HIV and AIDS

Baroness Gould of Potternewton Excerpts

Monday 18th January 2016 Lords Chamber

[Baroness Gould of Potternewton (Lab)]

My Lords, I also thank the noble Baroness, Lady Barker, for initiating this debate as it gives me the opportunity to raise the plight of women with HIV and the particular barriers that they face.

Since the start of the global HIV epidemic, women have remained at a much higher risk of HIV infection than men, with young women and adolescent girls accounting for a disproportionate number of new HIV infections. As the noble Baroness, Lady Barker, said, a consequence is that HIV remains the leading cause of death among women of reproductive age, yet access to HIV treatment remains low. This lack of comprehensive HIV and SRH services means that women are less able to look after their sexual health and are more at risk of HIV infection—a problem that is often made worse for young women as such services are available only for married women with children.

In Kenya, Rwanda and Senegal more than 70% of unmarried sexually active girls cannot receive contraception due to age restrictions. That is not helped by healthcare providers often lacking the necessary training and skills to inform women on how to protect themselves, and on how to use anti-retroviral drugs. While overall access to HIV testing and counselling is improving it is still far too low. Discriminatory social and cultural norms are translated into laws which stop women and girls accessing HIV prevention treatment, care and support services. Women often face stigma and judgmental attitudes to drug use, sex work and homosexuality, resulting in the denial of healthcare.

The situation is that women are being left behind in terms of access to HIV treatment, exacerbated by the high cost of treatment, which creates weak and insufficient health systems and supply chains. This situation could be improved by community and home-based testing as an effective way of reducing costs. There is a correlation between HIV and poverty. Addressing poverty has shown to reduce sexual risk behaviour. A study in Malawi showed how cash transfers that were conditional on keeping girls in schools reduced HIV and STI prevalence, as well as high-risk behaviour. The World Health Organization states that 30% of women worldwide have experienced intimate partner violence or have been physically assaulted. These women are more likely to acquire HIV. Women experiencing abuse are coerced into sex and unable to negotiate practices such as condom use. Very often it seems that the men who are committing the abuse are more likely to engage in risky behaviour. A woman who depends on her partner economically cannot afford to jeopardise the relationship, even when she suspects that he may be HIV positive.

One hundred and twenty five countries have legislation criminalising domestic partner violence, sexual violence, child sex abuse and sexual harassment, but despite this progress the evidence for establishing the crimes is very weak. For instance, only 52 countries recognise rape within marriage as a crime, again making it difficult for women to protect themselves from such sexual violence or negotiate safe sex.

DfID has identified the needs of women and girls as a clear priority for the UK Government, but to date has not explicitly made the connection between the women and girls agenda and the HIV response. I ask the Minister to clarify the position, for addressing HIV and AIDS is not an additional burden or add-on to DfID’s core priorities—rather, it supports them. Will the Minister confirm that HIV is not being deprioritised and absorbed into other conditions? Surely our target has to be to end the epidemic and to increase focus on protection of women with HIV and AIDS, not the reverse. Additionally, the UK aid strategy makes no reference to HIV and AIDS and gives no indication of how the UK intends to contribute to meeting the SDG target.

In conclusion, it is widely recognised that gender equality is vital to an effective HIV response. There needs to be renewed political and financial commitment to eliminate gender inequalities and gender-based violence, and to increase the capacity of women and girls to protect themselves from HIV. We cannot forget, as so often seems to happen, that, in the words of the executive director of UNAIDS:

“This epidemic unfortunately remains an epidemic of women”.