Infrequently Asked Questions

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Mon Dec 3, 2012

Paula Donovan Answers Infrequently Asked Questions: Happy World (Ignore Women and) AIDS Day!

By Paula Donovan

The following post originally appeared on The Huffington Post Canada.

Hats off to the spin doctors who managed to turn this year's World AIDS Day into a global celebration. A mere 34 million people are living with HIV! The end of AIDS is near! It's a triumph of exclamation points over data points.

Impossible, you say, that the people in charge of responding to the AIDS epidemics in developing countries could ever persuade all the world's major media outlets to stick to one good-news-story script? Not if you control the world's AIDS data, and can withhold some facts, manipulate others, bury the bad news -- and remember to always, always steer clear of women.

Absent from UNAIDS' and PEPFAR's World AIDS Day talking points was the year's most startling trend: Although for decades, women were outnumbered by men among adults living with HIV, their share of the global total has been rising steadily for the past several years. Women now hold a solid majority of adults infected, and there's everything to indicate that it will keep getting larger.

Another stunner was also omitted from the political-rally-style announcements of progress past and possible: new infections among young women are completely out of control. Last year in sub-Saharan Africa, 72 per cent of the 15-to-24-year-olds who became newly infected were female.

It's hard to reconcile those stats with the smiling faces delivering this week's news. Is it possible that they don't know what's happening to women? But of course they're aware of the facts, and of course they made a conscious decision to downplay the catastrophe, in the US plan, the UNAIDS Global Report, and its lengthy accompanying essay called—what else?—"RESULTS." Who wants to hear sad stories just before the holidays? (And then there's the old maxim: It serves no one's career ambitions to be known as the constant bearer of bad news.)

Wait, you say: surely people would notice if women were glossed over entirely? In fact, this year's "Getting to Zero!!" message seems to focus quite a bit on women in low- and middle-income countries: 57% of HIV-positive pregnant women received drugs to prevent HIV transmission to their babies. That's good news, right?

For children, yes. But consider this: 7 out of 10 of those pregnant women were given drugs so that they wouldn't endanger their babies' health, and sent home without ever being treated for their own HIV disease. And 32 countries still used a cheap, single-dose fix that puts women at risk. Those efforts, called "prevention of mother-to-child transmission" (a program title that helps if you're wondering where to assign blame) are just about all you'll find under the category of women-and-prevention.

It seems not to matter that the women who seek that treatment are already infected, and that last year, pregnant women living with HIV accounted for only about 0.3 per cent of the women and girls in sub-Saharan Africa. But there's no sign of prevention programs at all for the vast remaining numbers at risk of contracting the virus. Now just wait, you'll say; this goal that's getting so much hype by the UN and the US isn't all about children: after all, it's called "Elimination of New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive". The grammatically awkward ending may be an obvious "Oops! Stop the presses; we forgot about mothers!" tag-on. But this year, the program was given all of Chapter 3 in the UNAIDS Global Report! That's good news, right?

Not for women. Look closely at how "and keeping their mothers alive" is defined: "The world has embarked on an historic effort to end new HIV infections among children and reduce the number of women living with HIV who die from pregnancy-related causes." In other words, keep women alive until they've delivered their babies?

Under "prevention," or sometimes under "most at risk populations" (a designation that remains closed off to young African women, for some inexplicable reason that certainly isn't based on numbers), you'll also find references to female sex workers. By now, perhaps you'll venture toward a slightly cynical question: who's really the focus of protection here—the women who sell sex, or the men who buy it?

If you're still adamant that people would surely notice if crucial facts were being withheld in the service of keeping things upbeat (and keeping donors hopeful and generous), ask yourself this: What happened to all those orphans whose unbearable losses used to dominate World AIDS Day coverage? Where are the over 17 million kids whose parents died of AIDS? Search this year's UNAIDS reports cover to cover, and you won't find one mention of orphans—or the women who care for them.

