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| sub-Saharan Africa |
In sub-Saharan Africa 12-13 women are infected by HIV for every 10 men, and the average rate of infection for teenage girls in some countries is five times higher than that for teenage boys. Most of these infections occur through unprotected heterosexual interactions. Women are limited in their ability to control these interactions because of their low economic and social status and because of the power that men have over women's sexuality.
Most of the world's women are poor and most of the world's poor are women. Women make up almost two thirds of the world's illiterate people and are often denied property rights or access to credit. They earn 30-40% less than men for the same work, and most of those who are working are employed outside the formal sector in jobs characterised by income insecurity and poor working conditions. Women's economic vulnerability and dependence on men increases their vulnerability to HIV by constraining their ability to negotiate the use of a condom, discuss fidelity with their partners, or leave risky relationships.
An example of this is a study of women on low income in long term relationships in Mumbai, India. The women believed that the economic consequences of leaving a relationship that they perceived to be risky were far worse than the health risks of staying in the relationship. They reported having very little economic leverage to bring about changes in their husbands' behaviour.
In many countries the power imbalance in heterosexual interactions leads to a culture of silence that surrounds women's sexuality. This restricts women's access to information about their bodies and about sex, which in turn contributes to their inability to protect themselves from HIV infection. Rural women from South Africa and urban women from India reported not liking condoms because they feared that if the condom fell off inside the vagina it could get lost and perhaps travel to the throat or another part of the body. In Latin America adolescent boys are more likely than girls to know how to use a condom properly and to recognise the symptoms of sexually transmitted infections. In some cultures, such as in Brazil and Thailand, there is a powerful norm of virginity for unmarried women, which limits young girls' ability to ask for information about sex or condoms for fear that they will be thought to be sexually active. The norm of virginity also puts young girls at risk of rape and sexual coercion in countries with a high prevalence of HIV because they are presumed to be free of infection and because of the myth that sex with a virgin can cleanse a man of infection.
The most extreme manifestation of the unequal power balance between women and men is violence against women. In population-based studies worldwide, 10% to over 50% of women report physical assault by an intimate partner, and one third to one half of physically abused women also report sexual coercion. In studies in Papua New Guinea, Jamaica, and India women reported that bringing up the issue of condom use, with its inherent implication that one partner or the other has been unfaithful, can result in violence.
To protect women from HIV infection we must find ways to empower them. This means implementing policies and programmes that increase women's access to education and information and to productive resources, such as land, income, and credit. It also means providing women with HIV prevention technologies that they themselves can control. One way to do this would be to make the female condom more readily available. Another option is to invest in the development of microbicides, topical agents that women can apply intravaginally to protect themselves from HIV.
We must also increase social support for women by facilitating their opportunities to meet in groups and become organised, allowing them to draw strength from numbers and to derive practical solutions from each other. Simultaneously, we must promote sexual and family responsibility among young boys and men and enable them to examine the damaging effects of prevalent notions of masculinity and male power. Finally, we must recognise that violence against women is a gross violation of women's rights that has important implications for the health of women and communities.
If we are to contain the HIV epidemic we must tackle its root cause: gender inequality. It is this that is compromising the ability of women to protect themselves and promoting a cycle of illness and death that is threatening the future of households, communities, and entire nations.
Geeta Rao Gupta
President, International Center for Research on Women
Extract from YMCA World March 2003
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Seven global youth organisations have joined their effort, expertise and grassroots work to create the Empowering Africa's Young People Initiative. This unique initiative aims at decreasing the HIV infection rate among young people (10-25 years) over a period of 5 to 15 years in selected sub-Saharan countries.
More than 28.5 million people living with HIV in sub-Saharan Africa - 8.5 million of whom are young people aged 12-25 - are living with the virus, and 3 million children under 15 are now living with AIDS. Almost 11 million children are orphaned by AIDS and this is the highest figure anywhere in the world. Young girls are especially vulnerable in sub-Saharan Africa. More than two-thirds of newly infected 15-20 year olds in Africa are women.
The World Alliance of YMCAs forms part of this initiative, together with the World YWCA, the World Organisation of the Scout Movement, the World Association of Girl Guides and Girl Scouts, the International Federation of Red Cross and Red Crescent Societies, the International Award Association and the International Youth Foundation.
The Empowering Africa's Young People Initiative is an intergenerational, multi-sectoral programme that seeks to empower young people through holistic approaches for preventive care and support in combating HIV/AIDS. The seven organisations and their networks represent more than 100 million young people world-wide, of whom over 20 million are in Africa. This is an incredible asset in fighting the epidemic.
Each of the seven organisations is already involved in specific programmes to combat HIV, but a joint initiative would allow sustained access to young people, both women and men. The non-formal educational approach is designed to reach youth in a continent where one out of two young persons is out of school.
A co-ordinated initiative
By working together, the seven global youth organisations are developing a co-ordinated effort in addressing the pandemic and, in turn, this joint initiative will add a significant value to the ongoing programmes of the individual organisations.
