UNAIDS Action Framework:

Transcription

1 UNAIDS Actio Framework: Addressig Wome, Girls, Geder Equality ad HIV August 2009 Our challege is to make access a reality for all regardless of geder, age or HIV status.geder equality must become part of our DNA -- at the core of all of our actios. Together with govermets ad civil society, we must eergize the global respose to AIDS, while vigorously advacig geder equality. These causes are udeiably liked. -Michel Sidibé, 2 March 2009

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3 Executive Summary The UNAIDS Actio Framework: Addressig Wome, Girls, Geder Equality ad HIV (herei referred to as Actio Framework ), focuses o the critical eed to scale up policies ad programmig for wome, girls, geder equality ad HIV. It builds o past accomplishmets ad adopts a strategic ad prioritized approach, emphasizig greater coordiatio of policies, programmes, ad resources alog with focused, cotext-specific guidace to help accelerate ad expad actio for wome, girls ad geder equality i the cotext of HIV at the coutry level. 1 With the overall goals of achievig uiversal access to HIV prevetio, treatmet, care ad support for wome ad girls ad geder equality, the Actio Framework seeks to itesify efforts toward a comprehesive, geder-trasformative AIDS respose. The Actio Framework supports ad is grouded i the full realizatio of the huma rights of wome ad girls. It is based o UNAIDS ad Member States commitmets to uiversal access to HIV prevetio, treatmet, care ad support, 2 with a focus o wome ad girls, as well as to the Milleium Developmet Goals (MDGs). 3 Achievig uiversal access ad the MDGs rests o addressig geder equality ad the empowermet of wome ad girls as huma rights, as critical public health cocers, ad as essetial developmet objectives -all of which are core elemets of effective ad sustaiable AIDS plas ad programmes. The Actio Framework draws upo kowledge from umerous geder assessmets ad aalyses, i additio to 4 the UN Secretary Geeral s Task Force o Wome, Girls ad HIV/AIDS i Souther Africa (SGTF). 5 It also builds o the importat cotributios that govermets, civil society (especially HIVpositive wome s orgaizatios, AIDS service orgaizatios ad wome s health ad rights orgaizatios), doors ad multilateral agecies have made to addressig HIV at coutry, regioal ad global levels. The Actio Framework focuses o actio i three areas i which the UNAIDS Cosposors, Secretariat, ad UNIFEM ca brig specific ad uique cotributios. 1) Stregtheig strategic guidace ad support to atioal parters to kow their epidemic ad respose i order to effectively meet the eeds of wome ad girls. 2) Assistig coutries to esure that atioal HIV ad developmet strategies, operatioal plas, moitorig ad evaluatio frameworks ad associated budgets address the eeds ad rights of wome ad girls i the cotext of HIV. 3) Advocacy, capacity stregtheig ad mobilizatio of resources to deliver a comprehesive set of measures to address the eeds ad rights of wome ad girls i the cotext of HIV. 1 These iclude Empowered ad Equal: geder equality strategy (UNDP 2008) ad Essetial Actios o Geder ad HIV ( udp.org/hiv/gedhiv.htm). 2 ad 3 Milleium Developmet Goals: 4 Please see documets from the UNAIDS Programme Coordiatig Board s (BCB) 20th meetig held i Jue Mai paper: org/pub/presetatio/2007/policy_guidace_address_geder_issues_item4_2_e.pdf; SGTF review which fed ito the paper above. uaids.org/pub/presetatio/2007/crp_sgtf_o_wome_girls_hiv_aids_e.pdf; 3 Geder Assessmets which also fed ito the paper above at data.uaids.org/pub/presetatio/2007/crp_geder_assessmet_e.pdf. See also, 22d PCB, draft geder guidace ad decisios, April

4 UNAIDS Itroductio Today, more tha twety-five years ito the AIDS epidemic, geder iequality ad uequal power relatios betwee ad amog wome ad me cotiue to have a sigificat ifluece o the HIV epidemic. Though there have bee sigificat commitmets to promotig ad protectig the huma rights of wome ad girls over the years, HIV highlights the gap betwee rhetoric ad reality. Cosequetly, it is imperative that HIV policies, programmig, ad budgetary allocatios expressly address the eeds of wome ad girls ad make the ecessary ivestmets to address geder iequality i the cotext of HIV. Existig huma rights commitmets provide a foudatio ad guide to actio to address the eeds ad rights of wome ad girls as cetral to a effective HIV respose. These commitmets rage from the Charter of the UN (1945) ad the Uiversal Declaratio of Huma Rights (1948), 6 each with a stated commitmet to the equal rights of me ad wome ad the digity ad worth of the huma perso; through iteratioal agreemets that touch o issues related to wome, geder equality, health ad huma rights, such as the Viea Declaratio ad Programme of Actio (World Coferece o Huma Rights, 1993), the Programme of Actio of the Iteratioal Coferece o Populatio ad Developmet (1994) ad the Beijig Declaratio ad Platform for Actio (1995); 7 to huma rights orms ad stadards articulated i iteratioal ad regioal coveats ad covetios (such as the Covetio o the Elimiatio of All Forms of Discrimiatio Agaist Wome (1979) or the Protocol to the Africa Charter o Huma ad Peoples Rights o the Rights of Wome i Africa (2005); 8 to iteratioal commitmets to scale up the respose to HIV, such as the Declaratio of Commitmet o HIV/AIDS (2001) ad the Political Declaratio o HIV/AIDS (2006) 9 (see Aexes 1 ad 2 for more detail). Those have bee clarified more precisely as time-boud iteratioal commitmets i the UN Milleium Declaratio ad the Milleium Developmet Goals (2000). 10 Globally, about half of all people livig with HIV are female, with variatio withi regios, coutries ad commuities. I low ad middle icome coutries, rates rage from a low of 31% i Easter Europe ad Cetral Asia to approximately 60% i sub-sahara Africa. 11 Rates also vary by age: i the Caribbea, where wome comprise 48% of people livig with HIV, youg wome are approximately 2.5 times more likely to be ifected with HIV tha youg me. 12 I Souther Africa, girls are 2 to 4.5 times more likely to become ifected with HIV tha boys, compoudig other vulerabilities such as poverty, 13 humaitaria ad food crises ad the icreased ecoomic ad care eeds of AIDS affected households. 14 Regioal differeces ca be quite stark: two-thirds (66%) of wome with HIV live i oly 10 coutries. 15 I the epiceter of the epidemic, ie Souther Africa coutries accout for just 6 ad ad ad UNAIDS, Report o the global AIDS epidemic, /4/ Sevety percet of the world s poor are wome (UNDP, Huma Developmet Report, 1995, New York) ad wome s opportuities ad optios for workig their way out of poverty are restricted by cultural orms that cotrol their social ad ecoomic mobility, icludig uequal access to property ad iheritace, as well as to techology ad credit (The World Bak, The World Developmet Report Agriculture for Developmet: The Geder Dimesios. Brief_AgDev_GederDim_web.pdf). 14 UNICEF, Childre ad AIDS: Third Stocktakig Report, South Africa, Nigeria, Keya, Idia Mozambique, Tazaia, Zimbabwe, Zambia, Ethiopia, ad Malawi (UNAIDS, UNDP, 2009). 2

