The HIV/AIDS pandemic and its gender implications

EGM/HIV-AIDS/2000/Rep.1
United Nations
Division for the Advancement of Women
World Health Organization (WHO)
Joint United Nations Programme on HIV/AIDS (UNAIDS)
The HIV/AIDS pandemic
and its gender implications
Report of the Expert Group Meeting
Windhoek, Namibia, 13 - 17 November 2000
Division for the Advancement of Women
Department for Economic and Social Affairs (DESA
2 UN Plaza, 12th floor, New York NY 10017
Tel: 212 963 9750, Fax: 212- 963 34 64
Web location: http://www.un.org/womenwatch/daw
E-mail: daw@un.org

---

TABLE OF CONTENTS
I.
Introduction
II.
Organization of work
A. Attendance
B. Documentation
C. Programme of work
D. Election of officers
E. Opening statements
III.
Summary of debate
A. Background
B. Human security, human rights, gender and HIV/AIDS
C. Key issues and concerns
IV.
Recommendations
A. Immediate actions
B. Specific recommendations
Annexes
I.
List of participants
II.
List of documents
III.
Programme of work
2

---

I.
Introduction
The Commission on the Status of Women has repeatedly expressed its concern over the
growing rates of sexually transmitted infections and human immunodeficiency virus/acquired
immunodeficiency syndrome (HIV/AIDS) infection among women in every region of the world,
especially in sub-Saharan Africa where women constitute 55 per cent of all adult HIV infections.
Of particular concern is the strong link between violation of the human rights of women and girls
and the HIV/AIDS pandemic. The former is not only one of the root causes of women and girls’
infection but also one reason why women are particularly severely affected by the pandemic.
The United Nations Commission on the Status of Women (CSW) took up the issue of
HIV/AIDS when it reviewed the critical area of concern “Women and Health” at its forty-third
session held in March 1999. It also discussed women and HIV/AIDS in the follow-up to the
Fourth World Conference on Women. Furthermore, the seriousness of the HIV/AIDS pandemic
has been pinpointed on several occasions at the international level and it is now recognized as a
phenomenon with wide development and security implications. In January 2000, an
unprecedented United Nations Security Council session was devoted exclusively to the impact of
HIV/AIDS on peace and security in Africa. The International Partnership against AIDS in
Africa, a joint initiative of the United Nations system, African Governments, donor countries,
non-governmental organizations and the private sector, which resulted from the session, is
addressing HIV/AIDS in Africa in a concerted effort.
The special session of the General Assembly on “Women 2000: gender equality,
development and peace for the 21rst century” (June 2000) called on Governments and other
actors to enhance international cooperation in fighting HIV/AIDS and take bold measures to
develop vaccines, low-cost diagnoses, adequate housing and social protection, assist girls and
boys orphaned by AIDS and provide gender-sensitive support systems for affected persons.
ICPD +5, the special session of the General Assembly to review progress made in the
implementation of the Programme of Action of International Conference on Population and
Development (1999), set specific benchmarks for providing access to young women and men
aged 15-24 years to information, education and services necessary to reduce their vulnerability to
HIV infection by the year 2000. It also set benchmarks to reduce the infection rate in that age
group by the year 2010.
Compelled by recent alarming developments with regard to women and HIV/AIDS, the
Commission on the Status of Women decided to consider the topic as a priority theme in its work
programme for the year 2001. The United Nations Division for the Advancement of Women, in
collaboration with the World Health Organization (WHO) and the Joint United Nations
Programme on HIV/AIDS (UNAIDS) organized an Expert Group Meeting on “The HIV/AIDS
Pandemic and its Gender Implications” to contribute to further understanding of the issue,
provide input to the report of the Secretary General to the Commission as well as to the special
session of the General Assembly on HIV/AIDS (2001). The meeting took place in Windhoek,
Namibia, from 13 to 17 November 2000.
The expert group meeting considered the topics of HIV/AIDS, gender, human rights and
human security and their interlinkages. It discussed the basic rights to be addressed in this
context and adopted a number or recommendations for immediate action as well as specific
recommendations addressing particular actors and areas of concern.
3

