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Women and Children First Women and Children First: ISBN: 1-905833-14-8 ISBN: 978-1-905833-14-6 Leadership and the HIV & AIDS The Foreign Policy Centre Suite 11, 2nd Floor 23-28 Penn Street Crisis in Africa London N1 5DL United Kingdom www.fpc.org.uk Supported by Women and Children First: Leadership and the HIV & AIDS Crisis in Africa A report by Josephine Osikena Acknowledgements About the partners This report and the associated series of roundtable discussions which it The Foreign Policy Centre (FPC) accompanies were produced by the Foreign Policy Centre with the support of The Foreign Policy Centre (FPC) is an independent, London-based foreign affairs Abbott. think tank. Established in 1998 by the then Foreign Secretary, the late Rt Hon The report builds on the discussions and insights shared during the round - Robin Cook MP, the FPC was developed to inject fresh thinking into foreign table series which was held in London during 2008. The author is very grateful policy debate and analysis, through cross-party engagement, in order to to all those who participated in the series, as well as to those who have promote a progressive and multilateralist approach to global affairs. The FPC provided ongoing support to the project, including: Niall Ahern, Rumbidzai has three Co-Presidents: Michael Gove MP (Shadow Secretary of State for Gotosa, Adam Hug, Owen Larter, Pavel Miller, Anna Owen, Armin Seif and Children, Schools and Families), Baroness Margaret Jay (Former Leader of the Stephen Twigg. House of Lords) and Rt Hon.Charles Kennedy MP (Former Leader of the Liberal Democrat Party). The Centre operates as a global network, with a diverse range About the Author of projects and programmes and aims to develop innovative policy ideas which popularise practical solutions to global challenges. This is carried out through This report was written by Josephine Osikena, Programme Director for the Centre’s research and publications, as well as a rich and diverse Democracy and International Development at the Foreign Policy Centre with programme of events. Further information can be found at: www.fpc.org.uk editorial support from Anna Owen, Events and Projects Director. Josephine's research is principally focused on the interface between the private sector, civil society, public policy reform and how all of these influence state transformation Abbott and HIV/AIDS in Africa. Abbott has been a leader in HIV/AIDS research since the early years of the Before joining the FPC, Josephine assumed various posts across central and epidemic. In 1985, the company developed the first licensed test to detect local government, including the Cabinet Office, the Department for Environ - HIV antibodies in the blood and remains a leader in HIV diagnostics. ment, Food and Rural Affairs (DEFRA) and the London Borough of Tower Abbott retroviral and hepatitis tests are used to screen more than half of the Hamlets. She has an MSc in Development Studies from the School of Oriental world's donated blood supply. Abbott has developed two protease and African Studies (SOAS) at the University of London and a BA (Hons) in inhibitors for the treatment of HIV. For more information on Abbott's Economics and French. HIV/AIDS programmes, please visit www.abbott.co.uk First published in 2009 by The Foreign Policy Centre Suite 11, 2nd Floor 23-28 Penn Street London N1 5DL United Kingdom www.fpc.org.uk © Foreign Policy Centre 2009 All rights reserved ISBN: 1-905833-14-8 ISBN: 978-1-905833-14-6 Disclaimer The views and opinions expressed in this report are not necessarily those of either the Foreign Policy Centre or Abbott. Designed by Soapbox www.soapboxcommunications.co.uk Photography by James McVeigh and Lawrence White Printed by Captiv8 UK Ltd 2 The Foreign Policy Centre Contents Foreword 5 Ivan Lewis MP, UK Parliamentary Under Secretary of State, Department for International Development (DfID) Project rationale 6 Recommendations 7 Overview – Global public health: A critical foreign policy challenge 9 Facing facts 9 The challenge of improving global public health 9 A critical moment for global public health 10 Section 1: The challenge of building sustainable healthcare systems 12 Summary: roundtable one 12 Recognising difference 12 Prioritising and improving data collection 13 Targeting the most at risk and most vulnerable 13 Promoting better reproductive and sexual health 14 Microbicides 15 Improving maternal and newborn health 16 Increasing the numbers of paediatric healthcare workers 16 Section summary 17 Section 2: Preventing mother-to-child transmission and improving child survival 18 Summary: roundtable two 18 Progress to date 18 …but still more to do 19 How to improve prevention rates for mother-to-child transmission (MTCT) 19 Early diagnosis 19 Accessible and affordable paediatric ARV formulations and dosage information 20 Expanding access to affordable drugs in low income countries 20 The provision of antibiotics such as cotrimoxazole and fighting co-infection 21 Safe and reliable infant feeding practices 22 Section summary 23 The Foreign Policy Centre 3 Section 3: Tackling stigma and discrimination 24 Summary: roundtable three 24 What is stigma and discrimination? 