5 over 40% of the world s HIV-positive wome. 16 I Lati America, for example, wome costitute 33.5% of people livig with HIV, up from 25% i I the Uited States today, wome accout for more tha oe quarter of HIV-positive people, 18 up from 7% i Throughout the world, ew ifectios primarily occur through sexual trasmissio, although specific risk factors vary from coutry to coutry ad from commuity to commuity. I sub-sahara Africa, for example, oe of the key drivers of ew HIV ifectios is multiple cocurret parterships. 20 Accordig to the report of the Commissio o AIDS i Asia, i that cotiet, at least 75 millio me buy sex regularly from wome, me ad trasgeder people, ad may are either married or likely to get married. 21 I Idia, where wome accout for 39.3% of HIV positive people, 85% have bee ifected through heterosexual sex, ofte with me who have sex with both wome ad me. 22 Wome who are typically margialized, such as sex workers ad female drug users, are at greater risk of becomig ifected with HIV. Moreover, the impact of HIV is more severe for them because their huma rights may be especially compromised ad they ofte have eve less access to legal, ecoomic ad health services ad commuity support. 23 Box 1 Wome ad Girls: Huma Rights ad HIV Basic huma rights priciples are core elemets for effective strategies to address the itersectio of geder ad HIV. Rights-based programmig priciples stress the uiversality, ialieability, iterdepedece ad idivisibility of rights. Commoly, rights-based approaches are uderstood to be based o huma rights priciples of o-discrimiatio, participatio, iclusio, empowermet, trasparecy, accoutability, obligatio ad itercoectivity (i.e. assurig the coditios for ejoymet of rights). Furthermore, accordig to huma rights priciples, for programmig to be meaigful, it must be available, accessible, acceptable, ad of high quality. Each of these poits ca help guide approaches to HIV programmig, icludig addressig the itersectio of geder ad HIV. A critical first step is participatio: esurig that groups that are differetly affected by the epidemic i a coutry (e.g. wome as well as me, girls as well as boys, people of differet sexualities) are meaigfully ivolved i the developmet, executio ad evaluatio of AIDS strategies. Source: UNAIDS, Geder Guidace for Natioal AIDS Resposes (UNAIDS/PCB(22)/ Youg people geerally, ad girls i particular, are icreasigly vulerable to HIV, with roughly 45% of all ew ifectios worldwide occurrig amog those aged years. Of this age group, oly 38% of girls ad youg wome show accurate ad comprehesive kowledge about HIV ad how to avoid trasmissio South Africa, Mozambique, Zimbabwe, Zambia, Malawi, Botswaa, Lesotho, Agola, ad Namibia (UNAIDS, UNDP, 2008) accessed 24/4/09 ad p accessed 29/07/ accessed 29/07/ Hele Epstei, The Ivisible Cure: Africa, the West, ad the Fight Agaist AIDS, New York, Farrar, Straus ad Giroux, 2007) Recet data from a 2007 South Africa Medical Research Coucil survey provides iformatio about trasactioal sex with youg wome (16-19) i a middle icome area i South Africa. 86% of wome surveyed had multiple cocurret parters, 63% had ot used a codom at last sex ad 71% said their parters had other parters. More tha 80% reported some itimate parter violece ad there was high alcohol use. 76% of the youg wome said they would ot have sex if they did t receive moey or some material gift i retur, but they did ot idetify themselves as sex workers, explaiig that trasactioal sex of this kid differed from commercial sex i the maer i which it was egotiated: ca I take care of you for toight? as opposed to how much do you charge for sex? Respodets were from a middle icome area ad were ot practisig trasactioal sex for survival, more for cosumptio ad to have the latest desiger goods. See Trasactioal sex ad ecoomic exchage with parters amog youg South Africa me i the rural Easter Cape: prevalece, predictors, ad associatios with geder-based violece, Dukle, et.al, Soc Sci Med September; 65(6): Commissio o AIDS i Asia, Report of the Commissio o AIDS i Asia, I Asia, overall, wome costitute 35% of people livig with HIV, accessed 24/4/ accessed 24/4/ UNAIDS,

6 UNAIDS Geder orms ad uequal power relatios betwee wome ad me cotribute to wome s risk ad vulerability. These ca also ifluece me s risk of ifectio. A effective respose thus requires workig with me ad boys: as parters ad family members of wome ad girls, as commuity leaders ad decisio-makers, as perpetrators of discrimiatio ad violece, ad as people with specific eeds for HIV advocacy ad services. Cultural orms of masculiity ofte preset barriers to a effective AIDS respose, particularly i terms of chagig power relatios betwee me ad wome ad i hiderig me from seekig iformatio, treatmet ad support or assumig their share of the burde of care. A growig body of evidece suggests that carefully desiged geder trasformative itervetios25 with me ad boys ca brig about importat improvemets i me s ad boy s geder ad HIV related attitudes ad practices. It ca also be a importat etry poit for educatig me about wome s vulerability to HIV ifectio ad promotig their roles as agets of chage. The specific diagosis, treatmet ad care eeds of wome affected by or livig with HIV also call for a geder trasformative approach. For example, both wome ad me ca be debilitated by HIV ad tuberculosis (TB) co-ifectio. However, wome face serious barriers to TB treatmet ad compared to me, wome have higher TB mortality rates. TB case detectio rates are sigificatly lower i wome because wome delay seekig treatmet, are missed by health promotio programs, ad face stigma ad discrimiatio. 