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Date : 08/09/2004
Source: Ministry of Health
Title: N Madlala-Routledge: National Conference of Intersect Coalition


KEYNOTE ADDRESS BY THE HONOURABLE DEPUTY MINISTER OF HEALTH OF SOUTH AFRICA, MRS NOZIZWE MADLALA-ROUTLEDGE AT THE NATIONAL CONFERENCE OF THE INTERSECT COALITION, Durban, South Africa, 8 September 2004

Programme Director
Intersect-Worldwide Founder - Sally Fisher
Distinguished Guests
Ladies and Gentlemen

Action against HIV and AIDS that does not confront gender inequality is doomed to failure.

I am glad to participate in this conference looking at the intersection of the twin epidemics of gender based violence and HIV and AIDS. As policy makers and activists for gender justice, we must be vigilant to the reality of these intersections and sharpen the focus of our interventions so that they are responsive and sensitive. The convergence of violence against women and girls and HIV and AIDS requires vigilance so that our responses are integrated, sustained, focussed and comprehensive.

In presenting this keynote address, I wish to extend a special word of thanks to Sally Fisher and Intersect-Worldwide, for the vision to bringing Intersect to South Africa and thereby providing South Africans with the opportunity to build Intersect Coalitions.

The magnitude of the HIV and AIDS crisis is staggering. According to UN figures, over 28 million Africans are living with HIV and AIDS. Since so many of those dying from AIDS are between the ages of twenty and forty AIDS is orphaning mullions of children. Added to this is the ferocious assault of the epidemic on women and girls. The toll on women and girls presents Africa and the world with a practical and moral challenge, which places gender at the centre of the human condition. We can no longer ignore the gender dimensions of this epidemic.

Africa is the only region where women and girls outnumber men and boys among persons living with AIDS. There is simple evidence that gender inequality, and the resulting economic deprivation and dependency, are fuelling Africa's HIV and AIDS epidemic.

As South Africa celebrates 10 Years of Democracy and Freedom Celebrations, all our Government Departments have been challenged to put themselves under a "spotlight" to openly declare and compare how far they have gone to institutionalise transformation in the ten years since our first democratic elections in 1994.

Very near the top of this transparency and peer review process are the issues relating to the mainstreaming of gender equity. 2004 is the "Review Year", a platform and an enhanced opportunity to progress the role of women in leadership. Present at this conference, we have a powerhouse of women from various sectors, where they have excelled and demonstrated that South Africa is all that much richer for having recognised the importance of involving greater numbers of women in all areas of decision making and leadership.

It is appropriate that this event is held so close after our celebration of South Africa's Women's Month and on the eve of the "16 Days of Activism for No Violence Against Women and Children" Campaign, which will run from 25 November-10 December 2004. I believe that the Intersect Coalition and its HIV/Violence Against Women and Girls Project will contribute immensely to the campaign to turn the tide against HIV and AIDS and the interlinking problems of violence and poverty. By coming together here we have already made the commitment and will leave having expanded our understanding of the many dimensions of HIV and AIDS.

As we confront the worldwide challenge of this dreadful disease, we need to build strong coalitions that will serve as vehicles to harness the energy that exists in government and all sectors of our society - in the media, business, faith based organisations, community based and non-governmental organisations. We need to mount a strong and sustained campaign, in order to succeed in the fight against HIV and AIDS and gender based violence.

There are a number of reports that show how violence against women and girls and HIV and AIDS fuel and compound each other. Access to preventative information, education and decision-making power is often limited for women and girls.

In a study entitled "Violence, Vengeance and Gender" Lisa Vetten and Kailash Bhana of the Centre for the Study of Violence and Reconciliation propose four hypotheses, linking HIV and AIDS and violence against women and girls. According to these hypotheses, the dual epidemics of HIV and gender-specific violence may overlap in women's lives.

The hypotheses are:

1. Rape may directly increase women and girls' risk of contracting HIV. Typically, rape does not occur in circumstances where a condom will be used. The violent nature of rape creates a higher risk of genital injury and bleeding while in cases of gang rape exposure to multiple assailants may also contribute to the risk of transmission
2. Abusive relationships may limit women's ability to negotiate safer sex
3. Women who have a history of childhood sexual abuse may engage in riskier sexual behaviour as adolescents or adults, increasing their risk of HIV infection
4. Women who receive HIV counselling and testing may be at risk of partner violence should they disclose their status.

A report released by UN Agencies at the XVth International AIDS conference in Thailand, Bangkok in July this year acknowledges the intersection between gender inequality, poverty and HIV/AIDS. The report observes that women are now over half of all people infected with HIV and AIDS. It documents the devastating and often invisible impact of AIDS on women and girls and highlights the ways discrimination, poverty and gender-based violence help fuel the epidemic.

