Sensitive and contentious issues
Some of the current programs at stake

© 2002 Antje Becker-Benton/CCP, Courtesy of Photoshare

A movement has arisen that proposes sexuality education for young people be restricted only or primarily to messages concerning abstinence from sex outside marriage. Abstaining from sexual intercourse – including anal and oral sex – certainly offers protection against infection with HIV/STIs and unwanted pregnancies; the advantages of this behavior therefore should be discussed during sexuality education. However, messages about abstinence-only cannot be the only information we give young people
because:

• Alarming numbers of female adolescents and adults around the world are sexually assaulted each day, including women who have been abstinent. They need information and access to services including counseling, post-exposure prophylaxis for HIV infection, STI diagnosis and treatment, emergency contraception and safe, legal abortion if needed.
  
• In countries of all regions of the world, considerable numbers of young people are marrying at a later age and eventually engaging in sex outside the context of marriage. These young adults need information about and access to services focused on contraception, HIV/STIs and pregnancy (antenatal care, adoption and abortion services) so that they can deal effectively with all health issues related to sexuality.
  
• In most countries of the world, marriage is still prohibited between same-sex partners. In these places, homosexual and lesbian men and women have no other option to express their sexuality than outside marriage.

“Young people have called for increased access to national and international resources in order to establish formal and informal educational programmes on HIV/AIDS, substance abuse and sexual, reproductive and mental health. There is a need for Governments to facilitate improved access for youth to health information and services, including sexual and reproductive health services.”

Report of the UN Secretary General
World Youth Report 2005, paragraph 67

Some women are engaged in behaviors or live in situations that expose them more often to risks of HIV/STI infection and unwanted pregnancies. They include adolescent women and girls who trade sex for cash or other goods and services and women who use illegal drugs or who are the partners of drug users. There are proven strategies that can help reduce the health risks that these women, their children and partners face and these programs must be enabled to continue and expand without unnecessary restrictions.

In the field of sex work, programs with sex workers give them access to steady supplies of affordable condoms and empower them by helping develop their ability to negotiate the terms of sex with clients. Work with law enforcement personnel to stop violations of women’s rights (e.g., arrests of peer educators or women who are found carrying condoms, punishment of policemen and guards who rape sex workers in custody) and organizational development (such as sex worker associations and unions) have contributed to a healthier and safe working environment for these women as well. Requiring NGOs and governmental agencies to sign “anti-prostitution pledges” is counter-productive. Organizations that work with sex workers must be able to continue their programs, without condemnation or moral judgments about the women they serve.

In October 2005, SANGRAM, an NGO based in Sangli, India, stopped taking USAID money for their anti-AIDS work by mutual agreement, as they understood the [anti-prostitution] pledge requirement would violate both the spirit of working respectfully with at risk-persons, and civil society organizations right of free expression. In May 2005, Brazil rejected $40 million in US anti-HIV/AIDS grants because they made funding conditional on recipient organizations adopting a pledge opposing sex work.

Human Rights Watch

In comparison with interventions to reduce perinatal HIV transmission, other reproductive health issues important to women living with HIV/AIDS have received insufficient attention. They include: screening and treatment for reproductive tract cancers, treatment of opportunistic infections that may make pregnancy riskier (e.g., anemia, Chlamydia, malaria), provision of information on contraceptives including possible interactions with other drugs, provision of information about and access to services to prevent and deal with unwanted pregnancies (emergency contraception, safe legal abortion). More efforts are also needed to work with traditional birth attendants (TBAs), who may be the primary or only caregivers that pregnant women see in many communities. Educating TBAs on how they can decrease risks of HIV transmission during delivery (to babies and themselves) is a first step; incorporating their help in programs to prevent perinatal HIV transmission goes a step further.

For the most part, women living with HIV/AIDS are not involved in policy and program formulation, design and evaluation at the local or national levels. NGOs, universities and other agencies must promote capacity-building and skills-building for women affected by and living with HIV/AIDS so that they can participate meaningfully in advocacy and policymaking.