African women are the hardest hit by HIV/Aids in Africa and yet the approach to fighting the epidemic advocated by the Bush administration fails to take account of their specific needs and circumstances. Yifat Susskind examines the "man-made" components of the crisis, including economic austerity measures, US pharmaceutical companies and onerous debt repayments.

Rebecca Lolosoli radiates a quiet authority beneath layers of elaborate beadwork that cover her forehead, neck, chest, and wrists. She smiles readily while addressing an audience of US college students, though to them, her topic is a metaphor for hopelessness. Rebecca is talking about AIDS in Africa, specifically among women in her Indigenous, Samburu village of Umoja, Kenya. "For years, people were dying and we did not know why," she recalls. "Now we know that AIDS can be avoided, but only by making great changes in our lives."

Thanks largely to the work of African public-health and social-justice advocates like Rebecca, growing numbers of people around the world know that sub-Saharan Africa is the epicenter of the AIDS pandemic: three-quarters of AIDS deaths worldwide have been in Africa, and today the continent is home to nearly two-thirds of all of those who are HIV-positive (more than 25 million people). Fewer people know that most Africans living with HIV/AIDS are women, and that young women are now being infected at a rate three to four times higher than young men. For many, this information is absorbed through a mesh of stereotypes that make human misery seem like a natural condition of life in Africa.

But while AIDS - like the litany of this year's natural disasters - may have originated in nature, the magnitude of its destruction is a man-made catastrophe. Consider the following:

- Since the 1980s when AIDS first emerged, the US has demanded "economic austerity measures" in impoverished countries. In Africa, these policies cut national health budgets in half just when public health systems needed to be ramped up to combat AIDS. Today, the pandemic is the single greatest obstacle to economic development in Africa.
- To bolster already-huge profits of US pharmaceutical companies, the Bush Administration has blocked the sale of affordable generic drugs that have saved millions of lives in rich countries.
- Women are made particularly vulnerable to HIV infection because they are denied the rights to refuse sex or insist on condom use. As the majority of those living in poverty and the poorest of the poor, women are more likely to contract HIV and more likely to develop symptoms of AIDS soon after they are infected.

AIDS, unjust economic policies, and women's inequality are mutually reinforcing crises; combating any one of these requires addressing them together. But too often, public health programs, government policies, and even activists compartmentalize issues, missing critical points of inter-connection that are keys to effecting change.

One reason for this myopia is that a singular focus on AIDS as a naturally occurring scourge allows policymakers to avoid tackling tough social issues like economic justice and gender equality. Take the relationship between AIDS and women's property rights in Kenya. Each year, hundreds of thousands of Kenyan women are widowed by AIDS. Because Kenyan laws and customs bar women from owning and inheriting property, women and their children are often forcibly displaced from their homes when their husbands die. Displacement increases women's risk of contracting HIV by exposing them to poverty, homelessness, violence, and disease, sometimes compelling them to trade sex for food and shelter. Protecting women's property rights is an urgent component of HIV/AIDS prevention strategies. But safeguarding these rights entails challenging law and tradition and spotlighting volatile issues related to land tenure and distribution of resources in an impoverished country.

In fact, any successful prevention strategy has to promote women's social and economic rights. Yet the dominant approach remains the Bush Administration's ill-conceived "ABC" strategy: "Abstain, Be faithful, use Condoms." Abstinence is not a choice for women who are raped or coerced into sex. Faithfulness is irrelevant for women whose husbands have multiple partners (for African women, marriage is actually a risk factor for contracting HIV). And condoms - presented by the Bush Administration as a "last resort" in the fight against AIDS -depend on men's willingness to use them and both partner's willingness to forgo having children. Moreover, by placing the burden for prevention on individual behavior, the ABC strategy allows policymakers to ignore the poverty and inequality that form the breeding ground for AIDS.

As 2005 ended it was clear that the UN's "3 by 5" initiative to provide anti-retroviral drugs to three million people by the end of the year would l fail by a two-thirds margin. In Africa, nine out of ten people with HIV/AIDS are still denied these drugs, now almost universally available in wealthy countries. The reason? Lack of political will and high drug prices. Universal access to treatment is an achievable goal, but it requires the US and EU to act.

Effective programs that combine HIV/AIDS treatment and prevention have been implemented in Uganda, Tanzania, Thailand and elsewhere. But rather than support the best of these efforts, the Bush Administration has put AIDS policy into the hands of Christian fundamentalists (who have pushed their ideological ABC approach to prevention) and drug-company lobbyists (who have prioritized industry profits over ensuring access to life-saving medicines). Today, the White House is issuing reminders of President Bush's "compassionate" $15 billion program to fight AIDS, particularly in Africa. But that promise was made over three years ago and most of the money has never materialized. In fact, Bush's initiative actually undermined effective international efforts to combat AIDS through the UN Global Fund to Fight AIDS, TB, and Malaria. Instead of paying its fair share to the Fund ($3.5 billion, or one-third of the total), the US has pledged just $0.6 billion for 2006-2007.

