AIDS Summit at the UN: Not Enough Talk About Sex

World leaders gathered at the United Nations to mark the 30th anniversary of the HIV/AIDS epidemic and put out a 102-paragraph declaration. Adrienne Germain, the president of the International Women's Health Coalition (IWHC), has been working on women's issues all her adult life and was active in the 1994 Cairo conference on women, also known as the CPD (International Conference on Population and Development). In an interview with the Huffington Post, Germain and Alexandra Garita, an international policy program officer at IWHC, discuss the declaration and the controversies that arise whenever sex is on the agenda. The declaration, produced every five years, gives U.N. agencies a mandate for their programs and advises governments where best to spend monies.

Q: What about access to family planning, to birth control?

AG: We lost reproductive rights and reproductive health language from the 1994 Cairo document and from early drafts here. Reproductive rights, for example, also includes the right to freely and responsibly decide on the number and spacing of one's children. If you lose that and you have no reference to family planning services in the document, then you basically have no reference to contraception for women. You also don't have protection for women living with HIV who are sterilized without their consent and who are forced to have abortion. It is not a rare occurrence in southern Africa (including South Africa).

Q: Who opposed rights for adolescents or women?

AG: Some people have referred to this as a perfect storm created by a combination of the Holy See and Egypt (less so Iran). Egypt co-opted about 40 nations in the Middle East and Africa (where the largest number of AIDS victims live). In the last CPD negotiations this year ( Commission on Population and Development that organized the 1994 Cairo women's conference) wealthy and very conservative U.S. non-governmental organizations took critical delegates to Arizona and trained them in the techniques of negotiations, the prior language that has been used and what they should do to counter it. There are CD ROMs and delegates have computers at their desk. In the CPD (in April) you could watch the Holy See text and then suddenly St Lucia would hold up their flags. It is very well orchestrated, from the Commission on the Status of Women, going to the CPD and then landing up here. (Alexandra Garita adds that the Swiss President of the General Assembly, Joseph Deiss, was not as strong a leader as Sweden's Jan Eliasson was five years ago and Botswana, one of the organizers, despite its own exemplary AIDS programs, did not pull sensitive parts of the text together).

Actually, the conservative delegates are more concerned about sexuality than they are about say, abortion. They are just terrified about sexual orientation and of course, parental control, especially patriarchal control.

Q: And what was the position of the European Union, usually a partner with the Obama administration on these issues?

AG: The European Union and its new member states can't be as strong on sexuality, adolescence and women's rights as they were five years ago. They speak with one voice and Malta, in particular, pulls them down. Q: Was sex education for adolescents mentioned?

Barely. Nearly 40 percent of the infections are in young people, aged 15 to 24 under a UN definition. But in the world the largest numbers of young people are under 19 years. If you are not working with kids by the age 10, both boys and girls, you will never change things. They have to know about their bodies, about sexuality. They have to learn about human rights, gender equality and how to relate to one another. Otherwise we are not going to end this violence and sexual coercion. We are not going to be able to encourage people to use condoms consistently. We need the schools, the community, and the parents to work together. I don't know where people's heads are.

The language also does not cover early and forced marriage which definitely makes girls vulnerable. The age difference between partners means the men are going to be sexually active and more liable to have AIDS. (see statistics)

Q: The declaration speaks of several medical breakthroughs. What do you think of them?

AG: We don't consider that the newer methods are necessarily breakthroughs. For example, male circumcism is recommended in countries with a high prevalence of HIV. And yet the document does not contain language of how important it is not to have sex until all is fully healed. They don't recognize how important it is that the projects to provide that particular method take into account how these men before and after the procedure relate to women, how they have sex and with whom. The research was biased in the beginning in not looking at what happens to women when you offer intervention for men.

Q: And how about the new studies on early intervention of Antiretroviral drugs (ARV) to reduce transmission, which are welcomed as a major breakthrough?

An important development is using ARV treatment much earlier in a person's life in order to reduce the amount of virus in the body. Therefore the person will be less able to transmit the virus to someone else and you can use treatment as prevention. In this document, it is treated as a miracle breakthrough. We don't look at it that way. Probably about half the people in the world who are living with HIV don't know it. You are most infectious right after you have been infected. But at that time you have no symptoms at all so why would you go forward with testing? So to think that a medicine, a drug, is going to end this epidemic when we don't even know how to get more people to come forward for testing -- is really foolish. But debates on how best to end the epidemic go on all the time -- how we should all be giving much more time to prevention. Yet this document ends up with four paragraphs -FOUR!-on prevention. Does that make much sense? No. Not in our book.

Q: What about mother-to-child transmission?

AG: There has been notable progress in reducing the vertical transmission of infection - man to the woman and then to the child she gives birth to. But well under 50 percent of women who are pregnant and who may be carrying the virus are being screened. And worse than that, most of those programs only give the woman the medicine to prevent infection in the baby. They do not screen the women herself in order to decide if she needs treatment -- and basically live to be a mother to the child that's she gives birth to. There are so many aspects to HIV/AIDS programming that this document does not recognize, that it could have recognized from a woman's perspective.

Q: Who is paying for treatment?

AG: UNAIDS estimated $22 billion to $24 billion and about $16 billion is in the pipeline. The richer southern countries put in the bulk of the national funds, which is great. But the poorer countries still need a lot of the ODA (official development assistance from governments). The North did not want absolute goals but a commitment of working towards them. And that weakens them considerably. The United States contributes 58 percent of ODA. Its public posture is to encourage other donor countries to step up and pay more of their share and for recipient countries to do more. This does not necessarily reflect the administration as much as it reflects the Congress. They barely scraped through with a slight increment and everyone is holding their breath (on possible budget cuts). Q: Homosexuals and prostitutes were a big issue five years ago, even among some delegates from the Bush administration. Has this changed?

They are in the document for the first time. There was one paragraph that names the community of drug users, men who have sex with men and sex workers. That is very good. But this listing is used once only and then there is UN mumbo-jumbo in other paragraphs where you should have specific references about the kinds of interventions needed to reach this population and what they face in their lives. And there is nothing on human rights for these people (despite the UN secretary-general's speech).

2011-06-13-adrienne.jpg Adrienne Germain