---

II.
ORGANIZATION OF WORK
A. Attendance
The Expert Group Meeting on " The HIV/AIDS Pandemic and its Gender Implications "
was held in Windhoek (Namibia), from 13 to 17 November 2000. It was organized by the
United Nations Division for the Advancement of Women, Department of Economic and Social
Affairs (DAW/DESA) in collaboration with the World Health Organization (WHO) and the Joint
United Nations Programme on HIV/AIDS (UNAIDS). The Namibian Government hosted the
meeting. The meeting was attended by eight experts from different regions, and 33 observers: 14
from Governments, two from intergovernmental organizations, eight from non-governmental
organizations and 10 from the United Nations System (see annex I for the full list of participants).
B. Documentation
The documentation of the meeting comprised three background papers (one prepared by
DAW, one prepared by UNAIDS and one by a consultant), eight papers by experts, four by
observers and several statements (see annex II). This report and all documentation of the meeting
are available on-line at the DAW website:
http://www.un.org/womenwatch/daw/csw/hivaids/index.html.
C. Programme of work
At its opening session on 13 November 2000, the meeting adopted the following
programme of work (see annex III):
Opening
Election of officers and adoption of the programme of work
Introduction to the meeting
Presentation and discussion of experts’ papers
Working groups on:
- “Prevention, treatment and care in the context of human rights”
- “HIV/AIDS as a human security issue: a gender perspective”
Introduction of draft recommendations and report in plenary
Adoption of final report and recommendations
Closing session
D. Election of officers
At its opening session, the meeting elected the following officers:
Chairperson:
Abner Xoagub (Namibia)
Vice-chairperson:
Sharifa Shahabudin (Malaysia)
Rapporteur:
Peter Aggleton (United Kingdom)
4

---

E. Opening statements
The meeting was opened by Dr. Doyin Oluwole, WHO Representative for Namibia. She
highlighted the seriousness of the HIV/AIDS pandemic which she defined as being a human
disaster affecting individuals, the family and community structures and particularly women as
they were more exposed to poverty and income inequality in households. The strategies
developed at global and local levels had not adequately addressed the problems associated with
women’s status, rights and needs, and due attention was not paid to their implementation. She
stressed the urgent need to develop a more holistic and gender-based approach and establish
effective interdisciplinary programmes for the reduction of inequalities between women and men
with a view to curtailing the spread of HIV/AIDS and controlling sexually transmitted infections.
In concluding, Dr. Oluwole underlined the importance of establishing an enabling
environment as a way to ensure that women and men could both prevent HIV infection and cope
with the pandemic more successfully. Women played a paramount role in promoting health and
providing care but these roles were not sufficiently recognized. She stressed that Governments
should formally acknowledge the role that women played in society and incorporate women’s
experiences in the planning process so that a more balanced representation of women in decision-
making positions and in management in the politcial, administrative and technical domains would
be the outcome. This would also improve the continuum of care, from prevention to
rehabilitation, from the family to health care institutions.
In a message from the Joint United Nations Programme on HIV/AIDS to the expert group
meeting, Ms. Marie-Pierre Poirier, Acting Resident Coordinator and UNICEF Representative,
underlined the urgency for action to be taken in the fight against HIV/AIDS given the very high
number of women and men living with HIV/AIDS in the world. She pointed out the need for
strategies that were sensitive to the specific needs of women and men and for focussing on the
role of men as partners in the fight against HIV/AIDS. Thus UNAIDS and its partners had
decided to select the theme “Men Make a Difference” for a two-year world campaign against
HIV/AIDS. Ms. Poirier stated that this meeting came at a very opportune moment for the African
region as it was taking place at the eve of the African Development Forum 2000 (Addis Ababa,
Ethiopia, 3-7 December 2000) on “AIDS: the greatest leadership challenge”, organized by the
Economic Commission for Africa and UNAIDS, UNDP, UNICEF and the World Bank. The
African Development Forum was expected to serve as a launching pad for a renewed and
sustainable commitment from African leaders to make HIV/AIDS a top priority in their
development agenda.
Ms. Dorota Gierycz, Chief of the Gender Analysis Section, Division for the
Advancement of Women, delivered a message sent by Ms. Angela E.V. King, Assistant
Secretary-General and Special Adviser on Gender Issues and Advancement of Women. In her
message, Ms. King stated that the theme of the meeting was particularly timely as the issue of
HIV/AIDS and its impact on women and girls had emerged as an international priority for the
Millennium Summit, the General Assembly, the Security Council, the Economic and Social
Council, the Commission on the Status of Women and other legislative bodies of the United
Nations. She stressed the significance of an historic meeting of the Security Council held in
October 2000 when the issue of women, peace and security had been discussed for the first time
at that level.
5