26 Fear of stigma, discrimiatio ad violece ofte impede wome s access to testig, treatmet ad care. These factors ca also have a adverse impact o wome s adherece to ati-retroviral treatmet. 27 Moreover, i terms of sexual ad reproductive health of HIV-positive wome, 28 reproductive cacers ofte go udiagosed ad the specific eeds of youg HIV-positive wome eterig puberty ad the impact of meopause o older HIV-positive wome are isufficietly addressed. 29 I may cases, HIV-positive wome do ot have access to the right iformatio or to the full rage of reproductive health services. I some cases, wome livig with HIV are egatively judged for their reproductive ad sexual health choices, couseled to avoid pregacy, sometimes forcibly sterilized, or forced to termiate their pregacy. The challeges of effectively reachig wome ad girls i cocetrated epidemics are sigificat. For example, beyod the gaps i reachig wome, particularly wome i key populatios 30 ad i typically margialized groups, may wome are ifected while i marriages or i log-term parterships. There ted to be fewer services to reach them ad their male parters (particularly me who have sex with both me ad wome ad ijectig drug users) with appropriate HIV prevetio services as well 25 A geder-trasformative AIDS respose seeks ot oly to address the geder-specific aspects of HIV/AIDS, but to chage existig structures, istitutios, ad geder relatios ito oes based o geder equality. WHO writes geder-trasformative itervetios are a more sophisticated set of approaches that ot oly recogize ad address geder differeces but go a step further by creatig the coditios whereby wome ad me ca examie the damagig aspects of geder orms ad experimet with ew behaviors to create more equitable roles ad relatioships. 2003, Itegratig Geder ito HIV/AIDS Programmes: A Review Paper. The Iteratioal Plaed Parethood Federatio further otes five key priciples of geder-trasformative programmig: 1. build equitable social orms ad structure; 2. advace idividual geder-equitable behavior; 3. trasform geder roles; 4. create more geder-equitable relatioships ad; 5. advocate for policy ad legislative chage to support equitable social systems. IPPF, 2009, The truth about me, boys ad sex. TruthAboutMeBoysSex.pdf 26 TB Alert, TB ad wome, udated, Referece oted i commets from Huma Rights Watch, Wome s Rights Divisio letter to UNDP, 9 Jue Huma Rights Watch, Hidde i the Mealie Meal New York: Huma Rights Watch. 28 S. Gruski, L. Ferguso, J. O Malley. Esurig Sexual ad Reproductive Health for People Livig with HIV. Reproductive Health Matters 2007:15 (29 Supplemet): Ipas, HIV-positive wome, MDGs & reproductive rights: Actios & research eeded. 30 The cocept of key populatios is explaied by UNAIDS as follows: A variety of social ad ecoomic factors icrease people s vulerability to HIV ifectio, icludig stigma ad discrimiatio, poverty ad lack of HIV awareess ad access to educatio, health ad other services Whe these factors exist, some people egage i behaviors such as uprotected sex or exchage of cotamiated eedles that put them at higher risk of becomig ifected. These commuities iclude me who have sex with me, people who use ijectio drugs, ad sex workers. The HIV-related stigma adds to the existig egative attitudes that people might have towards them. Frequetly, coutries have laws that crimialize their behaviors ad make it difficult for them to exercise their huma rights, icludig accessig health services. The resources that are devoted to HIV prevetio, treatmet ad care for these populatios are ofte ot proportioal to the HIV prevalece amog them this is ot oly a mismaagemet of resources but also a failure to respect fudametal huma rights. See UNAIDS: asp. 4

7 as care, treatmet ad support, i ways that empower them ad support their health, huma rights ad developmet. 9. Effective resposes also deped o kowig your epidemic ad respose. This icludes clear sexad age-disaggregated data to allow for uaced aalysis, particularly to uderstad who is most likely to become ifected with HIV. Epidemiological iformatio should be supplemeted ad complemeted by qualitative evidece, athropological ad sociological iformatio, ad kowledge o sexuality, geder idetity, ad cultural orms about appropriate femiiity ad masculiity. 10. A variety of factors affect wome ad girls i a disproportioate maer. Wome ad girls bear disproportioate burde of carig for others, ad may also suffer greater discrimiatio whe they are or are perceived to be livig with HIV. Issues such as poverty, violece agaist wome ad girls, 33 lack of access to lad ad property, coflict, homelessess or lack of stable housig, lack of access to comprehesive sexual ad reproductive health services, 34 drive ad/or exacerbate the impact of HIV o wome ad girls. 11. Structural factors ifluece the spread ad exacerbate the impact of HIV. This uderscores the eed to address legal, social ad ecoomic iequalities that icrease wome s ad girls risk ad vulerability to HIV. 35 For example, crimializatio of HIV trasmissio may deter wome from gettig tested, sice igorace of HIV status may be cosidered a legal defese. 36 Other critical issues iclude geder-based violece, sexual abuse ad exploitatio of girls, stigma ad discrimiatio i access to services, deial of property ad iheritace rights, uequal access to ecoomic assets ad skills traiig, lack of educatio for girls, ad iadequate likages betwee sexual ad reproductive health ad HIV. 37 Thus, beyod actios withi the health sector, a sustaiable, log-term respose must iclude the followig efforts: Workig i multiple sectors to tackle the structural iflueces of risk ad vulerability for wome ad girls, capitalizig o the Box 2: Illustrative list of factors ifluecig risk ad vulerability for wome ad girls Lack of ecoomic opportuity Geder-based violece Biological susceptibility Lack of kowledge Femiiity stereotypes Lack of empowermet Iadequate access to sexual & reproductive health services & commodities Uequal property ad iheritace rights Lower levels of educatio Iability to egotiate terms of sexual relatios Traffickig Iability to exercise rights Harmful traditioal practices Child marriage ad early pregacy Source: State of the Respose, UNAIDS Dialogue, New York, 20 May Prepared joitly by UNFPA, UNDP ad UNAIDS Secretariat. 