Today I have attended a women strategic meeting where there was an update on the negotiations that are taking place here in New York. These negotiations will set the commitments of member states of the United Nations for the next decade on how to address and reverse the HIV pandemic. So I suppose they are pretty important. It seems a very tough moment, and my impression is that we are still fighting some very basic battles, especially in regards to women ‘s rights.
The negotiations are done by blocks of countries. For example the African countries form a block, and US an Europe another, Latin America another etc.
At the moment the major problems seem to happen in three areas:
Setting targets: for example number of women on treatment, amount of money invested etc. US and EU are trying to keep those as vague as possible so that they do not need to make any financial commitments. For example Civil Society is asking for an 80% reduction of AIDS related maternal death, while the US/EU block is pushing for a ‘Substantial Reduction’. But if there are not numbers involved what does ‘Substantial Reduction’ really mean?
Language: This is also really important. Language is made of our values and can really influence our actions. Civil Society is really fighting to have a Human Rights based language. On rights based language US/EU are really good, while the African block is really pushing for using ‘Traditional values/family values’ and other conservative and potentially oppressive to women approaches. And there are many African women here who are very unhappy about this here. Especially women living with HIV.
Trade: The low price of ART are influenced by trading agreements. Big economic interests are at stake. We need elastic trading agreements so that generic drugs can continue being produced at affordable prices. However there are strong attempts to restrict trading agreements regarding production and distribution of ARTs.
Going back to language an area that is really important to women is obviously maternal and children health. As women living with HIV we are pushing for the right language in this area. We want the declaration to use ’preventing vertical transmission’ instead that ‘preventing mother to child transmission’.So you may ask : but why? Everybody understands what preventing mother to child transmission is, vertical transmission is obscure. The reasons why Vertical transmission is preferable have been articulated by the civil society as follows:
- Vertical transmission has been chosen by people living with HIV globally as the preferred term because it is the neutral technical medical term and it takes the potential emotional blame which is still widely attached to women out of the title.
- PMTCT is often cited as under ‘gender’ or ‘women-centred’ programmes. However, if limited to preventing transmission to the foetus/baby it is not necessarily a gender or women-sensitive approach at all, and may actually put positive women’s long-term health at risk. Using the language of vertical transmission separates out the transmission piece from the longer term care, treatment and support for HIV positive mothers – which often isn’t in practice included in ‘PMTCT programmes’.
- Mother to child vilifies the mother, placing the burden of blame on her. It places blame even in situations wherein treatment and care were observed by the mother, however were unsuccessful in preventing a positive birth.
- It is absolutely essential that all possible is done not to make women feel to blame, since there is clear evidence from South Africa and elsewhere that pregnant women are avoiding ante-natal care, for fear of the HIV test (which is administered as a mandatory test in many places) being negative and for fear of the negative treatment they will receive as a consequence. This means that MDGs 4 and 5 are being undermined, as well as 6 (and 3).
- Prevention of mother to child makes the assertion of choice on the part of the mother (even in settings where treatment or prevention programs are not widely available)
- Full positive engagement of women in their babies’ care is crucial to the child’s survival and healthy start in life (Gerhardt S 2004). Therefore everything must be done at all costs to bring the baby’s mother on board in a positive and supportive way, to fulfil her rights to motherhood as safely for herself and her baby as possible.
- Vertical transmission was the term used at the 2011 High Level Consultation on the Sexual and Reproductive Health of Women Living with HIV, held in the context of the Commission on the Status of Women.
- UNAIDS Strategy uses the language of “vertical transmission”, including the following goal: “Vertical transmission of HIV eliminated and AIDS-related maternal mortality reduced by half.”
- The UNAIDS/WHO Working Group on Global HIV/AIDS and STI Surveillance also uses the language of “vertical transmission”
Well I hope this update is useful, and that I didn’t make any gross mistakes in the reporting.