The response of the international community to the feminization of the epidemic
Dr Margaret Chan
Director-General of the World Health Organization
Distinguished first ladies and leaders, colleagues in the United Nations system, distinguished guests, ladies and gentlemen,
First and foremost, let me say how honoured I am to speak in your presence. I am a firm believer in the unique, but often underestimated power of women. I admire what you are doing.
You are unleashing this unique power in the interest of some very worthy causes. You are matching the feminization of the HIV/AIDS epidemic with a feminization of leadership. You are giving the special needs of girls and women a highly visible face and a strong political voice. You are bringing some sensitive issues, some taboo subjects, out into the open.
In the context of this epidemic, many of these issues place women in a disadvantaged position, increase their risk of infection, and reduce their access to services, including those providing treatment.
You are making it socially acceptable to talk about sensitive issues that are root causes of stigma and discrimination, and heighten the vulnerability of women and adolescent girls.
And, of course, you are fighting to raise the status of women. Unfortunately, in far too many cultures, women are still regarded as the second sex, the weaker sex, the junior partner in male-and-female relationships, in household decisions, and usually in decisions about sexual relationships as well.
Ladies and gentlemen,
All around the world, culture tends to assign certain stereotyped roles to women. These roles are often engrained from childhood on. Little boys tend to play with soldiers and guns. Little girls play with dolls. Little boys are expected to fight. Little girls are expected to patch things up.
Some of these stereotypes are repressive and confining, leaving women at a distinct disadvantage. For example, some cultures confine the activities of women to the children, the kitchen, and the church.
Social attitudes can limit opportunities for education and employment. All too often, women are the victims of domestic and sexual violence. These are critical dimensions of female vulnerability that must be addressed as part of a comprehensive response to HIV/AIDS.
But some of the stereotyped roles assigned to women can actually be used to great strategic advantage. I would go so far as to argue, especially within the context of this complex and challenging epidemic, that some qualities attributed to women constitute a unique power base.
Women are said to be emotional. I often advise women not to be afraid to cry. This is an expression of our compassion. As we know from almost three decades of experience with HIV/AIDS, compassion is a foundation for global solidarity. Compassion has persuasive power.
Women are traditionally viewed as caregivers. We take care of the sick and ailing. We bear children, and bear much of the responsibility for bringing them up. It is absolutely right for us to care about the impact this epidemic is having on adolescent girls and women. It is right to speak out, though it does take courage.
Women are often the moral conscience in communities and societies, the standard-bearers of what society considers right, wrong, or fair. This places you in an excellent position to tackle attitudes and cultural norms that limit opportunities for girls and women to receive education and information, and restrict their access to services, including those for sexual and reproductive health.
Evidence tells us that attitudes and norms that place women at added risk can indeed be changed. Globally, it is nearly always groups and coalitions of women who take this task on their shoulders and get the best results.
Finally, women are said to be very persistent in getting what they want. This is an especially important skill when the goal is policy change. Much can be done at the policy level. In cases where discrimination is institutionalized, laws need to be changed.
The rights of women also need recognition in official policies. For example, women who are widowed by AIDS can be left destitute because of laws and customs governing inheritance and property ownership.
Persistent pressure helps politicians make the right decisions and holds them accountable to their promises.
I commend you for your work in all these areas.
Ladies and gentlemen,
At the global level, we have some encouraging results. At the end of last year, nearly 3 million people in low- and middle-income countries were receiving antiretroviral therapy. However, much more needs to be done to improve prevention in all regions of the world.
In 2007, an estimated 18% of pregnant women in low- and middle-income countries received an HIV test, compared with only 10% in 2004. At the end of 2007, the percentage of all HIV-infected pregnant women receiving medicines to prevent transmission to their infants reached 33%. This is a substantial increase compared with only 10% in 2004.
But, as far as the rights of women are concerned, we have a problem. Programmes tend to forget the mothers in mother-to-child transmission.
Although more women are receiving drugs to prevent transmission to their babies, far too few women are being treated for their own sake, for their own health. Women are important in their own right, as individuals, and not just as vessels or vehicles for reproduction.
Treating women for their own health saves their lives and also avoids making children orphans. We need to aim for both objectives.
Globally, we are seeing another important trend. This is the use of microfinancing schemes for women as a tool for combating HIV/AIDS. When women earn and control a part of household income, their social status improves, often very rapidly.
When the status of women rises, they have more power to make decisions, also about sexual relationships. As an added benefit, when the status of women rises, domestic violence goes down.
We should all be encouraged by these recent trends.
Ladies and gentlemen,
Let me make one final point. I believe that women leaders in Latin America are well-placed to serve as role models for female leadership in other parts of the world.
Many countries in this region endorse health as a fundamental right, and give great importance to the values of equity and social justice, as expressed in primary health care. These rights and values are the foundation for a long-term and sustainable response to HIV/AIDS.
Some countries in this region pioneered strategies for delivering antiretroviral therapy to all in need. Experiences in Latin America paved the way for the 3 by 5 initiative, and for the subsequent commitment to universal access.
Much has been achieved but much remains to be done. I encourage you to carry on your dynamic leadership, using those unique powers of compassion, moral authority, tireless persistence, and above all, that famous Latin American passion.