31 UNAIDS, Practical Guidelies for Itesifyig HIV Prevetio Towards Uiversal Access (UNAIDS/07.07E/ JC1274E). org/pub/maual/2007/jc1274-towardsuiversalaccess_e.pdf. 32 Thu Ah Nguye, Paulie Oosterhoff, Aita Hardo, Hie Nguye Tra, Roel A Coutiho, ad Pamela Wright. A hidde HIV epidemic amog wome i Vietam, BMC Public Health, Article available from: 33 Aroud the world, there is also a strog associatio betwee geder-based violece ad vulerability to HIV. For example, i South Africa, wome who experiece violece from their parters have bee foud to be 50% more likely to be livig with HIV tha other wome (see Dukle, K et al. Geder-based violece, relatioship power, ad risk of HIV ifectio i wome attedig ateatal cliics i South Africa. The Lacet 363 (9419):1415, 2004). I the Uited Republic of Tazaia, the odds of reportig violece are 10 times higher for youg HIV-positive wome compared to youg HIV-egative wome (see Mama, S et al. HIV ad Parter Violece: Implicatios for HIV Volutary Couselig ad Testig Programs i Dar es Salaam, Tazaia. New York, Horizos, USAID ad Populatio Coucil, 2001). 34 WHO, UNFPA, IPPF, UNAIDS, UCSF, Sexual & Reproductive Health ad HIV Likages: Evidece Review ad Recommedatio. who.it/reproductive-health/hiv/likages_evidece_review.pdf, accessed 11/6/ G. Rao Gupta, J. Ogde, J. Parkhurst, P. Appleto, A. Mahal. Uderstadig ad addressig structural factors i HIV prevetio. The Lacet, August 2008, Vol. 372 No. 9640: M Dhaliwal. Caadia HIV/AIDS Legal Network HIV/AIDS Policy ad Law Review. Volume 13, Number 2/3 (December 2008). 37 J. Kim ad C. Watts. Gaiig a foothold: tacklig poverty, geder iequality, ad HIV i Africa. BMJ, 2005; 331:

8 UNAIDS comparative advatage of the UN system, by fosterig ad likig to efforts for wome s ad girls ecoomic ad legal empowermet, huma rights protectio ad access to justice, property ad iheritace rights, educatio, safety i schools ad workplaces, programmig to egage me ad boys to challege harmful geder orms ad redefie masculiities; ad prevetio of geder-based violece i all settigs. Mitigatig the impact of the epidemic, particularly by supportig mobilizatio for commuity led solutios. Solutios should emphasize the participatio, empowermet ad rights of wome ad girls to care ad support. They should iclude support for grassroots wome s orgaizatios, icludig i rural commuities, that provide care ad support. Solutios should also address the uequal burde of care that falls o wome -- especially elderly wome ad youg girls. This ca be achieved through the promotio of more resposive health care ad commuity systems ad services; stregtheig social protectio systems ad workplace educatio ad services; providig food ad saitatio; ad respodig to the specific eeds of households dealig with HIV ad the geder-specific burde this places o wome ad girls, icludig i situatios of humaitaria cocer ad crisis. 12. The ecoomic crisis is likely to exacerbate risk ad vulerability for may wome ad girls. As social services deteriorate as a result of govermet ad door budget cuts, wome ad girls are likely to be amog the hardest hit. Dimiishig household icome may icrease usafe sexual activities, potetially raisig the umber of sexual trasactios ad possibly risk. If fiacial pressures force families to keep childre out of school, youg girls i particular may ot beefit from the protective effects of educatio. Moreover, there is some evidece of icreases i geder-based violece i previous ecoomic dowturs. 38 This suggests that the curret ecoomic crisis may be a cause of geder-based violece i some settigs. 13. Social protectio itervetios are critical to effectively addressig the eeds ad rights of wome ad girls i the cotext of HIV, particularly durig times of ecoomic crises, as wome ad girls, icludig wome from key populatio ad margialized groups, are ofte disproportioately egatively affected. 39 I additio, well-desiged, comprehesive educatio ad outreach programmes are essetial to address kowledge gaps ad reduce girls ad wome s risk ad vulerability to HIV. 14. HIV-positive wome s orgaizatios, wome s orgaizatios ad idividual wome, i partership with govermets, are essetial actors i the AIDS respose. I most coutries, civil society remais at the forefrot of HIV prevetio, treatmet, care, support, ad especially i reachig out to people i key populatios icludig the most margialized. Promotig ad facilitatig the meaigful participatio of groups of HIV-positive wome ad groups that work o wome s huma rights icludig sexual ad reproductive health ad huma rights, geder based violece, rights of sex workers, rights of wome who have sex with wome, ad trasgeder persos as a core part of atioal AIDS resposes, will cotribute to the effectiveess of these resposes. 15. Effectively addressig the full rage of issues related to eeds ad rights of wome ad girls i the cotext of HIV requires a comprehesive respose that is grouded i the experieces of wome ad girls, ad iformed by evidece ad based o the promotio ad protectio of the huma rights of all 38 UN Ecoomic ad Social Coucil, Report of the Secretary-Geeral, ECOSOC High-Level Segmet, Thematic Sessio, Jue/July 2009, Curret global ad atioal treds ad their impact o social developmet, icludig public health. Accessed 10 August 2009 at docs/adv2009/2009%20sgs%20report%20o%20the%20thematic%20discussio_website_29%20april.pdf. 39 See Commuique for the 4th Global Parters Forum o Childre Affected by HIV ad AIDS at GPF_commuique_e.pdf ad the 3rd Childre & AIDS Stocktakig Report 2008 at 6

