Women can turn the tide in HIV/AIDS epidemic

Keynote address of Dr Margaret Chan - Director-General of the World Health Organization At the International Women’s Summit: Women’s Leadership on HIV and AIDS Nairobi, Kenya, 5 July 2007

In December 2003, the 3 by 5 initiative was launched here in Kenya o­n World AIDS Day. The initiative was the vision of my predecessor, Dr JW Lee.

At that time, more than four million Africans were in need of antiretroviral treatment. o­nly 100,000 of these people were receiving treatment.

The initiative did not have a perfect strategy. There was no guarantee of success.

Not every problem of eligibility, logistics, implementation, and funding had been solved.

The sceptics were certain that something so complex as antiretroviral therapy could not work in resource-poor settings.

They said doctors could not prescribe. Patients could not comply. Governments could not pay.

But an engine was set in motion. The spirit – the force that drove that engine – was pure and simple: something must be done!

The 3 by 5 initiative was also an appeal to fairness. Is it fair to deny access to life-sustaining treatment for reasons of country of birth, income level, or social status?

That argument was compelling.

Research offered simplified treatment regimens. Commitment increased, as did funds. NGOs, activists, and civil society rallied.

Drug prices dropped. People were brought back to life by these “resurrection” drugs.

Last year we saw a very important milestone. The number of people in sub-Saharan Africa receiving these drugs passed the o­ne million mark.

That is proof of principle. It can be done.

We have seen a second milestone: a commitment to universal access to prevention, treatment, care, and support for all who need it by 2010.

We must all work together to make sure this promise is kept.

We have seen considerable progress, but we are still running behind this devastating, unforgiving epidemic.

For every person starting treatment, another six people will become newly infected within a year.

How can we catch up?

I believe there are three critical pathways to follow.

First, we must steam ahead, full power, in the quest for universal access to treatment and care. It is the o­nly fair and humane course to take.

Second, we must seize every opportunity for prevention. This is the o­nly way to catch up.

We need to catch up o­n the prevention of HIV infections in infants. The principle of fairness dictates that we do so.

Half a million infants are born with HIV each year. Around 80% of them are born in sub-Saharan Africa.

In affluent countries, mother-to-child transmission of HIV has been virtually eliminated.

Here in Kenya, as in many other countries, fewer than o­ne in ten of eligible women is benefiting from antiretroviral prophylaxis to prevent transmission to their babies.

Again, something must be done. WHO has helped define highly effective drug regimens for preventing HIV infection in infants. A strategy for scaling up coverage will be launched later this year.

As we think about prevention, we must remember: we have been struggling against this disease for a quarter of a century. We are in this for the long-haul.

We must never lose sight of the need for sustainability, comprehensive services, and the strengthening of capacities in long-lasting ways.

We know that containing HIV/AIDS is not about responding to a single disease.

We have to deal with multiple opportunistic infections, sexually transmitted diseases, tuberculosis, malaria, reproductive health, mental health, and psychosocial support. That is why WHO stresses the need to address this epidemic in ways that strengthen overall health system capacity, and most especially the capacity of sexual and reproductive health services to reach those in need.

As we do so, we must not forget the “mothers” in mother-to-child transmission. For a mother to pass o­n infection to her child is a cause of unspeakable grief.

It is also a signal of the failure of health services to care for her o­n multiple counts. We must do better.

We must also seize every opportunity for women to learn their infection status. Being married is not a safe haven.

When testing is done o­n a routine basis, with consent, counselling, and confidentiality, it becomes more normalized.

Making any dimension of this epidemic more normal helps counter the three big enemies: stigma, fear and discrimination.

This brings me to my final and most important point. Women must be in the driver’s seat. We know enough to reach this conclusion.

Women can turn the tide in this epidemic. Women are best placed to make existing tools work.

You in this room, including so many HIV positive women, are the living proof.

Women are best placed to make existing tools work better. For example, microbiocides hold great promise for giving women greater control.

Ladies and gentlemen,

Poverty, gender inequality, and intimate partner violence drive this epidemic. Women and girls in sub-Saharan Africa now bear the brunt.

The HIV/AIDS epidemic has put the spotlight o­n deep-rooted constraints that hold women back in many areas of life.

Traditional attitudes and behaviours change gradually, sometimes over several generations. This epidemic gives us no such luxury of time.

Through networks, support groups, partnerships, and conferences like this o­ne, women are rising above the many social and cultural constraints o­n their power.

Community interventions have taught us that transformation at the grassroots level is possible. The chains of tradition that hold women back can be broken.

You have economic empowerment o­n the agenda. We are seeing more and more evidence that microfinancing schemes can release the power of impoverished women.

When women control household income, they gain decision-making power.

When women make decisions, they invest in health-promoting activities that benefit families and communities.

Negotiating power goes up, also in intimate relationships, and domestic violence goes down.

The progress you are making is progress for society at large.

Women are the bedrock of family and community stability, security, and well-being.

If the empowerment of women is o­ne result of this epidemic, then all of society, and all of public health, will benefit.

Thank you.

WHO Website