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A heartbreaking report on the health of women.

November 11, 2009

On monday the World Health Organization released a report stating that AIDS is the leading cause of death globally for women of reproductive age. This is heartbreaking news. It represents the intersection of two of the world’s largest problems: lack of health care and misogyny – violence against women, and lack of education for women. While these are huge issues in the United States, it’s in the global south were the effects are seen most starkly. 33 million people are living with HIV and majority of them live in poor countries.

Health Care
There is a lot needed to be fix world health care: a functioning infrastructure, more health care professionals, access to medicine, and spread of knowledge. These are not neutral problems. The fact that these are most needed in the global south is a fundamental source of injustice, and there is a lot the United States can do.

Access to medicine is one of the greatest obstacles to fixing the AIDS epidemic. High prices, low quality and inaccurate treatment means that patients in poor countries often get little or no health benefits. This injustice is supported by policies of the WTO , an undemocratic and nontransparent institution in which the US has undue power, and drug companies, many of which are based in the US and whose profits go to the US. The WTO’s TRIPS Agreement of 1994 means that drug products as well as processes are patented, and the patent owner is the sole manufacturer for 20 years, controlling the prices. Obviously, this makes medicine unaffordable for many, and WHO’s Doha Declaration in 2001 which allows for parallel imports of copy medicines, has not been effective to solve the issue. Drug companies, as an industry, also focus on medicines that will make the most money, and therefore produce way more drugs for “western diseases”. The Global Forum for Health Research has coined the term the 10/90 gap to describe how only 10% of health research goes to address 90% of the world’s health problems.

An additional, complicated problem is the lack of health care professionals, 4.3 million more are needed worldwide, but you can guess where they are needed the most. The issues of “brain drain” or “brain theft” is the migration of health workers from the global south to the global north, without any repayment of resources to their home countries.

What upsets me the most, is that our current debate about AIDS prevention is not about the issues, but rather about morality. This moral stigmatization concerning safe sex and fidelity takes the focus away from what’s really important: human rights, fighting poverty, access to medicine, and prevention. The most popular model of prevention is ABC: Abstain, Be faithful, use Condoms, but the Catholic Church and the United States give their aid with the focus on the first two. The shaming of sexuality that we complain about so often here on this blog, is not an issue that remains in the United States, but is in fact imported through international aid (particularly PEPFAR). What’s saddest to me, is that while world leaders are debating the morality of the condom, millions are dying from the infection.

Women’s Rights
You may have noticed in the earlier statistics, that infection of HIV is about equal for men and women worldwide, so why is this the leading cause of death for women?

Women’s position in society puts them at much higher risk for infection and much less availability for treatment. Norms and laws that subjugate women discourage them from seeking and obtaining knowledge about prevention and infection. WHO found that only 38% of young women are able to describe the main ways to avoid infection and they are less likely to know that condoms can protect against HIV than young men. Many countries in sub-Saharan Africa actually have a higher prevalence among young girls ages 15-19. WHO says this can largely be explained by sexual violence. Michel Sidibe, Executive Director of UNAIDS:

We know that there is a strong relationship between violence against women and HIV. We need to help young people develop the skills for mutual consent in sex and marriage and put an end to violence and sexual coercion. This is key to preventing HIV and to achieving gender equality in all aspects of life.

Gender inequalities impact not just infection, but treatment. The report describes how inequalities in education, income, health care, nutrition and political voice all impact women’s health. The report found that:

• Women provide the bulk of health care, but rarely receive the care they need
• Women live longer than men but these extra years are not always healthy
• Despite some biological advantages, women’s health suffers from their lower socio-economic status
• Policy change and action is needed within the health sector and beyond

As Dr Margaret Chan, WHO Director-General simply states:

Despite considerable progress over the past two decades, societies are still failing women at key moments in their lives

The report also present solutions: strong leadership and a coherent institutional response ; making health systems work for women; leveraging changes in public policy to encourage fundamental social change (through, for instance, targeted action to help girls enrol in school); and building the knowledge base and monitoring progress. The United States, who has had a large role in contributing to this injustice, also has the ability and responsibility to support WHO’s measures for urgent action within the health sector, and reverse current policies which exacerbate the problem in the global south.

Changemaker, where I’m interning here in Norway, asks the question: Why are millions dying in the Global South of diseases there are medicine for? This is not an issue we can just ignore or put on someone else’s plate. We have a role. We are involved. The policies and attitudes of the United States are affecting the world’s women. Action must be taken now.

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