9 wome ad girls. Efforts should address the specific issues that HIV-positive wome ad wome who are affected by HIV face. I additio, wome who care for HIV affected idividuals, families ad commuities should receive particular attetio. 16. Ultimately, the resposibility for programmig to address the eeds ad rights of wome ad girls i the cotext of HIV rests with govermets. However, i may coutries, a gap exists whe it comes to geder ad HIV: o the oe had, Natioal Strategic Plas ofte metio specific geder issues as uderlyig drivers of the epidemic, but it is far less commo for these to be traslated ito cocrete programmes ad budgets. A gap also exists betwee HIV strategies ad structures o oe had, ad developmet plaig structures o the other. For example, Natioal AIDS Authorities ad atioal developmet plaers at times do ot lik HIV strategies to poverty reductio strategy programs or geder equality plas. 17. The UN Charter states a clear commitmet to the equal rights of wome ad me ad the digity ad worth of the huma perso. The UN has a log-stadig commitmet to promotig ad protectig the huma rights of wome ad girls 40 ad supportig the ivolvemet ad empowermet of wome ad girls withi atioal AIDS resposes. I additio, the UN ejoys good relatios with govermets ad civil society ad is therefore well-positioed to lead, support ad advocate for the eeds ad rights of wome ad girls i the cotext of HIV ad geder equality. Addressig the eeds ad rights of wome ad girls is fudametal to achievig uiversal access ad reachig all of the MDGs. Still, the severity of the AIDS pademic ad its impact o wome ad girls illustrate the scope of the challege, ad demads that the UN system reviews, improves, aligs, harmoizes ad urgetly expad its efforts, as called for i the Paris Declaratio The Joit UN Programme o HIV/AIDS (UNAIDS) Cosposors ad Secretariat idetified promotio of geder equality 42 ad actio for wome ad girls as key outputs i both the ad Uified Budgets ad Workplas (UBW). 19. The Joit Actio for Results: UNAIDS Outcome Framework, sets a actio ageda with ie priority areas for achievig uiversal access ad the MDGs, icludig for wome ad girls. Key priorities idetified iclude: reducig sexual trasmissio; stregtheig the likages betwee sexual ad reproductive health ad HIV policies, services ad programmes; stoppig violece agaist wome ad girls; equal access to treatmet, care ad support for wome ad girls; removig puitive laws, policies, practices, stigma ad discrimiatio; ehacig social protectio; ad empowerig youg wome. It is evisaged that this combiatio of actios will traslate ito better HIV outcomes for wome ad girls, while also cotributig to broader health, developmet ad huma rights results. Box 3 is adapted from Joit Actio for Results. 40 UN Charter (1945) ad the Uiversal Declaratio of Huma Rights (1948) both iclude a commitmet to o-discrimiatio, icludig o the basis of sex. 41 Paris Declaratio o Aid Effectiveess, March 2005 ad Accra Ageda for Actio, The UN Office of the Special Advisor o Geder Issues ad Advacemet of Wome uses the followig defiitios: Geder Equality refers to the equal rights, resposibilities ad opportuities of wome ad me ad girls ad boys. Equality does ot mea that wome ad me will become the same but that wome s ad me s rights, resposibilities ad opportuities will ot deped o whether they are bor male or female. Geder equality implies that the iterests, eeds ad priorities of both wome ad me are take ito cosideratio recogizig the diversity of differet groups of wome ad me. Geder equality is ot a wome s issue but should cocer ad fully egage me as well as wome. Equality betwee wome ad me are see both as a huma rights issue ad as a precoditio for, ad idicator of, sustaiable people-cetered developmet. Geder refers to the social attributes ad opportuities associated with beig male ad female ad the relatioships betwee wome ad me ad girls ad boys, as well as the relatios betwee wome ad those betwee me. These attributes, opportuities ad relatioships are socially costructed ad are leared through socializatio processes. They are cotext/ time-specific ad chageable. Geder determies what is expected, allowed ad valued i a woma [[[[if i origial text pls leave as is ad add [sic]]]]or a ma i a give cotext. I most societies there are differeces ad iequalities betwee wome ad me i resposibilities assiged, activities udertake, access to ad cotrol over resources, as well as decisio-makig opportuities. Geder is part of the broader socio-cultural cotext. Other importat criteria for socio-cultural aalysis iclude class, race, poverty level, ethic group ad age. OSAGI, Geder Maistreamig: Strategy for Promotig Geder Equality Documet, August

10 UNAIDS Box 3: Priority Areas for Wome ad Girls The text i bold ad italics below is additioal laguage that seeks to articulate some of the specific implicatios for wome, girls, geder equality ad HIV 1. We ca reduce sexual trasmissio of HIV: Sexual trasmissio accouts for more tha 80% of ew HIV ifectios worldwide. Reversig the global AIDS epidemic requires a dramatic icrease i commuity, atioal ad global actio for sexual ad reproductive health ad rights, ad i idividual commitmet to safer sex. This icludes expadig access to appropriate HIV prevetio ad sexual ad reproductive health services ad esurig that the voices ad perspectives of wome ad girls are core elemets of efforts to address sexual trasmissio, ad iclude specific efforts to empower wome to protect themselves. 2. We ca prevet mothers from dyig ad babies from becomig ifected with HIV: By scalig up access to ad the use of quality services for the prevetio of mother-tochild trasmissio (+) as a itegral part of sexual ad reproductive health services ad reproductive rights for wome, their parters ad youg people. This icludes esurig that wome who access PMTCT go o to access ART ad that HIV prevetio, care, treatmet ad support for wome, ad their parters, ad childre i affected families is available ad accessible. 3. We ca esure that people livig with HIV receive treatmet: By scalig up ad sustaiig treatmet coverage ad, itegratig utritioal support withi treatmet programmes, addressig the geder specific adherece eeds of wome ad girls, ad icreasig the umber of skilled ad equipped health workers. This meas effectively ad systematically bridgig the gap betwee sexual ad reproductive health ad HIV. 4. We ca prevet people livig with HIV from dyig of tuberculosis: By esurig a effective itegrated delivery of services for HIV ad tuberculosis as well as utritioal support i all settigs. This meas reachig a greater uderstadig of how TB impacts wome ad me differetly ad that HIV positive wome have access to appropriate TB prevetio, treatmet, care ad support services, ad that utritioal support programmes esure equal access for wome ad me. 5. We ca protect drug users from becomig ifected with HIV: By makig comprehesive, evidece-iformed ad huma-rights-based itervetios accessible to all drug users (i.e. harm reductio ad demad reductio), icludig programmes to reduce hepatitis co-ifectio, ad by esurig that legal ad policy frameworks serve HIV prevetio efforts. This icludes programmes ad services for female drug users, as well as outreach services ad support for female parters of male drug users. 