Marketing surveys must be telling the powers-that-be that the world is over those sad stories about women and children. Everyone is so over those tales about impoverished elderly women raising their grandchildren. Enough, already, of the wife inheritance, and marital rape, and intimate partner violence, and little girls forced into marriage; enough whining about women with disabilities getting left out of the data, and widowed women being divested of their homes and property, and HIV-positive women being forcibly sterilized; enough about rape in conflict zones. And that whole contraception question—not again!

The marketers will have said, you sound like a broken record: no improvement in women's unmet needs for contraception, virtually no female condoms to be had, women can't get men to wear male condoms, no access to safe abortion, injectable contraceptives may or may not increase HIV risks, donors won't fund research into better options—in fact, research overall involves mostly male subjects, so results may not even apply to women... I can picture the editorial meetings (as clearly as though I'd been in the room, because years ago, I was in those rooms.) I can just hear the communications types going at it with the statisticians, safe behind the closed doors of UN agency conference rooms: You keep raising these same issues year after year! What's it going to take to convince you that there's just NO interest in, and NO funding out there, for women's issues? Hello? Can we move on? Donors like progress they can count in units. So basta with the tenacious problems that can't be solved with a drug or a commodity. Take sexual violence. Yes, okay, it leads directly to HIV. But it doesn't sell - and hey, in this economy, we all have to downsize. So how about this triage approach? If we can't claim that we'll solve a problem in the next 1000 days, it goes to the back burner.

It's hard to imagine, otherwise, how the chapter on gender ended up on page 70 of the 90-text-page UNAIDS Global Report. Gender had to get an honorable mention (after all, as that chapter's subhead says, "Gender Inequality Drives the HIV Epidemic"), but the gender chapter was wrapped up in just over seven pages, in a space shared by women, men, and transgender people. And sexual violence—a buzz-kill on a day of celebration if ever there was one—was neatly put to rest in the introduction: "In the Political Declaration on HIV and AIDS, countries pledged to eliminate...gender-based abuse and violence... Efforts to accelerate progress towards this goal continue to be undermined by...the persistence of gender-based violence." Who can argue with that?

Sometimes adding or omitting words can't disguise what the numbers have to say, but the spin doctors have discovered a couple of great tricks. One is to avoid measuring progress since the last World AIDS Day - not always significant. They've found that it looks so much better to compare this year to 2003 when talking about treatment, or to 2001 when talking about new infections in adults, or to 2009 when talking about new infections in children, or jump to 2005 when talking about deaths from AIDS—whatever makes progress look most impressive—and just set aside any fear that they might be accused of using statistics to deceive rather than to inform. Another trick is to give percentages without raw numbers so that dodgy-looking factoids can't be questioned, and say that the data will be "available soon" (that is, after the media has stopped paying attention.)

It's interesting to muse about how the World AIDS Day news about women and AIDS might have been different in 2012 if women had actually been among the AIDS experts making the decisions about "key messages." What if, instead of allowing the multi-billion dollar worldwide AIDS conglomerate to operate pretty much like Wall Street—largely unregulated and decidedly male-centric—a small part of the budget were set aside to give women some role in oversight, or at least in producing shadow reports?

What if a few feminist hands had been on the wheel when the global response to AIDS starting taking a U-turn back to the 1950s days of women as mothers-only? What if UN Women had been allowed to become a co-sponsor of UNAIDS, like 10 other UN agencies, as soon as it opened its doors in 2011, instead of having to wait a year and a half for a seat at the table? What if, when Harvard "assembled a group of the world's foremost global health leaders" to examine the first 30 years of the global epidemic and plot the future, the gender balance of its Advisory Council had been different than 18 men and one woman? When the World Bank and USAID held its high-profile discussion of "major challenges in AIDS science, policy, and practice" at July's International AIDS Conference and streamed it live to the 25,000 delegates and the world, what if the 11 "thought leaders" hadn't all been men? All that certainly would have made for a different set of reports in 2012. But then what would we celebrate?