International Congress on AIDS in Asia and the Pacific

By: Shannon Hayes
October, 02, 2009

"Huairou Commission members, working with grassroots women, were able to bring forward the realities facing grassroots communities."

From 9-13 August 2009, 4 representatives of the Huairou Commission participated in the 9th ICAAP, held in Bali, Indonesia, representing grassroots communities who are in many ways hardest hit and most vulnerable to HIV.

The theme of this Congress was "Empowering Communities, Strengthening Networks." In Asia, the focus remains strongly on the most at-risk populations, particularly men who have sex with men, sex workers, injecting drug users. Other major themes addressed at the Congress are condom use, sex education, trafficking, laws that discriminate against people living with HIV/AIDS, evolving ART. Many people from government, NGO, bilateral and multilateral communities were also discussing the high risk of women who are married, particularly those married to migrant laborers, and where education and awareness of HIV and access to reproductive health services is low. However, there was little proactive vision of how to reach those at-risk communities. Food security was another theme that resonated with our grassroots representatives.

Huairou Commission members, working with grassroots women, were able to bring forward the realities facing grassroots communities.

	"We believe that grassroots organizations are absolutely key to implementing prevention, support and in many cases treatment of malaria, tuberculosis and delivering ARV. In every talk I give on health systems...I always say that community strengthening should be part of funding and building a health system in a country."
	Michel Katzatchkine, director of the Global Fund on AIDS, Tuberculosis and Malaria

On August 10, the World YWCA and the Huairou Commission co-organized a session that showcased the realities grassroots women are facing and the strategies and contributions grassroots women are making to fighting AIDS in their communities.

Naseem Shaikh from Swayam Shikshan Prayog then shared the experience from rural India. SSP, a member of GROOTS International and the Huairou Commission, began organizing in Maharashtra after the devastating earthquake of 1993. They supported womeni n the community to organize themselves for safe water, health and sanitation, livelihoods for sustainability, and around women's needs. Their network now numbers 75,000 women. Leaders in the network began to identify HIV/AIDS as an emerging problem in the community, and committed themselves to address the issue after attending a Grassroots Women's International Academy in Nairobi in 2007. Naseem admitted that because they do not understand HIV/AIDS, many women in their communities they work in discriminate against women living with HIV, sometimes even putting their own relatives out of their homes. From the basis of their large grassroots women's network, SSP is attempting to remedy this situation through peer education.

Peer educators in SSP are linking HIV positive women in the community to government health services such as CD4 testing and antiretroviral therapy. The self-help groups have established an emergency fund to pay for transport to the hospital for those who cannot afford it, and for emergency medicines. They are also ensuring all pregnant women in their region are tested for HIV, and linking those who test positive to hospitals to ensure prevention of parent to child transmission. Because they are organized in the community already, these women are able to reach many more people than a government program or outside NGO would be able to.

	"The funding is only working efficiently if grassroots and community-based organizations are getting the funding."
	Cristoph Benn, Global Fund for AIDS, Tuberculosis and Malaria

Naseem ended by calling on government, donors and those providing technical assistance to recognize the great contributions of grassroots women and involve them in decision-making and implementation of programs in recognition of their work and capacities. We heard next from Matilda Parau, HIV/AIDS coordinator for the YWCA of Papua New Guinea. Using radio programs and peer education, and working with community leaders including ministers, the YWCA of PNG is attempting to change the patriarchal society from the bottom up, and to empower women with information to claim their rights, particularly around sexual and reproductive health and violence against women. Women in their network are starting to see the importance of self-worth, of valuing themselves and acting from that starting point.

	"We call on donors, government, big INGOs to partner with local women's groups in a way that respects women's leadership and women's efforts, so we don't continue to have women's groups as implementers, but also as decision-makers."
	Nyaradzai Gumbonzvanda

Matilda shared that young women in their communities who have been empowered with this information are taking it upon themselves to reach out to other young women in the community, to become agents of change, and are not asking for any money or waiting for donor support. She asked partners to recognize the leadership young women are taking in addressing this issues, and encouraged all of us to work to make change in our own communities, motivated by our vision of what we want to see, rather than because we are being paid.

UPWD has a large focus on fighting evictions, and Sina clearly laid out the linkages between poverty, lack of secure tenure and HIV. When HIV+ women are widowed, they become responsible for the entire household, and often end up selling property to support their families when their income is insufficient. Without their own homes, these women have to pay high rents for very meager homes, they often cannot afford transport to go to the hospital to attain ARVs (which are free in Cambodia), and their treatment is further jeopardized when they cannot access food. When people living with HIV are evicted, and relocated to very poor settlements far from their existing social networks, far from hospitals or sources of employment, the situation becomes even more dire. Sina asked the global community to recognize the importance of food security and land for people living with HIV, and to build the capacity of people living with HIV in poor communities to organize and engage with policy-making processes.

