Walking the Talk - VSO

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However, as highlighted in Chapter 3, VCT, PITC(provider-initiated testing and counselling) and othercounselling services may not be accessible to womenand girls. These services are crucial gateways tosupport groups (including faith-based groups), whichprovide the mainstay of care and support for womenand girls. These groups provide them with anopportunity to share survival strategies, information andexperiences, and to access counselling and advice.They also often provide life-changing emotional supportnetworks for those who may have been abandoned orostracised by friends and relatives, as well as offering asource of collective strength for advocacy on humanrights and gender equality. 160 Some support groupsprovide other kinds of assistance such as incomegeneratingactivities, advice on nutrition, positive living,orphan care and succession planning. The extent of theimpact of this psychosocial support is illustrated by thecomments of one support group member interviewedby ICW:“The people whom I met at Mashambanzon gaveme the strength to go on. They were alwayscheerful and they were always laughing. Duringmy first few days I could not believe that theywere HIV-positive. How can one be so happywhen she knows she is going to die?” 161Research undertaken for this report in Namibia foundhundreds of support groups, mostly attended bywomen. A similar situation can be seen in Ethiopia,where 50 out of 70 members of one association werewomen. Focus group participants in Namibia andEthiopia felt this disparity existed because women aremore likely to identify a need for support while men“curtain themselves and hesitate to come forward, takemedicine secretly without any information and consentof their family members”. 162 In some circumstances,focus group participants in Namibia reported that malepartners opposed women attending support groups forfear it will reveal their own HIV status:“Men make jokes about the activities of supportgroups and therefore create a barrier for otherpeople to become a member of our group.” 163In Namibia, women attending these groups are typicallyolder widows who do not need permission from aspouse. Members agreed that girls and young womenwere often unable to attend because of dependence ontheir family, husband or boyfriend. Leonard Shikollolo,Director of an HIV and AIDS NGO in Namibia calledTKMOAMS, highlights that many women in thecommunity would like to start a support group, but donot have the information, skills or funds necessary toorganise or sustain counselling, income generation andinformation-sharing activities. 164Donors and governments must deliver more funding tosupport groups of women and girls. Capacity-buildingsupport must also be channelled to organisations ofwomen and girls living with HIV and AIDS to enable themto develop skills around management, leadership, groupdynamics, team building, community mobilisation,advocacy and self-empowerment. Support must also begiven to groups dominated by males to increase femalemembership and leadership within their organisations.Such support must be both sustainable and provided ona much larger scale by donors, both geographically andin terms of breadth of financial support.Access to medical care and supportThe majority of medical care and support for peopleliving with HIV and AIDS takes place in the home.However, research for this report suggests that womenand girls’ access to home-based medical care andsupport often relies on men’s approval. A communitycare provider highlighted to ICW the impact on womenand girls’ ability to seek care when sick:“… it is difficult to access a sick female client untilthe husband approves... some men even lock theirgates when they see us coming, in most instancesmen accept caregivers at their homes when theybecome sick or bedridden… as long as they arestill mobile, they do not accept us…” 165In Ethiopia, for example, our research found that, whenboth the wife and husband are living with HIV and AIDS,care preference will often be given to the male. 166Furthermore, women and girls may be encouraged toput the health of the family before their own healthbecause of their role as primary care providers. Thisoften means they seek healthcare at a later stage thanmen, frequently when their illness is already welladvanced. One research participant from Pakistan, forexample, reported her in-laws telling her, “You areresponsible for everything for your children becausetheir father remains ill. So forget about your disease forthe sake of your children.” 167Another barrier to accessing medical care revolvesaround culture and belief. A significant number ofwomen in the developing world go to traditional healersinstead of formal health systems. Approximately 70-80% of the population in sub-Saharan Africa initially seea traditional doctor when they become sick. 168 InVanuatu, for example, while some areas lack nurses,doctors, or other medical staff, almost every communityhas a kleva, or traditional healer. She or he is often the38 Walking the talk putting women's rights at the heart of the HIV and AIDS response