6. We ca remove puitive laws, policies, practices, stigma ad discrimiatio that block effective resposes to AIDS: By collaboratig with civil society ad all stakeholders to uphold o-discrimiatio i all efforts, couterig social judgmet ad the fear that feeds stigma, deliverig o the broader huma rights ageda, icludig i the areas of sex work, travel restrictios, homophobia ad crimializatio of HIV trasmissio, esurig that laws ad policies affirm ad protect the rights of wome ad girls for example, legal protectio, esurig access to justice ad use of the law by promotig property ad iheritace rights, protectig access to ad the retetio of employmet ad protectig margialized groups ad reiforcig the work of UN Plus. This icludes iheritace ad property rights; legal protectio agaist marital rape; protectio from violece for all wome, icludig female sex workers ad lesbias ad trasgeder wome who have sex with wome; ad addressig the growig tred toward iappropriate crimializatio of HIV trasmissio. The latter is particularly problematic for wome livig with HIV who are at risk of sexual violece ad coercio. 7. We ca stop violece agaist wome ad girls: By makig the respose to AIDS a opportuity to reduce itimate parter ad sexual violece ad developig comprehesive resposes to geder-based violece ad HIV prevetio withi ad beyod the health sector. This icludes a comprehesive, multifaceted respose ecompassig the risk of ifectio with HIV that survivors of violece may face, ad the risk of violece that HIV-positive wome may face. Actios to address, prevet or reduce violece should icorporate all forms of violece that wome ad girls face, icludig but ot limited to sexual violece. 8. We ca empower youg people to protect themselves from HIV: By puttig youg people s leadership at the cetre of atioal resposes, providig rights-based sexual ad reproductive health educatio ad services ad empowerig youg people to prevet sexual ad other trasmissio of HIV ifectio [[is this i the origial text?]]] amog their peers. By esurig access to HIV testig ad prevetio efforts with ad for youg people i the cotext of sexuality educatio. Ad by esurig eablig legal eviromets, educatio ad employmet opportuities to reduce risk ad vulerability to HIV. I may cotexts, youg wome are particularly vulerable to HIV ifectio ad its cosequeces. Hece, programmig must be specifically tailored to address the particular vulerabilities ad eeds of girls ad youg wome (e.g.: safe schools, girls-specific programs ad spaces, ad youth-friedly sexual ad reproductive health services). 9. We ca ehace social protectio for people affected by HIV: By promotig the provisio of a rage of social services to protect vulerable populatios, icludig populatios of humaitaria cocer, refugees, iterally displaced persos ad migrats, iformal-ecoomy workers, people experiecig huger, poor utritio ad food isecurity ad orphaed ad vulerable childre.[[[eed to check puctuatio i origial text]]] By promotig corporate social resposibility, workplace policies ad icome geeratio for people affected by HIV. By empowerig govermets, particularly miistries of labour, employers ad workers to adopt, implemet ad moitor HIV-related policies. Ad by couterig discrimiatio ad promotig HIV prevetio, treatmet, care ad support through workplaces, icludig through UN Cares, ad their liks with the commuity. Wome ad girls costitute a sigificat proportio of these vulerable populatios, ad as such, require appropriately focused social protectio, services ad support. Wome ad girls are also disproportioately resposible for providig care ad support to idividuals ad to their commuities this role eeds to be recogized ad bolstered, especially at the commuity level. 8

11 Box 4: A comprehesive set of measures to address wome ad girls risk ad vulerability A eviromet coducive to promotig ad supportig geder equality betwee wome ad me i the cotext of HIV requires laws, policies ad structural itervetios that: Promote ad guaratee the huma rights of all wome ad girls, icludig protectio from discrimiatio, violece ad coercio i all areas of public ad private life. Esure wome s leadership ad participatio icludig wome livig with HIV ad wome s health ad rights advocates i the plaig, implemetatio ad review of HIV/AIDS resposes. Take the ecessary legal ad policy measures to esure wome s access to volutary HIV testig ad couselig; HIV prevetio, treatmet, care ad support services; ad comprehesive sexual ad reproductive health services ad educatio. Esure legal services for wome who are livig with HIV, sex workers, people who use drugs ad their parters, as well as traiig of law eforcemet agets to reduce police harassmet, itimidatio, ad violece. Eact, eforce, ad implemet laws ad policies to eradicate violece agaist wome ad girls ad harmful practices, icludig sexual violece, disclosure-related violece, forced marriage, forced sterilizatio ad female geital cuttig/mutilatio. This should iclude public campaigs ad programmes to address violece agaist wome ad egage me i chagig harmful geder orms. Eact ad eforce laws to protect wome s property ad iheritace rights. Address the likages betwee HIV, wome s ecoomic security, wome s access to lad ad property ad poverty; ad promote wome s ecoomic empowermet, icludig through access to credit ad microfiace for wome livig with HIV. Develop policies ad social protectio mechaisms that address the disproportioate burde of care bore by wome ad girls (especially older wome ad youg girls), icludig home-based care workers. Respect ad fulfill the sexual ad reproductive health ad huma rights of wome livig with HIV. Create ad sustai multi-sectoral likages ad coordiated policy-makig, plaig ad programmig ad budgetig betwee differet miistries ad govermet agecies. These iclude miistries of health wome s affairs, justice, iterior, social welfare, ad other relevat miistries at the atioal, regioal ad local levels. stregtheig health care systems ad public sector capacity ad supportig wome ad girls who are ivolved i commuity ad home-based care. All programme, plaig, ad itervetios for prevetio, treatmet, care ad support should be evidece-iformed, developed with, ad protect the rights of wome ad girls. This icludes: Surveillace ad assessmets i efforts to kow your epidemic ad desig appropriate resposes with full respect for wome s rights to privacy ad bodily itegrity. Research o the vulerability of wome who have sex