24 Developing a family-centred and community focused approach: The role of boys and men 24 The link between violence against women and HIV & AIDS 25 Men take a stand against violence 26 The need for policies that target violence against women 27 Opposing the criminalisation of HIV exposure and transmission 27 Serving and protecting versus discrimination and punishment 27 Increasing marginalisation, vulnerability and risk 28 Tackling inequality 29 Section summary 29 Conclusion – Global public health: The road ahead 30 Promoting public health in a global economic downturn 30 Glossary 32 Bibliography 33 Roundtable participants 35 4 The Foreign Policy Centre Foreword Global efforts have achieved considerable progress In Achieving Universal Access – the UK’s strategy in delivering HIV services to millions of people, for halting and reversing the spread of HIV in the especially in low- and middle-income countries. developing world, we identify the three main areas But there is still much to do. We know what works, which also form the basis of the report’s but the epidemic continues to expand and is taking recommendations: building sustainable healthcare a heavy toll on women and children, especially in systems; preventing mother-to-child transmission; and sub-Saharan Africa where women and young girls tacking HIV and AIDS related stigma and account for more than 60% of infections. discrimination. We know that the primary cause of paediatric HIV, We have learnt much about HIV transmission and mother-to-child transmission, occurs during how to prevent it, but we must continue to listen and pregnancy, labour, or breastfeeding and that about to learn from what others have to say in order to lead 90% of newly infected children worldwide are in sub- global efforts to curb its spread with evidence-based, Saharan Africa. Without early treatment, half will sound actions. die by their 2nd birthday. Effective programmes must At DFID we are acutely aware of the need for be community-focussed and family-centred, good leadership, coupled with better coordination addressing prevention, treatment and care needs of and a shared determination to take action to sustain mothers, fathers and children. and strengthen a broad response to AIDS, and to Engaging a broader audience and promoting ensure that tackling AIDS in Africa remains a high broad-based coalitions – from young people to political priority. I am delighted that this Foreign women’s organisations, business leaders, Policy Centre report helps take us in the right governments, religious organisations and people living direction. with HIV and AIDS – is crucial during this global economic downturn, especially when some have argued we should turn our backs on developing countries. We know that in a highly interdependent world, in turbulent times which severely threaten developing countries, this is not an option. The FPC roundtable series and this report, highlighting women and children and reinforcing the Ivan Lewis MP importance of promoting AIDS as a global public UK Parliamentary Under Secretary of State, health issue, are very timely. They provide useful Department for International Development (DfID) conclusions for addressing our future challenges. April 2009 The Foreign Policy Centre 5 Project rationale Throughout 2008, the Foreign Policy Centre, with fatal combination of biology, poverty and inequality. the support of Abbott, held a series of roundtable In 2007, the number of 15-24 year olds living with discussions. The FPC event series brought together HIV in sub-Saharan Africa had reached 3.4 million, small but focused groups of experts and specialists of which 2.55 million were young women of drawn from government, the media, academia, the childbearing age (Unite for Children Unite Against medical profession, local and international civil AIDS, 2008). society, public bodies and institutions, the private The issue of global health illustrates the sector and representatives from the diplomatic challenges of providing and delivering global community in London. Together, they explored the public goods in an increasingly interdependent challenges faced by women and children, who often world, where partnerships are no longer options but experience the effects of the HIV & AIDS epidemic imperatives. Public health issues now feature more severely than men, particularly in Africa south prominently
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