The theme for this year's World AIDS Day is "leadership," which I find fitting. First, we have experienced a change of leadership in Washington that I think has given those of us in the reproductive health community a reason to hope. Second, this change in leadership also gives us a new reason to adopt the mantel of leadership ourselves as we fight HIV and AIDS worldwide.
For the last eight years, we have lived in an environment where our sexual lives were treated as a political issue, rather than as an issue of health and wellness. This is not only ridiculous, it hinders efforts to encourage all people to understand their sexuality, their behaviors and the risks they are taking. Globally, young people, ages 15-24, make up nearly half of all new HIV infections. It's time to change the political game where ideology determines policy rather than science. President-elect Obama has promised to remove harmful obstacles that hinder science-based HIV prevention efforts. He has committed to enact policies that give people the tools they need to protect themselves and their partners from HIV infection, including supporting comprehensive sex education both here and abroad.
The reauthorization of the President's Emergency Plan for AIDS Relief (PEPFAR) this past summer presents some major obstacles for President-elect Obama. The current plan still includes problematic restrictions such mandating that "any country with a generalized epidemic uses more than 50 percent of its PEPFAR funding for prevention against sexual transmission to promote anything other than abstaining from sex or being faithful, it must be justified to the Office of the Global AIDS Coordinator who then has to justify it to Congress." While a new Administration has the potential to implement these provisions in a positive way through the policy's guidance, the U.S. must also ensure that funded countries know they have more freedom to develop strategies that specifically address the HIV epidemic among their citizens. I am looking to this new administration to work with the global health community to do just that.
The change in our government has brought all of us in the reproductive and sexual health community renewed hope. We have been on the defensive for so long, forced to make do with the ineffective tools we were given to fight a pandemic, that we are almost desperate for changes. Now, with new leadership in the United States, we have renewed motivation as we to take leadership in our communities and in the policy arena.
But, with this hope
comes responsibility. We no longer have a non-receptive administration
as an excuse to not get things done. It is no longer acceptable
(was it ever?) to play it safe for fear of getting attacked on issues
such as access to condoms or needle exchange. We cannot afford to think
small when working on U.S. policy because of a bad political climate.
Instead, for World
AIDS Day this year, I see people thinking big and taking the lead.
I see plans for an international "blog-a-thon" taking shape because everyone is willing
to commit and bring others on board. At George Washington University
where I attend school, I see a larger coalition of activists putting
together a full week of programming to raise awareness around the disease.
So - my question for you - - how will you take the lead next Monday and in the future in fighting the global HIV pandemic?
For more information or to participate in the blog-a-thon hosted by Advocates for Youth from December 1-7, 2008, go to: www.AmplifyYourVoice.org/WorldAIDSDay ]]>Recently, a provision was included in the reauthorized President's Emergency Plan for AIDS Relief (PEPFAR) to end the statutory HIV travel ban passed in 1993. That's the good news! The bad news is that this action is only the first step. The Department of Health and Human Services must now remove HIV as one of its "communicable diseases of public health significance" in order to completely eliminate the travel ban. As a US citizen, I am disappointed that I am from such a powerful country that refuses to step up and stand for the human rights of those living with HIV.
The International AIDS Society (IAS) has recognized the hypocrisy of countries claiming to stand up for people living with HIV/AIDS, yet banning them from their borders. IAS has taken a firm stand against holding any meetings in countries that continue to impose a ban. In her remarks on a panel regarding these travel bans, Congresswoman Barbara Lee relayed her embarrassment over the fact that the United States, one of the biggest funders of the effort to combat AIDS, through PEPFAR, can't even host an International AIDS Conference.
In 2006, the International AIDS Society had the structure and grassroots organizational pressure to convince Canada to strike its travel restrictions in order to host the XVI International AIDS Conference. The International AIDS Society should re-activate such efforts towards making entry of people living with HIV and AIDS a priority for all countries and making visas more accessible for those traveling to the Vienna International AIDS Conference in 2010. Ideally, the United States will have completely lifted its travel ban and we will be able to see an International AIDS Conference in the United States in 2012.