with wome to HIV ifectio ad AIDS ad the itroductio of appropriate programmatic resposes, icludig addressig the violece, discrimiatio, ad huma rights abuses wome who have sex with wome may face. Developmet of geder aalysis ad idicators addressig key aspects of a comprehesive respose. Allocatio of specific fiacial resources to support wome s health ad rights orgaizatios, etworks of wome livig with HIV, ad youg wome s etworks ad orgaizatios to develop ad implemet evidece-iformed programmes addressig wome s health ad rights i the cotext of HIV. Cofidetial, volutary HIV couselig ad testig. Expad ad stregthe programs that promote wome s ecoomic empowermet, icludig by esurig access to credit ad microfiace for wome livig with HIV/AIDS. Expad ad stregthe programs that keep girls i school ad promote their access to educatio especially secodary level educatio. Access to comprehesive health services, icludig HIV treatmet, care ad support for wome livig with HIV, with attetio to eglected areas such as diagosis ad treatmet of reproductive cacers, special attetio to the eeds of youg wome livig with HIV, ad the eeds of older HIV - positive wome. Comprehesive sexual ad reproductive health services, icludig comprehesive PMTCT+, for all wome ad girls. Traiig ad sesitizig health-care providers to protect the rights of wome livig with HIV, particularly with regard to cofidetiality ad iformed coset. Educatig ad traiig health providers to address the specific health eeds of HIV-positive wome ad girls ad to detect ad respod to violece ad sexual abuse. Support to care-givers with particular attetio to the disproportioate burde of care that falls o wome ad girls. Support for sex-worker led resposes to HIV, educatio ad iformatio about their rights ad their health icludig ART, ad easy access to comprehesive, ojudgmetal health services, as well as codoms ad lubricats. Access to prevetio iformatio ad educatio that target the particular eeds ad cocers of wome, icludig prevetio techologies that wome ca cotrol, such as female codoms ad post-exposure prophylaxis. Comprehesive iformatio ad educatio about sexuality, geder, ad geder equality, especially for youg people. Empowerig wome ad girls to egotiate safer sex, through skills-buildig ad ivestmet i programmes that affirm their rights ad aim to chage power relatios betwee girls ad boys ad wome ad me. Targeted outreach to margialized ad particularly vulerable groups of wome ad girls, such as refugees, migrats, wome i coflict ad crisis situatios, ad girl orphas. Targeted harm reductio programmes that address the specific health eeds of wome who use drugs or sexual parters of drug users. Programmes for orphas ad AIDS affected households that pay particular attetio to the eeds ad rights of girl orphas. Source: Adapted from feedback ad writte cotributios followig cosultatios i New York ad Geeva Cosultatios, which took place o 20 ad 29 May, 2009 respectively. 9

12 UNAIDS Overview of the Actio Framework 20. Despite wide recogitio that wome, girls ad geder equality represet a importat pillar of the AIDS respose, systematic ad strategic approaches to addressig the eeds ad rights of wome ad girls are yet to be scaled up. Box 5: Guidig Priciples for the Actio Framework HIV programmes targetig wome ad girls must have as their fudametal basis the promotio, protectio ad realizatio of huma rights icludig geder equality. Geder equality cotributes to reducig risk ad vulerability i.e.: reducig poverty, violece agaist wome ad girls, deial of property ad iheritace rights to wome ad girls, deial of sexual ad reproductive health ad rights, sexual abuse of wome ad girls; ad violatios of other civil, political, ecoomic, social ad cultural rights. The participatio of wome ad girls is a essetial compoet of sustaiable, efficiet programmig to ed geder iequality ad geder-based violece ad to foster sexual ad reproductive health ad rights. Actios must iclude ehaced commuity participatio, especially the egagemet ad leadership of wome livig with HIV ad wome s groups, ad the participatio of me ad boys as resposible actors i edig geder iequality ad geder based violece HIV programmes must be evidece iformed ad adapted to the relevat epidemiological, ecoomic, social ad cultural cotexts i which they are implemeted. This meas kowig the specifics of each coutry s epidemic as it relates to the impact o wome ad girls ad me ad boys differetly. Source: Adapted from UNAIDS, Practical Guidelies for Itesifyig HIV Prevetio: Toward Uiversal Access, p The UNAIDS Actio Framework: Addressig Wome, Girls ad HIV, seeks to respod to the eed to scale up programmig o wome, girls, geder equality ad HIV. It builds o past actios ad accomplishmets, but adopts a more strategic ad prioritized approach, with greater coordiatio of policies ad programmes ad a emphasis o focused ad cotext-specific guidace to help accelerate ad expad successful actio at the coutry level. It ecompasses the work of the UNAIDS family ad UNIFEM. 22. The Actio Framework takes ito accout the cotext withi which UNAIDS works. For example, i additio to the extesive efforts already uderway to address geder iequality withi HIV work, the UN family makes strog cotributios to broader, multi-stakeholder efforts o geder equality ad wome s huma rights, ad to sexual ad reproductive health ad reproductive rights. 44 It is also importat to emphasize that a broad rage of actors eed to work together to achieve the goals outlied i the Actio Framework. Actors iclude commuity orgaizatios, wome s groups, atioal govermets, doors ad others. The Actio Framework focuses o ad reiforces the comparative advatage of each of the UNAIDS Cosposors ad the UN family as a whole i providig strategic ad ormative guidace, facilitatig techical support provisio ad coordiatio, ad stregtheig the capacity of local actors to lead their ow resposes. The UN also has a importat coveig role, helpig to foster atioal AIDS resposes that draw o the capacity ad experiece of may actors, icludig a variety of govermet miistries (brigig HIV, health, justice, social protectio ad geder miistries, for 44 Three key documets guide UN work o HIV, geder equality ad sexual ad reproductive health ad rights. The UNGASS Declaratio of Commitmet (2001) sets out Member States commitmets to work o HIV, ad provides the framework for UN support to all actors i atioal, regioal ad global AIDS respose. Regardig work o geder equality, the correspodig documet is the Beijig Declaratio ad Platform for Actio from the 1995 Fourth World Coferece o Wome. Regardig work o sexual ad reproductive health ad huma rights, the key documet is the Programme of Actio of the Iteratioal Coferece o Populatio ad Developmet (1994). 10