Comparing these lived experiences with the plenary and other major presentations at ICAAP, it was clear that the issues grassroots women are coping with are not largely being addressed in major AIDS responses. During the plenary on the 2nd day of the Congress, Geeta Rao Gupta, of the International Center for Research on Women, spoke about the importance of addressing gender in AIDS responses. She praised the unprecedented attention to gender in the global AIDS response, and said that "no other field in development as advanced gender analysis and action in the way the AIDS response has." However she called to our attention the fact that enormous challenges still need to be faced in regard to gender-related vulnerabilities. As grassroots women working at the community level know and as Sina and Naseem made clear, these vulnerabilities include women’s lack of secure livelihoods, secure land tenure, food security, and meaningful recognition of their capacities and contributions.

The link between women's land and housing rights and HIV/AIDS were explored in-depth in a satellite session on August 12th, co-organized by UNDP, Huairou Commission, GROOTS Kenya, UNIFEM, and the Fordham Law Leitner Center for International Law and Justice. Session Chair Mandeep Dhaliwal, TITLE, opened the session by laying out some of the key interlinkages between land and AIDS for women. Citing the Commission on Legal Empowerment Report, she noted that land ownership reduces the spread of HIV and women's vulnerability to violence. Owning a piece of land and a home enables caregivers to better manage and cope with the effects of HIV. Lack of land for those living with HIV inhibits their ability to access treatment and care, and cuts them off from social networks that are vital for their health and well-being. Dr. Dhaliwal went on to cite a sobering statistic released the day before that 1.5 million women in Asia are living with HIV, and 50 million are defined at-risk, thereby underlining the urgency of action to reduce women's vulnerability to HIV.

	"If you don't have personal property, you cannot exercise your rights."
	Anand Grover, UN Special Rapporteur on Health

Presentations by Anand Grover, UN Special Rapporteur on Health and Rup Narayan Shrestha from the Forum for Women, Law and Development in Nepal laid out the context of women’s property and inheritance rights and the intersection with HIV in Asia. UNDP-sponsored research by Mr. Grover and Mr. Shrestha's work in Nepal make clear that, even where constitutional law and legislation protect women's property and inheritance rights and equality, customary laws, court decisions, and practical barriers to accessing justice such as lack of awareness, possession of documents, court fees, lack of implementation of court orders stand in the way of women claiming those rights. The case is even more challenging for women living with HIV, as they face further discrimination including abandonment by husbands upon diagnosis or women being denied their custodial rights over children when they test positive. Furthermore, lack of secure tenure makes women more vulnerable to HIV as they are often forced to migrate to urban areas to earn an income, cutting their social networks and making it more likely that they will engage in sex work.

Esther Mwaura-Muiru, coordinator of GROOTS Kenya and a member of GROOTS International and the Huairou Commission, presented a methodology for effectively addressing many of the challenges raised by Anand and Rup. Women in Kenya face many of the same challenges as those outlined in the Asian presentations. Constitutional legislation and governmental policies ensure women's rights to property and inheritance, but particularly in rural communities, customary law prevails and women and orphans were being disinherited upon the death of their husbands and fathers by opportunistic family members with no consequences.

Grassroots home-based caregivers in the GROOTS Kenya network noticed this problem very early on in the pandemic, and asked GROOTS Kenya to facilitate a process whereby they could get statistics on the extent of the problem. The mapping process (organized under the Women’s Land Link Africa initiative) revealed that disinheritance was shockingly widespread, and while legal aid organizations, NGOs and international institutions talked about trying to do something about it, these grassroots women decided they could not just sit by, so they began to organize Watch Dog Groups - community-level partnerships between home-based caregivers, local government administrators, and other stakeholders that effectively safeguard women's inheritance rights by raising an alarm at the village level when a woman or orphan is or is about to be disinherited, and mobilizing local authorities to stop the disinheritance. Watch Dog Groups have been recognized as transforming local accountability and governance institutions in Kenya and as significantly reducing corruption among Chiefs. In the past year Watch Dog Groups have been recognized by the government for their important role in implementing the law at the grassroots level. Remaining challenges include the lack of recognition for these types of community-driven interventions globally and there are few resources available for scaling up. Legal services still do not see the capacity of women to serve as experts in their communities. Rather, they are seen as targets for services and programs.

The session ended with Dr. Dhaliwal reviewing the range of interventions possible shown in the presentations including law reforms, legal analysis, procedures and how women access justice, and community redress mechanisms, and pledged UNDP and UNIFEM to move forward a process by which Asia could learn from the Kenya experience.

The Huairou Commission AIDS Campaign will build upon the connections made and the thinking stimulated during ICAAP by pushing for a major accountability initiative, showcasing how grassroots communities themselves can serve as monitors and evaluators of national and global AIDS responses. This initiative is particularly timely considering a renewed commitment to address vulnerability to AIDS considering the financial crisis, and a set of recommendations from the Global Fund secretariat to its board, pushing for more inclusive national-level processes and greater communications between Country Coordinating Mechanisms and communities.

	"Some people say that AIDS is getting too much money. But we're talking about things that we never talked about 25 years ago thanks to AIDS - including women's empowerment"
	Shiba Phusailatpam, Asia-Pacific Network of People Living with HIV/AIDS (APN+)