first point of contact for any illness, includingopportunistic infections and STIs. While traditionalhealers may offer crucial emotional and spiritualsupport, they do not always provide correct informationand advice on HIV and AIDS.Access to socio-economic care and supportSocio-economic care and support includes access toincome-generating activities, food security, creditschemes, skills and vocational training, access to loansand banks and social protection. Socio-economic careand support is essential to ensure women and girlscope with the impact of HIV and AIDS and are able torealise their “right to a standard of living adequate forthe[ir] health and wellbeing” [and that of their family]“including food, clothing, housing and medical care andnecessary social services”. 169Social protection interventions, for example, have beenshown to increase the quality of life and health ofwomen and girls. A recent DFID pilot project in Zambiafound that “social transfers can have an immediateimpact on hunger and poverty, and a wider impact onthe poor accessing health and education services”. 170Despite this, access to social protection and incomegeneratingactivities is at best patchy, at worst nonexistent.As a result, there is an overwhelming demandfor these services from civil society, support groups andwomen and girls living with – or vulnerable to – HIV andAIDS so that they can realise their right to a decentstandard of living. To protect the economic rights ofwomen and girls, governments, with donors’ support,should increase social protection mechanisms to supportwomen living with HIV and AIDS with the costs of (amongothers) their rent, children’s education, food and clothing.Even where social protection interventions do currentlyexist, poor local implementation or poor awarenessamongst potential beneficiaries undermines their value.Governments must therefore provide accessibleinformation on available assistance such as disabilitygrants, child support and pensions, and removecustomary or civil laws that prohibit women fromaccessing banks, loans, land or credit.Research for this report shows that support groupmembers wanted to become more independent andself-supporting by earning their own money to visitmedical facilities, and living healthy and productive lives.Yet many NGOs lack the expertise to accomplishincome-generating projects successfully. In Pakistan,support-group members called for income-generationactivities so that people living with HIV and AIDS couldlive independent lives. They added that socio-economiccare and support should include accommodation costs,utility bills, marriage expenses, education costs for theirchildren and unemployment allowance. In South Africa,respondents cited vegetable gardens, bread-makingand knitting as areas where they could undertakeincome-generation activities – respondents wanted towork and earn to support themselves and their familiesbut lacked the funding and skills training to do so onanything but a very small scale. 171Despite the inadequacy of support for incomegeneration and economic empowerment of women andgirls, success stories abound. For example, anintervention by the Provincial Directorate of Women andSocial Action in Maputo, Mozambique, provided womenliving with HIV and AIDS with mobile phones andtraining on money management. The women wereunemployed, unable to buy sufficient food or some ofthe medications necessary for treatment ofopportunistic infections. However, after chargingcommunity members to use the mobile phones, thewomen were able to earn enough money to eat threemeals a day and to buy medicines. One of the womenreported that her family treated her with more dignity.Because of the income she earned, she was seen assomebody with something to contribute to society. 172To enable women and girls to claim their rights to adecent standard of living, to work and earn a living,governments and donors should increase their supportfor, institutionalise and expand strategies designed toincrease poor women’s financial independence. Thiswould include microcredit schemes, financial support forcare providers and local employment andeducation/training opportunities. These strategies mustalso be designed to empower women and girls to makekey financial decisions (see Chapter 2). Finally,governments and donors must fund the capacitybuildingof grassroots women’s organisations, supportgroups and networks of women living with HIV andAIDS to develop income-generation initiatives.Women’s rights and legal supportEnsuring that legislation and policies respect women’srights is key, but is of little practical value if women andgirls are unable to assert their rights. Despite loftylegislation and ratification of international human rightsinstruments, a lack of legal proceedings for rightsviolations contravenes the rights of women and girls tolegal redress. These violations can also leave womenand girls living with HIV and AIDS deprived of property,trapped in abusive relationships, or isolated from theirchildren and families.Walking the talk putting women's rights at the heart of the HIV and AIDS response 39
Page 1 and 2: Walkingthe talkPutting women's righ
Page 3 and 4: ContentsContents 1Glossary 2Definit
Page 5 and 6: DefinitionsUniversal Universal acce
Page 7 and 8: Gideon Mendel/Corbis/ActionAidAdero
Page 9 and 10: Prevention, treatment and care and
Page 11 and 12: Gideon Mendel/Corbis/ActionAidStree
Page 13: Figure 1: Number of women and men l
Page 17 and 18: marriage, harassment or other socie
Page 19 and 20: childcare arrangements or to take t
Page 21 and 22: Multilateral organisations1) The Jo
Page 23 and 24: and testing. A few of the strategie
Page 25 and 26: Box 2. The Climbing to Manhood Proj
Page 27 and 28: some of the problems facing women a
Page 29 and 30: Box 3. The Gender Violence Recovery
Page 31 and 32: 3.5. Recommendations Donor governme
Page 33 and 34: non-discrimination. Failure to do s
Page 35 and 36: Box 4. The power of ART in Nigeria:
Page 37 and 38: 3) The Global Fund to Fight AIDS, T
Page 39: support. While their efforts suppor
Page 43 and 44: ‘care provider’, rather than th
Page 45 and 46: In some circumstances, the cost of
Page 47 and 48: The stipends can also be hard to ac
Page 49 and 50: ecause they do not have access to t
Page 51 and 52: HIV rally, Nairobi, Kenya.Jess Hurd
Page 53 and 54: 2) The Global Fund to Fight AIDS, T
Page 55 and 56: 39Women’s rights and universal ac
Page 57 and 58: 114www.who.int/hiv/topics/prophylax
Page 59 and 60: 191USAID/UNICEF/UNAIDS/World FoodPr

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