So, when I read the abstract for a session on the sexual and reproductive health of people living with HIV and AIDS, put on by the Guttmacher Institute, I was intrigued. The panel included four presenters, two from the US, one from Nigeria, and one from Zimbabwe. I went to the session hoping to hear about true integration of reproductive rights and HIV/AIDS movements. Instead, I was disturbed by the lack of understanding between the two movements. A theme ran through the presentations, given by the US-based colleagues, which was both incredibly problematic and incredibly enlightening.
Both of these presentations addressed contraception as an HIV prevention method, rather than contraception as a family planning option for HIV-positive women. In fact, one of the presentations, "contraception as a way to prevent HIV," directly followed the presenter from Nigeria, a woman living with HIV who spoke movingly about the lack of access to comprehensive support for women living positively, including lack of adoption options and support for women choosing to have children. Just seeing the title slide from the subsequent presentation made me nervous: was this presentation going to be about stopping HIV positive women from having children?
As stated by the woman from Nigeria, one of the largest obstacles in the fight against HIV is the lack of access to information and commodities, such as contraceptive options, for vulnerable populations. However, this lack of family planning options should not be treated as a cause of HIV infections, but as another symptom of the marginalization of groups such as youth, women, those below the poverty line, injection drug users, men who have sex with men, and sex workers. A strategy around providing sexual and reproductive health services, including family planning, to these vulnerable populations is important to the AIDS movement because it provides information and access, empowers them to make healthy sexual choices in their own lives, and can help decrease stigma and prejudice, all pieces of what makes members of these communities more at risk for HIV. But most of all, sexual and reproductive health services should be important to the HIV/AIDS movement because they are a basic human right.
I'm sure the US-based presenters would agree with everything I just wrote. However, the way they framed the connection between family planning access and HIV/AIDS was much different. One presentation connected access to family planning and HIV prevention by emphasizing the importance of contraception in preventing unwanted, HIV-positive children. It was argued, with scant evidence, that women who are HIV positive are more likely to have unintended pregnancies and that the focus has been too much on preventing mother-to-child transmission once a woman is pregnant. This framing is, first of all, incorrect because it gives the impression that preventing the unintended pregnancies of HIV-positive women is more important than preventing the unintended pregnancies of negative women, simply because these women are HIV positive. Second, it is insensitive to women living with HIV and AIDS, a population that has more often than not been told they should not reproduce rather than told they can.
As the moderator and final presenter had an opportunity to change the framework around sexual and reproductive health and people living with HIV and AIDS to one about basic human rights, she only repeated this problematic framework. All in all, I was disheartened.
This problem reminds me of one we have been dealing with in the reproductive justice movement for years; the language around the choice of not having a child does not resonate for populations who have experienced forced sterilization, been coerced into having fewer children, or marginalized. It does not resonate for many women of color in America and it does not resonate with people living with HIV and AIDS.
I have been so excited about the change from a "pro-choice" framing to a reproductive justice framing in the past couple years because I thought that it represented a shift in the way we talk about family planning to a way that makes sense for all populations. I was extremely disappointed that this framing was missing when it came to talking to the HIV/AIDS community. Reproductive justice is inclusive and when it comes to HIV-positive people, is something we need to incorporate into our framing. If we stand for basic human rights, we should stand for the rights of those living with HIV and AIDS, not because we hope they will have fewer children, but because they also deserve sexual and reproductive health and justice. ]]>This is why, when the evidence for circumcision as a mode of preventing HIV infections in men is brought up, I am extremely concerned over how it would play out in a political and social context such as the one that exists in Kenya. I eagerly awaited discussion on this topic at the International AIDS Conference, and today was my first opportunity to attend a session. "Male Circumcision: Addressing Implementation Challenges and Demonstrating Impact" consisted of a series of presentations highlighting research on the implementation of male circumcision as a way to prevent HIV and AIDS. It was disappointing, although I take some of the blame for it not living up to my expectations. While I was looking for answers around social implications, this session focused mostly on the science and individual level results.