---

Ms. King’s message highlighted the importance for the expert group meeting to build on
the recommendations of the twenty-third special session of the General Assembly on Beijing +5,
in particular the call for enhanced international cooperation against HIV/AIDS. She emphasized
the need to encourage all actors, including men, to translate Governments’ commitments made at
the special session into reality, to empower women to have sufficient access to affordable and
quality health services and have a blueprint for partnerships between Governments, civil society,
international organizations, non governmental organizations and the private sector in resolving
these problems.
Speaking on behalf of the United Nations Division for the Advancement of Women and its
Director, Ms. Dorota Gierycz expressed her gratitude to the Government of Namibia for hosting
the expert group meeting. It was particularly important that this meeting took place in sub-
Saharan Africa where some Governments were making great efforts to address the problem of
HIV/AIDS. She pointed out the need to take a gender-sensitive approach in the fight against
HIV/AIDS as embodied in the Beijing Platform for Action and reiterated in the report of the
special session of the General Assembly on Beijing+5. Women should play a central role in
combating the pandemic and, therefore, should be empowered through education and
participation in decision-making. Ms. Gierycz highlighted the necessity to define holistic
strategies against HIV/AIDS and the need for the international community to continue pursuing
special initiatives with regard to HIV/AIDS. In concluding, she underlined the importance of
encouraging gender mainstreaming in all policies and programmes dealing with HIV/AIDS as an
effective tool to implement the international agreements addressing this issue.
Ms. Malene Mugunda, Deputy Minister of Women Affairs and Child Welfare stated that it
was an honour for Namibia to host this expert group meeting. Highlighting the challenge of
HIV/AIDS to everybody and the necessity to combat the pandemic now, she underlined the need
of commitment at the highest political level, at community and individual level in order to fight
HIV/AIDS worldwide. Only when there was commitment at all levels, women and men could be
equally empowered and would have greater control over their lives, thus slowing down the spread
of HIV/AIDS infection and preventing further infections.
Ms. Mugunda pointed out the need for women to join forces to face the challenge of
HIV/AIDS and the necessity to consolidate all initiatives to come up with an effective response,
including the review and formulation of acts and policies to improve women’s status in their
respective societies. It was important to look at strategies to ensure true partnership between
women and men, to review cultures systematically and respond with appropriate behavioural
change, to strive for the empowerment of women to enjoy their right to have safe sex and ensure
the economic empowerment of women.
6

---

III. SUMMARY OF DEBATE
A. Background
The HIV/AIDS pandemic is growing with alarming speed. Estimates indicate that by
December 2000 worldwide 36.1 million people will be living with HIV, up from 10 million in
1990, 95 per cent of which are living in developing countries. AIDS is the number one cause of
mortality in Sub-Saharan Africa with over 24.2 million adults being infected. By the end of
2000, an estimated 10.9 million men and 13.3 million women in Africa were living with HIV.
Since the beginning of the pandemic, an estimated 21.8 million have died of AIDS, three/quarters
of whom in Africa. Over 13.2 million children have been orphaned as a result of AIDS, over 12
million of which in Africa.
In early 2000, the United Nations Security Council emphasized that, if unchecked,
HIV/AIDS was likely to pose a major threat to stability and security. There were few sections of
society unaffected by the epidemic in the hardest hit regions of the world. AIDS impacted upon
agricultural and industrial production through its effects on the supply of labour; it affected
education through its impact on the teacher workforce and on pupil attendance; it affected health
services both in terms of supply and demand; and it threatened good governance through both
social and economic instability and the illness and death of politicians, decision makers and the
productive workforce including civil servants.
The UN Commission on the Status of Women, the Millennium Summit, the special
sessions of the UN General Assembly on ICPD +5, Beijing +5 and Social Summit +5 and other
recent international meetings affirmed the importance of working to halt and begin to reverse the
epidemic, and recognized the gender and human rights issues involved. The Committee on the
Elimination of Discrimination against Women (CEDAW) has repeatedly recommended inter alia
the provision of more information for prevention, education in sexual and reproductive health and
increased HIV/AIDS education and services to all women when considering reports of States
parties to the Convention. The UN General Assembly special session on ICPD + 5 set specific
benchmarks for access by young men and women aged 15 to 24 to the information, education and
services necessary and global reduction of HIV prevalence for that age group. The UN General
Assembly special session on Beijing + 5 drew attention to the need for enhanced international co-
operation in fighting HIV and AIDS, increased efforts to assist girls and boys orphaned as a result
of AIDS, and actions to provide gender-sensitive systems for affected persons. The Millennium
Summit highlighted the need to provide special assistance to children orphaned by HIV/AIDS
and to help Africa build its capacity to respond to the epidemic. In numerous statements and
declarations, UNAIDS and its co-sponsoring organizations have asserted the importance of a
gender-sensitive response in which the different experiences and needs of women and men are
recognized and responded to.
7

