SITUATION OF
WOMEN CARRYING
THE CARE
BURDEN OF
HIV AND AIDS
— DFID commit to question country plans
and programmes which rely exclusively or largely on unpaid labour
for the provision of care, the majority of which is provided by
women and girls.
— A timetable is set for the disbursement
of and accounting for the £200m already pledged for social
protection.
— Following this, increased funding
allocated to programmes which cater to broader needs of women
and girl carers including livelihoods training.
— DFID commit to invest in building
the capacity of grassroots women's organisations to develop income
generation and educational opportunities for home based carers.
ADDRESS STRUCTURAL
INEQUALITIES AND
WOMEN' ECONOMIC
DISEMPOWERMENT
— DFID allocates funding to increase
social protection and improve the economic position of women,
particularly women living with HIV.
— DFID agrees to work with Foreign
and Commonwealth Office towards in-country political and legislative
reform intended to promote gender equality and women's rights,
including land and property rights, leading to an increase in
the number of women owning and claiming their rights to own land
and property.
— DFID allocates increased funding
for education of girls and adult women, leading to training and
educational opportunities.
— DFID pledges to work with donors,
institutions and developing country governments to address the
economic factors which undermine women's ability to avoid HIV
infection and to cope with the impacts of HIV and AIDS and develops
a global advocacy strategy accordingly.
TREATMENT ACCESSIBILITY
AND ADHERENCE
FOR WOMEN
While the DFID strategy did not refer to the
need for a gender sensitive approach to HIV treatment, ActionAid
believes that this is an area in need of attention. Our report
"Walking the talk: putting women at the heart of the HIV
and AIDS response" highlighted that while a slight bias in
favour of women exists in relation to treatment access, a number
of gender related obstacles impede women's adherence treatment
and hence reduce their survival chances. These barriers include
lack of money for travel and treatment related costs, dependence
on male partners for money, inability to take time off work to
travel to health facilities, distance to facilities, lack of confidentiality
in health care settings, and many others. There is a need for
research to promote better understanding of these barriers. We
therefore recommend that:
— DFID promises to work with its partners
to improve gender disaggregated data collection on HIV treatment
access and adherence as well as understanding of this data.
— On the basis of this data, DFID pledges
to address the barriers faced by women and girls in accessing
and adhering to HIV treatment.
— DFID agrees to fund treatment literacy
and out of pocket social protection programmes for women, leading
to increased number of women accessing and adhering to ART.
— Recognising that cost is a barrier
for women, DFID commits to championing the removal of user fees
for services associated with HIV.
— Recognising that distance to health
care facilities is a barrier for women, DFID increase funding
for provision of HIV treatment at PHC level, and for mobile drug
distribution and treatment points.
INCREASED INVOLVEMENT
OF WOMEN
LIVING WITH
HIV AND AIDS IN
POLICY MAKING
While the DFID strategy references the need
to consult people living with HIV when making decisions and setting
policies which affect them, it does not specifically tackle the
need to consult women and girls. ActionAid believes positive efforts
are needed to ensure the voices of women and girls affected by
HIV and AIDS are heard. We therefore recommend that DFID:
— Commit to consult women living with
HIV and AIDS on their own country plans and programmes.
— Pledge to question any civil society
consultation where women have been excluded, particularly in-country
consultations.
— Commit and allocate funding to support
women's organisations and enable them to develop skills around
management, leadership, community mobilisation, advocacy and self
empowerment.
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