Even so, I was bothered by several parts of this presentation. First, I am concerned by the seeming promotion of circumcision instead of condoms. On further questioning, all the panelists stressed that male circumcision should be part of a comprehensive strategy that includes education, access to condoms, and counseling. However, in several off-hand remarks, and in the tone of the presentations, I sensed an attitude towards male circumcision as if it was the best thing to happen to the HIV/AIDS activist community since sliced bread. Don't get me wrong, the science is exciting. With studies suggesting that circumcised men are 50-60% less likely to get HIV, I would be shouting from the rooftops if I were a scientist. But male circumcision programs will not deal with abstract groups of potential HIV carriers, they will deal with human beings living in complex social realities.
This is why the panelists' lack of attention to the social realities that make male circumcision so complex annoyed me. In fact, I made a point of asking a question regarding the role of social realities in designing research and policy, and got basically no answers. The epidemiologists on the panel squirmed in their seats, and later one excused this omission by saying they did not focus on the social aspects - that was for someone else to do. This divide between the sociological and epidemiological aspects of HIV and AIDS only hinders efforts to find a comprehensive solution, and distorts the research evidence that is found. One presenter highlighted the success of programs in areas of Kenya to incorporate HIV/AIDS education and priorities into traditional initiation ceremonies (that included circumcision). However, because it was with a population that already circumcised its adolescent males, I was skeptical of its success.
A couple of the presenters replied that the results of their studies debunked myths that certain groups would be resistant to male circumcision. When I went up to the presenter who had shared his results from Kenya, however, he acknowledged the need for sensitivity towards political and social realities in the implementation of male circumcision programs and the importance of ensuring that circumcision is a choice for men, instead of a necessity. He also acknowledged the political realities. I was happy to hear that this was not being completely ignored, but disappointed that recognition of societal issues was an afterthought, rather than a focus of the panel.
Another omission by the panelists was that of the role of male circumcision and how this affects women. The panelists all noted possible biological benefits for women. When asked about women, a couple of the presenters mentioned that partners of the subjects of their study often approved of the circumcision for personal reasons. Frankly, I found these answers insulting. You are asked about the role of women and all you can come up with are that they really like how the circumcised penis feels in bed? What about the fact that male circumcision requires men to take on a burden, while male resistance to condom use already shows us that overcoming burdens is not always a realistic option? What about women as emotional and intellectual partners and loved ones of men, not just sexual partners?
Finally, one study, on male sexual pleasure and performance before and after circumcision, underscored this preoccupation with the sexual and physical over other aspects that influence the decision to be circumcised. I was confused as to why this study was important or relevant at all, since I am pretty certain that male circumcision has been around for centuries and Jews, Muslims, and other groups that are all traditionally circumcised seem to be able to function sexually just fine, as do groups that don't traditionally circumcise. When the findings showed little quantitative difference, this just confirmed the ridiculousness of the study to me.
Male circumcision can be an important tool in the fight against HIV and AIDS, but the panel I attended today only confirmed my fears over the way it will be used. There is another one on Thursday that I hope will address the complex social issues instead of the unenlightening and superficial ones.
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Some commitments to date include
pledges to make youth sexual and reproductive health and rights (SRHR)
services more youth-friendly; to create leadership positions for young
people, and to start an SRHR campaign for young women.
On Monday morning, the Mayor of Mexico City, Marcelo Ebrard Casaubón, stopped by. We were also excited when Ban Ki-Moon, the Secretary General of the United Nations, visited the Youth Pavilion to address young people on his work with HIV/AIDS. He spoke briefly to a strictly screened audience (no one over 29 years old). He emphasized the problems of stigma and discrimination towards people living with HIV and AIDS, but failed to take advantage of the opportunity to make a commitment to youth.
As a member of YouthForce, I was disappointed that Ban Ki-Moon did not provide us with the respect of acknowledging our rights. Furthermore, he failed to make a pledge at the commitments desk. The commitments desk was created to help decision-makers commit to youth. Why is it so difficult for many leaders do so?
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