---

1.
Impact
In many countries, women and girls are bearing a heavier burden than men in terms of
rate of HIV infection, the stigmatization that results from their being blamed for HIV/AIDS, and
the burden of family support and care. Disclosure of women’s HIV status is likely to cause abuse
or abandonment by their families and loss of their rights to children and property.
Although physiology affects women’s greater risk of transmission, it is women’s and
girls’ relative lack of power over their bodies and sexual lives, supported and reinforced by their
social and economic inequality, that renders them vulnerable to contracting HIV and coping with
HIV/AIDS. Some cultural and religious practices, sex trafficking and poverty, among other
factors, increase young women’s special vulnerability to infection.
Yet the same gender roles and relations that enhance women’s vulnerabilities to
HIV/AIDS also increase some of the risks for men. Dominant ideologies of masculinity and
‘manliness’ encourage men to demonstrate sexual prowess by having multiple partners, and by
consuming alcohol and other substances that may predispose towards sexual risk-taking and
violence. These same ideologies encourage men to see the direct provision of care as a woman’s
(rather than a man’s) responsibility.
The extended family, the backbone of society in developing countries is being decimated
by HIV/AIDS. As AIDS affects those age groups that are most economically active, families are
losing breadwinners. The burden of caring for the sick and dying drains the physical and
financial resources of families. Agricultural production is threatened and children are withdrawn
from school. Women and girls are particularly vulnerable within this context. Many families
face an uncertain and impoverished future that further increases their vulnerability to HIV/AIDS.
Within the developing world, poor diet, hard physical work, stress due to stigmatization,
exposure to immuno-suppressing pollutants and lack of proper health-care is causing the early
deaths of women and men. The early deaths of parents lead to economic insecurity and child
insecurity. Orphaned children are likely to be malnourished, poorly educated, emotionally
traumatized and alienated from society. As adults, they may have multiple partners and be unable
to adequately parent the next generation. This has serious implications for peace and security
both within and between states.
Poverty is not only a cause but also a consequence of HIV/AIDS. Increased poverty,
reduced productivity, the consequent decline in national food security, deteriorating living
conditions, increased illiteracy, depletion of the skilled work force and general social instability
and malaise all jeopardize national development and political stability. This, in turn, threatens the
well-being and security of the entire community of nations and the future of humankind.
A gendered understanding of HIV/AIDS highlights the multiple and inter-related levels of
inequality that shape vulnerability to infection and the personal, social and economic impact of
the epidemic. As a result, gender should be viewed as a cross-cutting issue that has implications
for all aspects of the epidemic. More significantly, the relationship of gender and HIV/AIDS
reveals that the transformation of gender relations is fundamental to our ability to effectively
address the epidemic.
8