This initiative will help each of the organisations to widen the scope of its work. Although 20 million is the direct target, indirectly 200 million will benefit from the programme by concerted efforts in remote areas, refugee camps and displaced communities.
It will also contribute to affirm African identity. The national and local associations involved in the programme are well rooted in their respective communities. The cultural dimension in combating HIV is a unique one and, in joining their effort at the grassroots level and using cultural assets to address the pandemic, more efficiency can be achieved.
Through their various programmes, all seven organisations emphasise the most vulnerable, oppressed and marginalised people. With this joint initiative, specific attention will be given to girls and young women, who are the most vulnerable: gender inequality in these societies makes girls vulnerable to unwanted sexual and risky relationships.
The holistic approach will include prevention, care and advocacy against stigma and discrimination, and for access to affordable medicine, for the rights of people living with HIV/AIDS and for more resources to combat the disease. As a united front, we will have increased capacity to lobby governments, NGOs, churches and the international community.
Finally, the joint initiative will develop amongst the constituency of the seven organisations, a complementarity of programming which will create more opportunities and abilities for reciprocal learning.
Participatory planning
To develop the proposal, a planning meeting was held in Nairobi, Kenya in August 2002, which brought together volunteer and professional representatives of the seven organisations from Ghana, Kenya, Tanzania, Uganda and Zambia. In total 56 leaders - including Regional Directors and Chief Executives - from 28 youth organisations took part in the event.
The main outcome of the meeting was a consolidated commitment of the African leadership to combat in a more co-ordinated manner the scourge of HIV/AIDS at local, national and regional level.
The participants designed a framework for the programme identification and implementation for the selected pilot countries as well as follow-up action plans. This initial planning meeting was followed up in December by a consultation of Regional Directors and the Chief Executives of the seven organisations. They reviewed and further developed the five-country plan, and designed strategies for raising funds to support the initiative. Every country will create a co-ordinating structure - Country Co-ordinating Committee (CCC) - and will launch its own programme when the necessary resources are available.
Operational framework
The Empowering Africa's Young People Initiative plans to use three main strategies to achieve results: focusing on non-formal education to impact young people, investing in capacity-building leadership training and skill development, and providing support for best practices.
Each of the country level programmes will be developed around the following action lines:
* emphasis on girls and young women
* peer education
* awareness-raising on the known causes of HIV and its impacts
* advocacy on stigmatisation, access to affordable drugs and rights of people living with AIDS
* volunteerism and economic opportunities
* care and support for People Living with Aids (PLWA) and orphans
So far, five CCCs have been formed in Ghana, Kenya, Tanzania, Uganda and Zambia. They have developed a country plan including mutually agreed upon goals and objectives, joint strategies and evaluation plans. The CCCs have also selected one of their members to serve as Secretariat. In Kenya the YWCA is playing this role, while in Tanzania, it's the Tanzania Scout Movement, in Zambia and Uganda the Red Cross, and in Ghana the YMCA.
A Regional Alliance, based in Nairobi, will be responsible for maintaining accountability for the funds, organisation plans and budgets.
Carlos Sanvee
Executive Secretary
World Alliance of YMCAs
Sub-Saharan Africa
Sub-Saharan Africa bears by far the greatest burden: 12% of all children in this region are orphans, almost double in comparison with 6.5% in Asia and 5% in Latin America and the Caribbean.
The total number of double orphans (i.e. where both parents have died) in sub-Saharan Africa increased from 2.8 million in 1990 to 5.5 million in 2001, with 3.6 million of them losing at least one parent to AIDS. This total is expected to jump to 7.9 million in 2010, with 6.5 million of them losing at least one of their parents to AIDS. By 2010, 5.8% of all children in the region will be orphaned by AIDS.
HIV prevalence in Uganda peaked in the late 1980s at around 14% and then began to decline dramatically to an estimated 5% in 2001. The number of orphans, however, continued to increase for 10 years after the country's epidemic had peaked, and is only now beginning to decline, from 14.6% in 2001 to a projected 9.6% in 2010. This is due to the 10-year lag between infection and death. South Africa, on the other hand, has seen a rapid increase in HIV prevalence over the past 10 years, from less than 1% in 1990 to 20% in 2001. The number of orphans in South Africa is expected to increase from 1.5 million (10%) in 2001 to 2.3 million (16%) in 2010.
Capacity Building for YMCAs
Many YMCAs in Africa are engaged in programmes to combat HIV/AIDS. We have excellent reports from Ghana, Nigeria, Senegal, South Africa and Togo in the area of Adolescent Reproductive Health (ARH). It may be noted that YMCAs could develop a uniform approach through peer education and community organisation in this area.
For the moment, only the Ghana YMCA is involved with the Initiative. The criteria used by the CEO group is questionable as it seems to be focused on countries where some big donors (like USAID) have some interest in selecting the pilot country.
To participate in such an initiative requires clarity of mission, institutional competence, and ability to implement the programmes. This is where we can raise the question of capacity, for it is not yet sure how the YMCAs involved in the initiative will perform. The scope of the HIV impact is so huge that substantial results can only be achieved through alliance-building.
