Framing the problem from a gender equality perspective

In 2016 this same suite of documents articulates the policy frame on women, girls and HIV. This includes description of the factors which increase the risk and vulnerability of women and girls to HIV infection and its impact and sets out the actions that must be taken by governments to reverse the increasing HIV

infection rates among young women.

The core documents reviewed in this section are the same as for the public health and biomedical and human rights framing. Two additional documents are of relevance for the negotiations: the resolution put forward by Botswana on behalf of the Southern African Development Community (SADC) to the

Commission on the Status of Women adopted and included in the final report of proceedings (United Nations 2016a). (This is significant because the MS putting forward the resolution are numerous, and come from the continent where most young and adolescent women are being infected with HIV). Second, The Global Strategy for Women’s, Children’s and Adolescents’ Health (2016-2030)

(Secretary General 2015). Together these documents provide the technical and political policy framing of the HIV epidemic as it affects women and girls.

Current data from the UNAIDS 2017 reports are added for comparison where available, but note that this data was not available when PD2016 was

negotiated.

There is consistency across the documents in terms of the issues to be

addressed. When it comes to the proposed solutions there is consistency among the technical agencies in the strategies, but not among MS.

Women and girls are more vulnerable to HIV infection than men and boys.

Globally, AIDS is the leading cause of death among women of reproductive age.

Men and boys however, have greater risk of death from AIDS-related illnesses.

Deaths were ‘27% lower among women and girls in 2016 than they were among men and boys’ (UNAIDS 2017d, 4). Whilst the number of deaths among women aged 15-49 dying from AIDS-related causes has decreased since 2010, young women and adolescent girls experience elevated HIV risk and vulnerability on an ongoing basis. In 2014, 63 percent of the 2.8 million young people aged 15-24 years living with HIV in sub-Saharan Africa were female; 56 percent of all new infections among those aged 15-24, and 62 per cent of new infections among those aged 15-19, were among girls and young women (Secretary-General 2016.

25). More recent data shows that:

‘Differences in the number of new HIV infections between men and women are more pronounced at younger ages: in 2016, new infections among young women (aged 15– 24 years) were 44% higher than they were among men in the same age group. Since 2010, new infections among young women globally (aged 15–24 years) have declined by 17%, reaching 360 000 [210 000–470 000] in 2016. New infections also declined among young men (aged 15–24 years) during that time, falling by 16% to 250 000 [110 000–320 000] in 2016’ (UNAIDS 2017d, 6).

UNAIDS data from South Africa indicates that approximately 2000 young women age 15-24 are infected with HIV every week; approximately 12 per hour (UNAIDS 2017a).

The factors which put women and girls at increased risk of HIV infection are complex and include: a physiological vulnerability that is greater than in men, (though this is not the dominant factor); restriction of their human rights and fundamental freedoms (including inheritance rights) compounded by

discrimination and violence, including rape and intimate partner violence, which is increased in situations of conflict and humanitarian disasters; barriers in access to sexual and reproductive health information and services; limited HIV prevention options that are controlled by women; limited opportunities for education, in particular to receive comprehensive sexuality education; and gender inequality, including economic disadvantage and poverty, an increased burden of unpaid domestic care work and lack of autonomy and decision making power (Secretary-General 2016). (See annex 4).

4.2.1.4.1 Gender-based and intimate partner violence

One element of this increased vulnerability is violence, including intimate partner violence.

All forms of violence, including gender-based, sexual and intimate partner violence, may increase a woman’s risk of acquiring HIV. Young women and

adolescent girls have the highest incidence of intimate partner violence; in some settings, up to 45 percent of adolescent girls report that their first sexual

experience was forced. Young women who experience intimate partner violence are 50 percent more likely to acquire HIV than other women (UNAIDS 2015c, 37).

Sexual violence is increased in situations of conflict and crisis, and in these situations young women are often unable to protect themselves. Reported rates of sexual violence in conflict situations vary. Analysis of 19 studies found that an average of 21.4 percent of women displaced by complex humanitarian crises reported some form of sexual violence or exploitation (Vu et al. 2014). In 2011 the Security Council adopted resolution 1983, which focused international

political attention and action towards ending conflict-related sexual and gender-based violence and empowering women to reduce their vulnerability to HIV (Security Council Resolution 2011, Secretary-General 2016).