13 example, ito coversatio with each other), civil society (icludig those ivolved i geder equality, HIV, sexual ad reproductive health ad huma rights) alog with atioal AIDS authorities, academic istitutios ad experts, grassroots orgaizatios (icludig groups of HIV-positive wome ad girls ad those livig i rural areas), amogst others. 23. The Actio Framework situates itself at the itersectio of UN support i three areas: (1) geder equality; (2) HIV ad sexual ad reproductive health; ad, (3) huma rights. Operatioalizig the framework will warrat collaboratio with ad amog the wide rage of actors who provide leadership, policy ad programmatic expertise i these areas. The UNAIDS Cosposors, Secretariat, ad UNIFEM also recogize the uique role that the UN family has to play i fulfillig commitmets to wome ad girls by providig leadership ad guidace to explicitly address the itersectios of geder iequality, HIV, sexual ad reproductive health ad huma rights (see Box 6). 24. UNAIDS efforts to focus o wome, girls, geder iequality ad HIV is maifested i the work of the UNAIDS Cosposors, Secretariat ad UNIFEM i multiple ways ad at a rage of levels. While there is sigificat ogoig work i this area, the aim ow is to structure ad streamlie our collective efforts aroud a mutual ad shared framework. I that respect, it is evisaged that the actio framework addressig wome, girls, geder equality ad HIV is complemetary to, itrisically liked with, ad will be operatioalized i cojuctio with the UNAIDS Actio Framework o Uiversal Access for Me who have Sex with Me ad Trasgeder People The Actio Framework will assist key stakeholders at coutry level ad beyod to rapidly assess programme ad policy gaps. It will also focus attetio o idetifyig ad promotig rights ad evidece-based actios eeded to address these gaps. The goal is to haress ad expad capacity at coutry, regioal ad global levels. The UN will emphasize its role i providig advisory support to coutry actors to most effectively egage i this process, icludig through assistace with resource mobilizatio. The UN will also foster activities to Box 6: Cotext of the UNAIDS Actio Framework Parterships Geder Equality HIV/AIDS ad Sexual ad Reprodcutive Health MDGs Huma Rights Uiversal Access covee ad egage a wide rage of atioal actors, icludig HIV positive wome s groups, wome s health ad rights orgaizatios ad movemets, AIDS service orgaizatios, orgaizatios of me ad boys that address geder iequality ad geder-based violece, ad commuity-based orgaizatios. 45 UNAIDS, UNAIDS Actio Framework o Uiversal Access for Me who have Sex with Me ad Trasgeder People, May

14 UNAIDS Actio Areas: movig from policies to fully-fuded programmes Box 7: Parterships Actio Area #2: Addressig wome ad girls i plas ad budgets Actio Area #1: Kow your epidemic ad respose i geder terms. Natioal Aids Respose Actio Area #3: Stregthe advocacy, capacity ad mobilizatio of resources UNAIDS ad UNIFEM will parter with: - Govermet miistries - Natioal AIDS Authorities - Womese health ad rights groups - Huma rights orgaisatios - HIV-Positive womes groups - Commuity orgaisatios - Service providers - Employers, uios - Schools, etc. 26. The Actio Framework focuses o actio i three areas i which the UNAIDS Cosposors, Secretariat, ad UNIFEM ca brig specific ad uique cotributios. 1) Stregtheig strategic guidace ad support to atioal parters to kow their epidemic ad respose i order to effectively meet the eeds of wome ad girls. 2) Assistig coutries to esure that atioal HIV ad developmet strategies, operatioal plas, moitorig ad evaluatio frameworks ad associated budgets address the eeds of wome ad girls i the cotext of HIV. 3) Advocacy, capacity stregtheig ad mobilizatio of resources to deliver a comprehesive set of measures to address the eeds ad rights of wome ad girls i the cotext of HIV. 27. Each actio area reflects rights-based approaches, ad will be coducted i a iclusive ad participatory maer (govermet, civil society, the private sector, doors, iteratioal health iitiatives, ad the UN). The framework calls for buildig o the experiece ad leadership of wome s orgaizatios ad equivalet youth orgaizatios, valuig wome s cotributio to the AIDS respose, amplifyig the voices of positive wome, respodig to the eeds of those wome ad girls most affected ad those who are margialized, ivolvig me ad boys i addressig geder iequality ad geder-based violece, ad operatig through trasparet mechaisms. 46 I each of these areas, the importace of 46 The UN commitmet to rights-based approaches is articulated i the UN Commo Uderstadig, based o three cocepts: 1. All programmes of developmet cooperatio, policies ad techical assistace should further the realizatio of huma rights as laid dow i the Uiversal Declaratio of Huma Rights ad other iteratioal huma rights istrumets; 2. Huma rights stadards cotaied i, ad priciples derived from, the Uiversal Declaratio of Huma Rights ad other iteratioal huma rights istrumets guide all developmet cooperatio ad programmig i all sectors ad i all phases of the programmig process; 3. Programmes of developmet cooperatio cotribute to the developmet of the capacities of duty-bearers to meet their obligatios ad of rights-holders to claim their rights. See UNESCO, The Huma Rights Based Approach ad the Uited Natios system, Adré Frakovits. UNDP programmig, accordig to the workig guidelies for huma rights reviews iclude the followig: 1. huma rights stadards should uderpi baselies ad idicators; 2. assessig atioal capacity must iclude the capacity to realize huma rights; 3. Upholdig uiversality, advocacy must be directed agaist discrimiatio ad for equality; 4. programme priorities should focus o areas of greatest disadvatage; 5. aalyses must iclude the capacity eeds of ad costraits o duty bearers; 6. aalyses must also take ito accout the capacity of claims-holders to advocate ad participate; 7. attetio should be paid to mechaisms for redress; ad 8. project strategies must icorporate huma rights priciples. 12