Many other initiatives like this one may arise and YMCAs have to be prepared. Peer education for awareness-raising or preventive action are important, but not sufficient. There is a growing concern and need to advocate for People Living with AIDS, addressing the stigma, creating an environment of openness, advocating for human rights, and in particular addressing gender inequalities. The dimension of voluntary counselling and testing, and access to affordable drugs through a clear position against the World Trade Organisation policies on patents, monitoring and surveillance systems are to be further explored. The current initiative needs to be encouraged to focus on the above dimension.
As in many other areas, a distinct YMCA position or identity is required. YMCAs can add more value to the ongoing country plans, provided they have a framework and institutional guidance for such actions.
YMCAs have to go beyond ARH programmes and develop a holistic approach in combating the disease by integrating the social and economic dimensions, as well as strategies for reducing vulnerabilities. This implies an adaptation of our own institution and programme delivery capacity.
The Strategic Directions of the World Alliance and the consequent Global Operating Plan constitute a good vehicle to equip local and national YMCAs with the capacity to network with other organisations and to become involved in large-scale programmes which could affect positively the lives of millions of people.
Globalisation is creating more poverty and inequality. This poses a challenge to the YMCA and urges us to develop a new working paradigm. Working with vulnerable communities is more and more a question of life and death and we have to clearly equip ourselves so that "They all may have life in abundance" (John 10:10)
Extract from YMCA World - March 2003
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Stephen Lewis, the United Nations' Secretary General's Special Envoy on HIV\AIDS in Africa, is challenging the YMCA to "be outrageous and angry" in its response to fighting HIV/AIDS.
Stephen Lewis has focused much of his humanitarian effort on the African continent. As Canadian Ambassador to the United Nations from 1984-88, he chaired the Committee that drafted the 5-year UN Programme on African Economic Recovery. In September 1986, the Secretary General of the United Nations appointed Mr. Lewis as his Special Advisor on Africa to aid in "the mobilisation of the international community".
Most recently, Mr. Lewis was appointed as the Secretary General's Special Envoy on HIV/AIDS in Africa. His mandate includes ensuring follow-up to the April 2001 Africa Summit on HIV/AIDS and to the July 2001 United Nations Special Session on HIV/AIDS.
As a politician, diplomat and international envoy for humanitarian efforts, Stephen Lewis has dedicated himself to improving the human condition.
Stephen Lewis was a keynote speaker at the YMCA HIV/AIDS Global Capacity Building Forum in Durban, South Africa. He not only came with an up to date analysis of the situation, but also continued to be critical of the world's neglect of HIV/AIDS issues. Mr. Lewis has commented in the past that the lack of financial resources to combat HIV/AIDS was nothing less than "mass murder by complacency". Mr. Lewis commented that, "The truth is we have allowed the pandemic to go on, for people to die unnecessarily when they could have access to drugs. It is criminal negligence not to intervene early. It is criminal negligence of Western Governments because only resources are needed."
Stephen Lewis was most impressive in inspiring the YMCA world Movement in a call for action. Understanding the YMCA's scope worldwide, its focus on youth, its rootedness in the community and religious basis, he stressed that the YMCA was well placed to have significant impact on many fronts.
"The YMCA is a powerful mobilising force," said Mr. Lewis, and suggested two ways in which YMCAs should take action on HIV and AIDS: prevention and advocacy. He encouraged the YMCA to mobilise the power of its vast worldwide membership.
Mr. Lewis suggested many ways in which YMCAs could work. In prevention he told the YMCA to use explicit sexual messages with youth, regardless of age, and particularly with school dropouts, who have a higher rate of sexual activity.
One thing YMCAs could do internationally is to focus on gender equality. "It would be revolutionary," said Lewis. "Gender equality will break the HIV/AIDS cycle as it is one of the leading reasons for the spread of the disease."
The incidence of young women between the ages of 15-24 being infected in Africa is three to six times higher than that of men. He called on the YMCA to empower women and girls because this is the toughest and biggest challenge. "Gender inequality," commented Lewis, " is most difficult because men cannot relinquish power and authority."
The pandemic is driven by male sexual behaviour. In the meantime women are dying in disproportionate numbers and there is no time to wait. Mr. Lewis suggested that the YMCA should be a leader in gender equality and that this should be the central pillar of prevention.
He also discussed the importance of advocacy work, suggesting that the YMCA is uniquely positioned as a religious and grassroots organisation. The YMCA should be encouraging youth to become political and forceful on issues. Some of the areas suggested by Stephen Lewis for more YMCA involvement included the following.
 Youth need to encourage their political leadership to do more.
Religious leadership has come late into the arena, so the YMCA could help them to be more active.
The YMCA should embrace the move to have 3 million people in treatment by 2005.
Advocacy for orphans and vulnerable children is essential.
Mr. Lewis's call to action finished with this final appeal: "I encourage the YMCA to be outrageous, to be angry… I beg you to be principled and uncompromising. We have waited too long. Every day we lose several thousand who did not need to die. Millions have lost their lives to AIDS and it is just beginning."
Sherry Campbell, Manager
National and International Programmes
YMCA of Greater Toronto, Canada
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