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The Presidents Emergency Plan for AIDS Relief

The President's Emergency Plan for AIDS Relief: Focus on Women and Girls

Ambassador Randall L. Tobias, U.S. Global AIDS Coordinator
Remarks to the National Press Club
Washington, DC
December 1, 2004

I'm pleased to join you here today for World AIDS Day in Washington. I'm particularly pleased to be here with my fellow speakers.

I value the contributions of the organizations they lead, and thank them for their leadership against our common enemy. We are redoubling our efforts at coordination on the ground in the nations where we all work, and I am encouraged at the progress that's being made on that coordination.

I was recently in Mozambique, where I visited a home-based care program run by volunteers. Along with one of the volunteers, I visited a patient in her home--perhaps 12 feet by 12 feet, dirt floor, mud brick walls, corrugated metal laid across the top as a roof, dark inside with no windows. Tragically, she was days if not hours from passing away from AIDS.

Sitting on the edge of the woman's mattress was her 5 year old daughter. I asked the home-care volunteer who was taking care of the little girl now, and what would happen to her when her mother was gone. She told me no one had good answers. Her father had also passed away from AIDS, and she had no other family. While the neighbors looked in on her when they could, it was not clear that anyone would be able to help after her mother was gone. This was a child destined for the street. A mother passes away and a child is orphaned. And this is a tragedy that is repeated 8000 times each day.

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In trying to comprehend a number like 8000 deaths a day, or 3 million deaths a year, it is easy for these numbers to become just statistics. But it's important to remember that each one is an individual, with a name, a family, a story. The reality is that, especially in the hardest-hit countries like Mozambique, those stories are increasingly of women and girls. This year's observance of World AIDS Day recognizes the disproportionate burden they bear.

Consider this: women account for almost 50% of worldwide HIV infections, but in sub-Saharan Africa, they account for about 60% of infections. In some African communities, as many as 20% of girls aged 15-19 are infected, compared to just 5% of boys the same age.

In places where HIV is predominantly spread by heterosexual transmission, women and girls are especially vulnerable to infection. Cultural patterns, as well as biology, may give rise to this situation. In some places, social norms may accept multiple partners for men. Or older men may have sex with younger women and girls, who are disadvantaged by gender, age, and lack of economic power.

Rape, assault, prostitution, sexual trafficking, and sexual exploitation of women and children may also be major contributors to the problem. A recent survey of South African schoolchildren suggested that these issues are fueling the crisis there. Fully 71% of girls surveyed, and one-third of boys, reported that they had been forced to have sex. A shocking 58% of the children said that forcing sex on "someone you know" was not sexual violence.

Women and girls simply cannot be safe from HIV when coerced sex is common--and even widely accepted. And even when they are not themselves infected, women and girls still bear the brunt of the impact of the epidemic.

Women are primary caretakers in families and communities, charged with caring for the sick and for children orphaned by the disease. They are especially likely to lose jobs, income and schooling in order to fulfill family and community obligations.

Where, for example, is the next generation of educated women leaders in sub-Saharan Africa? For too many, even a basic education is becoming impossible, as they must care for suffering family members and become heads of households while they are still girls. This loss is just one of many catastrophic dimensions of this killer.

Women are also major contributors to the agricultural workforce, feeding their families and earning a meager family income in the marketplace. When women's health deteriorates, or when they must provide care to other family and community members, basic community needs such as food security come under threat. Perhaps most heartbreakingly, HIV-positive women also face the tragic possibility of passing the virus on to their children through pregnancy and childbirth. So those are some of the challenges women and girls face today. Let me take a moment to describe the U.S. response to this special vulnerability.

As I've explained, our strategy focuses on prevention, treatment, and care for those infected with or affected by HIV/AIDS. Because women are disproportionately hard-hit, they have the greatest need for, and are the primary beneficiaries of, these services.

I believe that making prevention, treatment, and care broadly available in severely affected countries is, by far, the most significant intervention the U.S. can make for women and girls. Our teams in each country are careful to make sure that they are fully included, and that their special challenges are addressed, in these core activities.

Here's one illustrative case. A woman, Buse Banga, was in a coma when she arrived at a hospital in Zambia. Her neighbors had already given her up for dead, another victim of HIV/AIDS. Buse's aunt, Ruth, brought her in to a U.S.-supported clinic anyway for antiretroviral drug treatment. Two weeks later, Buse opened her eyes. One week after that, she stood, and walked with her aunt's support. One month into their stay at the hospice she was discharged and driven back home. An eruption of cheers rang out as her neighbors swarmed the car. The woman who, as they said locally, "went dead," was now standing before them, ready to resume her role in the life of her family and community.

Who can say how many lives--in her immediate family, her extended family, and her community will be touched because America reached out to just this one woman? Moving beyond our core activities, let me highlight some of the interventions we support that are of particular benefit to women:

We are providing drug therapy and intensive counseling to prevent mother-to-child transmission of HIV. In fact, we quickly trained nearly 15,000 health workers and built capacity at over 900 different health care sites to prevent mother-to-child transmission in just 18 months.

The U.S. supports locally designed behavior change strategies that direct tailored messages to appropriate groups, support the roles of parents and others who can help protect girls, and strengthen families' and communities' ability to care for orphans and vulnerable children.

We are helping to build palliative care capacity, to help relieve the burden on women as home-based caregivers.

The U.S. is partnering with communities to find solutions to such issues as sexual coercion and exploitation of women and girls, as well as fighting sex trafficking and prostitution, while still serving victims of these activities.

To ensure that the problems women face are addressed from every angle, the President's Emergency Plan also includes highly successful relationship and anti-violence programs aimed at men and boys to help them develop healthy relationships with women.

Let me give an example on this last point. Earlier, I gave you some troubling data on South Africa. Well, the U.S. recently supported a "Men as Partners" and HIV counselling and testing day in South Africa. Male participants were encouraged to get tested and know their status, and also to get personally involved in fighting the violence against women that spreads HIV.

David Lelaka, a shop steward, who hadn't thought much about this before said, "I am going to have a meeting with those that could not make it today, and spread the message" which is so important.

The Reverend Steve Mahlatsi was convinced of the importance and vowed that he would impart his knowledge to his congregation.

Now, a workshop like this is a small step, but it's an example of the kind of grassroots effort that is needed--and that the U.S. will support.

Protecting women and girls must remain a priority, not only of America's Emergency Plan, but of the entire world in responding to HIV/AIDS. Yesterday, I was thinking about the many people I have met with around the world who are doing their part to fight HIV and AIDS.

Disproportionately, these people have been women. Like Asunta, who is here with us today, women all over the world are leading people living with HIV and AIDS, as well as community groups, faith based organizations and government ministries and commissions.

Mrs. Museveni and many of her fellow first ladies are using the power of their office to force greater action against this disease. At every level, women are making a difference in this fight.

So while today, we must work to raise awareness of the impact AIDS is having on women, at the same time, I want us to take this opportunity to also honor the impact women are having on AIDS. Let me close with an exhortation to all nations to rise to the challenge of HIV/AIDS. This must truly be a worldwide effort.

Vehicles such as UNAIDS and the Global Fund offer other donors a vehicle to sharply increase their advocacy and their commitment, as America has done. The entire world community must meet this moment with true leadership. This is a human crisis, and we must respond to this suffering with human compassion.

Let the world take the opportunity of World AIDS Day to redouble its commitment to this mission to provide hope to women, girls, men, and boys everywhere. Nothing less than the very future of the world is at stake. Thank you very much.


Released on December 9, 2004

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