In 2009 and 2010 I had the wonderful opportunity and great honour to co-chair the Leadership and Accountability Programme Committee, one out of three programme planning structures for the 18th International Aids Conference which took place in Vienna last July. In our committee we had an outstanding idea: we wanted to offer a session at the conference without any announced panellists, with some free seats at the stage, reserved for MPs who would attend the conference and would dare to disclose their HIV status publicly.
We intended to provide this session to give space for those who wanted to set an example, who wanted to stop the stigmatisation, who wanted to show that everybody can be afflicted by HIV/Aids, regardless of status, high profile, and sexual orientation. We were very excited about our great plan, discussing details of the moderation and the different questions we would raise.
The more we began to think about which MPs would dare to – so spontaneously taking the floor – the more we became doubtful and the more we lost the courage. Instead we were afraid to waist our valuable session slot and the frightening prospect of sitting with some hundred participants in a huge room – with an empty stage ahead – overcame us.
Why should MPs eventually risk their careers? Why should they be braver human beings and take all these hurdles, obstacles every single woman and man living with HIV have to face day by day? At the end we rejected our oh so brave idea and substituted it with an ordinary panel discussion of MPs who already successfully tackled HIV/Aids at their national parliaments.
Why did I tell you this story about the failure of our idea? I think it is a good example for the fact, that in parliaments just as within our societies, it is still almost impossible to live openly with this disease. A disease which meanwhile is most common among married women and no longer limited to the so called “edge of the society”. But those wrong assumptions, pictures we keep in our heads are excactly what makes it so difficult – to discuss about HIV/Aids frankly – without prejudices and take solid solutions.
It is up to us MPs to change the environment for people living with HIV/Aids within our own parliaments as a first step and after that within our societies as a whole. And I know that in doing so, we are facing many obstacles. Ten years ago, governments endorsed the UN Declaration of Commitment on HIV/AIDS, pledging to support a united response to the epidemic. But in the interim, the world has been hit by a range of crises – global financial collapse, environmental degradation, global warming, energy crisis, political instability, humanitarian crises, worsening poverty, food insecurity and many more.
With such a daunting scenario, we as MPs have been compelled to enter a new era in our response to HIV – shared responsibility, greater partnership, and mutual accountability. The days of isolationism are over. We are committed to better coordinating our action to jointly attain all the MDGs, especially those which are lagging globally. One of our accomplishments is the united front taking shape between the sexual and reproductive health, and HIV communities, to finally bridge the artificial divide between MDGs 3, 4, 5, and 6.
Despite the progress in many parts of the world, HIV is still the leading cause of death in several countries and has stalled hard-won gains in development. But, as we all know, HIV is not only about health, but about human rights, gender equality, cultural and religious background, and social and economic disparities – features that HIV shares with sexual and reproductive health. And if we scrutinize the collage of news headlines today, we find stories on HIV highlighting those very issues that ignite the passions of MPs worldwide – injustices begging for legal and policy reform.
At the moment most of all countries in the world suffer from low budgets. To decide about budgets and control their effects are two of the core challenges of MPs. In my career as a politician I learned that it is much easier to raise awareness for a topic and convince colleagues to get involved, if you are precise and concrete. And if you can introduce a well defined path which clearly leads to more success in our fight. Such a concrete plan is the linkage of HIV and sexual and reproductive health and rights. It is among the most recently accepted promising strategies but still not realized everywhere.
Linking policies, programmes and services on HIV/Aids and SRHR is a clear win-win solution - especially for MDGs 3, 4, 5, and 6, in concert with the other four MDGs. The reason why HIV and sexual and reproductive health intertwine so much is clear: the vast majority of HIV infections occur through sexual contact; the risk of HIV transmission is significantly greater in the presence of certain sexually transmitted infections; infants can become HIV positive during pregnancy, delivery, and breastfeeding; and social drivers like gender inequality and marginalization affect both HIV and sexual and reproductive health.
The potential benefits of linked services are also well established. They include better uptake of services, improved access of people living with HIV and key populations to services, reduction in HIV-related stigma and discrimination, provide greater support for dual protection through the use of male and female condoms, improved quality of care, gives better understanding and protection of individuals’ rights, enhance programme quality and effectiveness, and use money in a more efficient way by establishing synergies. Linkages are bi-directional and experience has been gained both in integrating sexual and reproductive health into HIV programmes, and the reverse.