This year's debt forgiveness offer by the G8 (the world's richest countries) is yet another empty promise to African AIDS sufferers. It's widely assumed that money freed up by the deal will be used to fight AIDS, but no mechanism exists to make this happen. In fact, the deal still leaves most African countries spending four times more on debt servicing than on health and education - the most critical sectors in the fight against AIDS. Actually converting debt payments into AIDS funding would yield $15 billion a year - the precise amount that UNAIDS needs to fund its programs. We know that the World Bank and International Monetary Fund can afford to cancel 100 percent of poor countries' debt without much impact on their operations. But these institutions' largest shareholder, the US, is opposed to unconditional debt cancellation. It's not really about the money, which is negligible in relation to the US economy. Rather, the US leverages the debt to ensure African governments' compliance with policies that suit US interests.

Towards the end of 2005, the United Nations released its annual report on the global AIDS crisis. It was mostly bad news, but it did credit aggressive prevention and treatment programs with reducing the adult HIV infection rate in Kenya from 10 to seven percent between the late 1990s and 2003; and with lowering infection rates for pregnant women in Kenya from a staggering 28 percent to nine percent during the same period.

Rebecca Lolosoli knows first-hand the importance of combining treatment and prevention in the fight against AIDS. Two years ago, Rebecca began working with MADRE, an international women's human rights organization, to bring HIV/AIDS prevention educators to her community. "In our trainings with MADRE, we've learned that we have a right to demand medicine for the women in our community. But our best hope is to avoid HIV in the first place. For that, we women must have the right to say no without being forced or beaten. And women need to be able to own and inherit land so that we can feed ourselves and our children. This is how we can stay healthy. Changing traditional ways is not easy," Rebecca says with a broad smile. "But it has many rewards."

* Yifat Susskind is Associate Director, MADRE. This MADRE article was published by Foreign Policy in Focus

* Please send comments to [email protected]

Sources

1 "The AIDS Epidemic Update," Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO), December 2005, http://www.unaids.org/Epi2005/doc/report_pdf.html.

2Ibid

3 Ann-Louise Colgan, "Hazardous to Health: The World Bank and IMF in Africa," Africa Action, April 2002, http://www.africaaction.org/action/sap0204.htm

4 "State of World Population 2005," United Nations Population Fund (UNFPA), http://www.unfpa.org/swp/2005/english/ch4/chap4_page1.htm.

5 "Access to HIV treatment continues to accelerate in developing countries, but bottlenecks persist, says WHO/UNAIDS report," WHO/UNAIDS, 29 June 2005, http://www.who.int/3by5/progressreportJune2005/en/.

6 Craig Timberg, "Number of People With HIV Doubled in Past Decade, UN Finds," The Washington Post, 22 November 2005.

7 See: "Uganda: 'Abstinence-Only' Programs Hijack AIDS Success Story; U.S.-Sponsored HIV Strategy Threatens Youth," Human Rights Watch, 30 March 2005 http://hrw.org/english/docs/2005/03/30/uganda10380_txt.htm.

8 Raymond W. Copson, "HIV/AIDS International Programs: Appropriations FY2003-FY2005," CRS Report for Congress, RS21181, 13 August 2004, http://usinfo.state.gov/gi/img/assets/5096/crsrs21181fy05.pdf.

9 "US Misses its Own Target to Finance the Global Fund," Oxfam, September 2005, http://www.oxfam.org.uk/press/releases/globalfund_us060905.htm.

10 Charles Mutasa, "Information Sheet on Africa's Debt," African Forum and Network on Debt and Development, 2003.

11 Thomas Maugh II, "HIV Rate Grows in Most of the World," Los Angeles Times, 22 November 2005.

12 Sony Kapoor, "Can the World Bank and IMF Cancel 100% of Poor Country Debts?" Jubilee Research at the New Economics Foundation for Debt and Development Coalition Ireland, September 2003, http://www.debtireland.org/ resources/Can-the-World-Bank-and-IMF-Cancel-debt-P.htm.

13 "The AIDS Epidemic Update," UNAIDS/WHO, December 2005.

Yifat Susskind explains why, if the MDGs are to be a tool for advancing women’s human rights, they will have to adopt a rights-based approach that goes beyond improving statistical indicators to addressing the root causes of human rights violations.

In 2000, world leaders representing all 191 countries that belong to the United Nations pledged to achieve the eight Millennium Development Goals (MDGs) by 2015. Since then, the goals have become the main framework for development policy worldwide. They have even been adopted by many of the international agencies and banks that control the budgets of most poor countries, giving the MDGs real currency in the political economy of UN declarations. The MDGs create opportunities for advancing women's human rights, but only if we are able to participate effectively in the process of realizing the goals.

Governments' commitments to the MDGs appear to be an extraordinary step forward, but when we scratch the surface of the goals, we find that their progress is measured by a set of technocratic "targets" and "indicators" that are limited in scope, contradictory in approach, and more concerned with statistical change than with creating the structural change that is crucial to improving the lives of women and their families worldwide.