Other violations of women’s rights include discriminatory laws and harmful practices such as forced marriage, female genital mutilation and restrictions on women’s equal access to decision-making, education, employment, property,

credit or autonomy. These violations can also prevent them from access to services and care, which further compounds vulnerability to HIV (UNAIDS 2015c, 14) (UNAIDS 2015c, 37).⁶

Sex workers and transgender women are some of the most vulnerable women.

HIV infection rates among sex workers are documented have to reached levels of 71.8 percent in Johannesburg in 2015 (UNAIDS 2016c, 10).

HIV prevalence among sex workers in Botswana, Rwanda, Swaziland and Zimbabwe can be 45 percent or more. Median HIV prevalence rates for sex workers across Africa are around 20 percent. Rates of 8.4 percent have been recorded in the Caribbean. The four main reasons for these high prevalence rates are violence, criminalization, stigma and discrimination and the lack of programmes to meet their needs (Piot et al. 2015, 11).

Transgender women are also at particular risk; 19 percent are estimated to be living with HIV. These rates are highest among transgender women who inject drugs and or sell sex. In many parts of the world stigma and discrimination towards sex workers and transgender women are high and violence is common (Piot et al. 2015, 13).

4.2.1.4.2 Rights, roles and responsibilities of men in ending AIDS

In 2015, UNAIDS hosted a high-level consultation to explore the rights, roles and responsibilities of men in ending the HIV epidemic and in 2017 issued a special report entitled ‘Blind Spot’ highlighting the challenges of addressing HIV infection and AIDS related deaths among men (UNAIDS 2017b). This group is neglected in the literature and in the HIV response. The background discussion paper prepared for this meeting, and ‘Blind Spot’ review the current literature and evidence, points to persistent and pervasive gender inequality in the very

6 (The) 20-year review of the Beijing Platform for Action found that, even where legal equality has been achieved, discriminatory social norms remain pervasive, which affects all aspects of gender equality, women’s empowerment and women’s and girls’ human rights (UNAIDS 2015c, 37).

structure of society, which gives men power and privilege disproportionate to women, and promotes social roles, expectations and gender norms, which not only reinforce the dominance of men and subordination of women, but also lead to harmful socialization of boys and, consequently to behaviours that put men at greater risk of illness, death and violence (UNAIDS 2015a, 7) (UNAIDS 2017b).

Globally 49 percent of people living with HIV are men and adolescent boys older than 15 years. Of that global male population living with HIV in 2015, about 10 percent were adolescent boys and young men, of which 64 percent were in sub-Saharan Africa, and 20 percent in Asia and the Pacific (UNAIDS 2015a, 10).

Globally there are approximately 1.8 million new HIV infections among adults, of which approximately 52 percent are among men age 15-49 years. ‘Outside of eastern and southern Africa, men accounted for about 60% of the estimated 950 000 new HIV infections among adults 15 years and older in 2016, and 58% of adults living with HIV in these regions were men’(UNAIDS 2017b, 8).Among young people aged less than 25, however, the vulnerability is greater among young women, as previously explained (UNAIDS 2015a, 10, 2017d).

Globally, there were approximately 1.2 million [980,000 – 1.6 million] AIDS-related deaths in 2014, out of which men constituted almost 60 percent and made up the majority of AIDS-related deaths in every region of the world. 58 percent of the global AIDS-related deaths among men occurred in sub-Saharan Africa , followed by Asia and the Pacific (26 percent), Latin America (5 percent) (UNAIDS 2015a, 12). Current data shows that ‘Men are more likely than women to die of AIDS-related causes: globally, they accounted for about 58% of the estimated 1.0 million [830 000–1.2 million] AIDS-related deaths in 2016’ (UNAIDS 2017b, 5).

These figures mask a diverse range of vulnerabilities, which the literature and the consultation unpack in further detail. Gay men and other men who have sex with men have high prevalence rates of HIV, rising up to over 40% in some

countries, with higher prevalence rates in some urban areas (UNAIDS 2017b, 16).

4.2.1.5 Goals and targets, strategic directions and actions on gender equality