But although integrating health services is essential, linkages require far more than that. Equally important are the system concerns such as coordination mechanisms, capacity building, partnerships, and commodities security. And perhaps most pertinent, to why we are assembled here today, are the policy and legal issues that can either hinder or support this joint work.
Linking SRH and HIV requires addressing human rights and development concerns such as age of consent for services, gender-based violence, child marriage, sexuality education, and the meaningful participation of key populations. Effective ways to tackle these issues require a multi-sectoral response, including policy and legal reform.
Role of Parliamentarians
So thus far, we have put our fingers on the pulse of the 30 years of HIV epidemic and we have argued the merits of uniting the sexual and reproductive health and HIV responses. But if we leave this session without a clear idea of how we, as MPs, can contribute to this united front of action, then this session will have failed. I can assure you that each one of you has a significant role to play.
An estimated 106 countries have laws and policies in place that impede an effective response to HIV, and there are untold numbers of countries with laws addressing sexual and reproductive health. In the scant time remaining, I will touch on several key entry points for legal and policy action that will further the joint concerns of HIV and sexual and reproductive health.
Let me target three different groups in the fight against HIV/Aids:
1. People living with HIV and key populations
As of 2008, one third of countries had still not enacted laws protecting people living with HIV from discrimination. Nor do most countries have anti-discrimination laws to protect the human rights of sex workers, men who have sex with men, transgender persons, prisoners, and people who inject drugs; but rather, criminalize their practices, driving people and behaviors underground and inaccessible for prevention education. Over 30 countries have HIV-specific laws that inappropriately criminalize HIV transmission or exposure. This approach is known to be counterproductive, driving key populations underground, and discouraging people from knowing their HIV status and from disclosing.
We as MPs could be at the vanguard of enacting laws that both respect human rights and support evidence-informed public health policy, addressing legislative reform in these and so many other areas.
You would not stand alone: UNDP and UNAIDS last year launched a Global Commission on HIV and the Law to increase understanding of “how laws and law enforcement can support, rather than block, effective HIV responses.”
Similarly, you could also staunchly advocate for the meaningful involvement and leadership of key populations and of people living with HIV.
Addressing the policy and legal issues related to linking sexual and reproductive health with HIV has the potential to make wide-sweeping changes in the lives of women and girls. Almost a third of countries have still not yet enacted laws or policies to prevent violence against women, especially sexual violence.
Essentially any law or policy should warrant reforms that further gender equality or empower women – both are non-negotiable conditions for addressing their vulnerability and mitigating impact. Such laws include those pertaining to gender-based violence, property and inheritance, credit and economic opportunities, education and information, marriage, sexual relations and child bearing decisions, care-giving, investment for women, and so many other human rights issues.
3. Young people and their access to information and services
We know the toll that HIV and ill sexual and reproductive health is taking on young people. Too many lives are endangered behind the culture of silence that prevents young people from exercising their rights to lifesaving information and services. New laws and policies need to break down the legal barriers to accessing rights-based, evidence-informed, age-appropriate sexuality education. Laws governing age of consent to HIV counselling and testing, and to youth-friendly sexual and reproductive health services also have to be reviewed and revised to enable more young people to make responsible decisions and to have the means to prevent HIV and unintended pregnancies, avoid coercion, and gain access to the related services and commodities to stay healthy and safe.
We have evidence to show that when these services are available, success follows. Young people have shown that they can be change agents in the prevention revolution.
Young people and others are also mobilizing to end child marriage, which unnecessarily robs young girls of their health, youth, educational attainment, and social opportunities, and exposes them to HIV infection. This is another key area for which parliamentarians can have a major influence. It is unacceptable that this practice still exists in the 21st century.
And finally, we MPs need to support the right to health, treatment, and non-discrimination. I want to encourage all parliamentarians to adopt legislation that supports universal access to HIV prevention, treatment, care, and support, especially of key populations. And since operationalising integration starts with planning: Joint planning and coordination mechanisms are essential to ensure that national AIDS plans and reproductive health plans are synergistic, coherent and linked to wider health plans.
If we have a precise image of concrete goals in our minds how to link services on HIV and SRHR and if we can build up to a strong political will, we will do much easier to take all the hurdles we face when dealing with the answers to the pandemic. Millions of people are counting on you to deliver your potential and to make the difference.
Thank you for your commitment.