Take Goal 3, for example (promoting gender equality and empowering women): its "target" is to eliminate gender disparity in education. Yet it will take much more than girls' education to combat the deeply entrenched violence, discrimination, stereotypes, laws, and customs that generate grave violations of women's human rights in every country of the world. The indicators intended to measure progress towards this goal are equally problematic.They include:
They include:
1. the ratio of girls to boys at all levels of schooling (with no regard for the quality or content of education and without addressing the social forces that keep girls out of school);
2. the proportion of seats held by women in national parliament (without regard for the more crucial question of whether these women respect human rights);
3. the share of women in non-agricultural sectors of the workforce (without recognition of the need for decent wages, working conditions, and public services such as day care, health care, clean water, and transportation that ease the time burden of women who are expected to work outside the home and fulfill their responsibilities within the family).

As we can see, the MDGs call for change, but not for creating the conditions to make real change possible. To address the root causes of the problems that the goals are supposed to rectify, we need to grapple with precisely those phenomena that the MDGs take for granted. These include policies that have increased poverty and inequality around the world (such as free-trade agreements, wage freezes, and hostility to worker organizing) and subordinated human rights to "national security" as defined by the Bush Administration. In fact, at a moment when the rights of both women and men have been badly eroded by such policies, we can see clearly the limitations of pursuing gender "equality." To whom should women be equal? Should women in Colombia demand "equality" with male co-workers who are being killed for union organizing? Should Rwandan women who are HIV-positive seek "equality" with Rwandan men who are denied high-priced AIDS medications? The real goal is not equality, but justice; and one of the best ways we have of ensuring justice is the fulfillment of human rights.

But the MDGs fail to even mention sexual and reproductive rights, women's labor and property rights, or one of the most fundamental obstacles to ensuring these rights, namely, violence against women. The glaring absence of these issues from the MDGs reflects the powerful role played by right-wing and fundamentalist governments such as the United States in their negotiation.

Reproductive rights, in particular, have been under fire by the US since 2000, when Bush took office and began defunding international family planning programs and revamping US reproductive health policy to placate his religious fundamentalist base. Women's human rights advocates have pointed out that sexual and reproductive rights are central to achieving at least four of the MDGs: women's equality and empowerment (Goal 3); reducing child mortality (Goal 4); improving maternal health (Goal 5); and combating HIV/AIDS (Goal 6). Moreover, since human rights are indivisible, empowering women is crucial to realizing all of the goals. Conversely, none of the goals can be realized without ensuring that goal.

One way to gain insight into any policy is to look at its authors. The MDGs are sponsored jointly by the United Nations, the World Bank, and the International Monetary Fund (IMF). While the United Nations operates within a human rights framework, the missions of the World Bank and IMF are to advance a set of economic policies that are often at odds with human rights. In fact, the MDGs infuse neoliberal priorities into development policy using the language of human rights. They seek to "eradicate extreme poverty and hunger" (Goal 1), but rely on the discredited notion that economic growth at the national level (GNP) can eliminate poverty; and they assume that privatization of services is a strategy for rather than an obstacle to-economic development. At the heart of the MDGs beats a fundamental contradiction: poor countries are expected to meet the MDGs by implementing the very neoliberal economic policies that have, in large measure, caused the crises that the goals are intended to address. These policies include cutting government spending, privatizing basic services, liberalizing trade, and producing goods primarily for export.

As we have seen, the methodology and assumptions of neoliberal economics inform the MDGs, which rely heavily on the indicator of "absolute poverty" (which measures the proportion of the population surviving on less than a certain amount of income each day). The MDGs use the World Bank standard of an income of US $1 per day to indicate extreme poverty.

This income-based measurement of poverty obscures the experience of millions of people, for whom poverty is not primarily a function of income, but of their alienation from sustainable patterns of consumption and production. Indigenous women, for example, assert that their poverty and wealth are determined primarily by access to, and control of, their natural resources and traditional knowledge, which are the sources of indigenous culture and livelihoods. In indigenous communities, human rights (namely, governments' recognition of collective indigenous rights over land, natural resources, and traditional knowledge) are key to fighting poverty.

But the MDGs do not recognize that poverty is a function of human rights violations (such as the right to an adequate standard of living, the right to freedom from discrimination, and the right to development). Indeed, the MDGs posit housing, health care, and access to food and water not as non-negotiable and universal rights, but as "needs" to be met. By extension, the poor are not seen as autonomous subjects demanding that governments meet their legal obligations, but as a passive "target group" of policymaking. Sustainable development - which depends on broad civic participation, social justice, and a fundamental shift in the balance of power - is sidelined by this failure of the MDGs to operate within a human rights framework.

In fact, human rights standards are a useful yardstick for evaluating the MDGs. They reveal that the MDGs are not a spontaneous expression of governmental goodwill. Rather, the MDGs constitute pre-existing international obligations, some dating back more than 50 years.

Ultimately, for the goals to be a tool for advancing women's human rights, they must be treated not as a technical process, but as a political process. MADRE is working with our sister organizations and other women's organizations internationally to push for a rights-based approach to the MDGs that goes beyond improving statistical indicators to addressing root causes of human rights violations.

* Yifat Susskind is associate director of Madre. This article first appeared on Madre’s website at www.madre.org/articles/int/mdgcritique.html

* Please send comments to [email protected]