---

2.
The importance of context
The epidemics of HIV and AIDS develop and grow within specific social contexts.
Historical factors as diverse as colonization, exploitation, contract and migrant labour systems,
and war and civil conflict have important consequences for how individuals lead their lives and
the risks they face. Processes of modernization and globalization impact upon individuals and
communities, both economically and socially, determining the circumstances in which people
live, as well as expectations about the future. Long held cultural expectations and beliefs, as well
as contemporary transformations within these, structure the vulnerability of individuals and
communities. None of the above are gender neutral processes in that they impact differentially
upon women and men, girls and boys.
Insofar as such factors have implications for freedom from want and fear, as well as
access to resources and opportunities, they have implications for human security. And insofar as
they deny opportunities for development to the point of maximum potential, they are likely to
have important human rights dimensions. It was against this background that the expert group
meeting considered the important issue of gender and HIV/AIDS, both with respect to human
rights and in relation to broader issues of development and human security.
B. Human security, human rights, gender and HIV/AIDS
1.
HIV/AIDS, gender and human rights
The patterning of HIV/AIDS reflects global inequalities, flourishing in conditions of
poverty and conflict. The increased vulnerability of women and girls in many parts of the world
points to the gender inequalities that fuel the epidemic. A gendered understanding of HIV/AIDS
suggests that it is women’s and girls’ relative lack of power over their bodies and their sexual
lives, supported and reinforced by their social and economic inequality, that make them
vulnerable in contracting and living with HIV/AIDS. Any effective response to the epidemic has
to address these interrelated levels of gender inequality, as well as the global inequalities that
frame them.
As stated earlier, an emphasis on human rights is central to effective work in dealing with
HIV/AIDS. A human rights approach emphasizes the claims or entitlements that all people have
to a full and satisfying life, in which each person is able to develop to his or her full human
potential. Human rights also impose obligations on states and non-state actors to ensure that
these claims are met, thus affirming democratic principles of accountability and participation.
Importantly, human rights set standards for human well being and development, and constitute
important resources for the achievement of this.
While there has been progress in relation to women’s human rights and to HIV/AIDS and
human rights, less attention has been paid to human rights as they relate to gender and
HIV/AIDS. As a result, HIV/AIDS has only been addressed in relation to health in relevant core
international documents on women’s human rights: the Convention on the Elimination of All
Forms of Violence Against Women, the Programme of Action of the International Conference on
Population and Development (ICPD), the Beijing Declaration and Platform for Action and the
United Nations Special Session of the General Assembly on ICPD+5 (1999) and Beijing+5
(2000). It has as yet been insufficiently mainstreamed as a cross-cutting concern. The primary
9

---

rights response to HIV/AIDS is set out in the “HIV/AIDS and Human Rights International
Guidelines”. These state that:
“In the context of HIV/AIDS, an environment in which human rights are respected
ensures that vulnerability to HIV/AIDS is reduced, those infected with and affected by
HIV/AIDS live a life of dignity without discrimination and the personal and societal
impact of HIV infection is alleviated.” 1
These Guidelines, which constitute a significant resource for a human rights approach to
HIV/AIDS, offer ‘an important means for supporting both human rights and public health,
emphasizing the synergy between these two areas’. They also include a section on the
vulnerability of women. They require extension and amplification, however, in order to address
the additional human rights concerns that emerge from a gender perspective. In particular, future
Guidelines need to address the global inequalities, including gender inequalities that fuel the
epidemic, as well as the obligations of both state and non-state actors to address these. Central to
this is the indivisibility and interdependence of political, civil, social, economic and cultural
rights.
More specifically, a gendered approach to HIV/AIDS and human rights should:
• Identify the human rights that specifically pertain to gender and HIV/AIDS;
• Recognize the interdependence and indivisibility of political, civil, social, economic and
cultural rights;
• Seek to ensure that all these rights are respected, protected and fulfilled at all levels in the
family, community, the workplace and the state as well as during armed conflict;
• Respect, protect and fulfill the rights of all states within the global community;
• Set out the obligations of all state and non-state actors, including international institutions,
multi-national corporations and the private sector;
• Ensure that cultural and religious practices promote the well-being and security of women
and men;
• Ensure that the experience of women and men infected and affected by HIV/AIDS is
reflected in the interpretation and application of human rights, in various international and
national documents;
• Set out a variety of legal and non-legal strategies for the achievement of rights;
• Set out an enabling framework that ensures that the rights of women and men are respected,
protected and promoted.
2.
HIV/AIDS, gender and human security
Human security presumes freedom from want and fear, as well as access to and control of
resources and opportunities. This includes:
• Survival (food, water, shelter, health);
• Safety (freedom from violence);
• Opportunity (education, employment, information);
• Dignity (tolerance, respect);

1 Office of the United Nations High Commissioner for Human Rights and Joint United Nations Programme
on HIV/AIDS, HIV and Human Rights, International Guidelines, New York and Geneva, 1998,
HR/PUB/98/1; Commission on Human Rights Resolution E/CN.4/RES/1997/33
10

---