According to the report, this situation in sub-Saharan Africa shows that more women than men are infected with HIV and dying of AIDS. In this alarming situation women make up 57% of those living with HIV. Young African women aged between 15-24 are three times more likely to be infected than their male counterparts.

The report suggests "Promoting concrete actions that address the reality of women's lives and help decrease their vulnerability to HIV is the only way forward. It stresses the importance of reducing violence against women and ensuring greater access to HIV prevention and treatment services and protecting their property rights.

Women's greater vulnerability to HIV infection can be explained as the outcome of biological, cultural, social, legal, and economic factors. For these reasons younger women are at a higher risk of HIV transmission than are older women. Their bodies, which are less mature, are more susceptible to infection. The presence of other STD's greatly increases the risk of transmission of HIV. The fact that girls frequently have to become the breadwinners of the family means they are increasingly having to engage in trading sex to survive, putting them at high risk of HIV transmission. Added to this is the fact that circumstances of poverty in general generate high-risk behaviour.

Women in abusive relationships are much more likely to be HIV positive. A study on gender-based violence conducted jointly by US and South African academics in 2004 shows that women who suffer violence at the hands of their male partners are more likely to become infected. According to this study "Women who are beaten or dominate by their partners are nearly 50 percent more likely to become infected with HIV, compared with women who live in non-violent households". This highlights the link between domestic violence and AIDS.

Another important factor putting women at greater risk is the issue of some traditional practices. Recently, the practice of polygamy has been highlighted as increasing the risk of infection, especially where younger women marry much older men. Women insisting on the use of condoms or refusing to have sex end up as victims of physical and sexual abuse that often results in HIV infection.

The situation of women in armed conflict needs special mention. Women in war situations are often subjected to increased rape and exposure to HIV infection, as rape is often used as a war tool. A report on women in Eastern Congo showed that 30% of women being treated for rape were HIV positive.

War situations increase the situation of trafficking in women for purposes of prostitution. A recent report on the war in Iraq has highlighted this issue, saying that women are being trafficked and used as "comfort women" for the soldiers. Prostitution exposes women to HIV infection, as it is not always possible to negotiate safe sex in such situations. Orphaned children are likely to be forced into prostitution as a way of economic survival.

How is the South African government responding?

Government programmes to fight the twin scourge of HIV and AIDS and violence against women and girls have included legislative reforms and campaigns. Since 1994 a number of laws have been passed or amended to deal with the abuse of children and women. There are ongoing programmes to train police and magistrates to sensitise them to issues of gender based violence. Special courts have been established to deal with sexual crimes. In addition, special programmes have been implemented to fight poverty and provide infrastructure to disadvantaged communities.

Gender awareness campaigns have highlighted the importance of women taking control over their bodies and giving them the tools to exercise their reproductive rights. The awareness raising campaigns have also focused on men, teaching them that women have the right to say no and to make decisions about their lives.

Government has progressively focussed on raising awareness around issues of gender-based violence. The annual 16 Days of no violence against women and children campaign has gained much momentum and all government departments are expected to participate. The past financial year saw a disbursal of R43 million to NGO's for funding HIV and AIDS programmes. The priority areas of our HIV and AIDS strategic plan include:

* Prevention of infection
* Treatment, care and support
* Research, monitoring and surveillance
* Human and legal rights

As a result we are beginning to see a high level of knowledge and awareness of HIV and AIDS among ordinary South Africans across all age groups. A cluster approach integrating health, social development, education public service and administration is targeting these issues in an integrated way. In 2002, more than a thousand people including leading celebrities took to the streets of Johannesburg to protest the vicious cycle of women and child abuse.

The high profile march under the auspices of the South African National AIDS Council formed part of the 16 Days of activism of no violence against women and children campaign. This campaign has not left men behind. It sees men as part of the solution.

A special march was organised in 2003, which mobilised large numbers of men under the theme, "South African Men Care Enough". Addressing the South African Men's Imbizo, Deputy President Zuma said:

Our belief is that HIV and AIDS and the abuse of Women and Children can only be addressed if we act together as a united force. Each one of us must exercise our individual and collective responsibility to take care of our own lives.

This awareness is already translating into behavioural change especially among the youth. Annual Antenatal Surveys for HIV prevalence among pregnant women receiving care in the public sector, has shown a steady decline in HIV prevalence levels among the less than twenty years old in the country over the last three years.

In our effort to meet the needs of those living with disabilities, the Department of Health has started to train health workers to use basic sign language. Government has produced videotape for the deaf community, using sign language to address issues around HIV and AIDS. People with disabilities are represented on the South African AIDS Council. South Africa is the first and the only country with an HIV and AIDS strategic plan translated in Braille to cater for the blind.

As part of SADC and Africa as a whole, South Africa has undertaken joint campaigns with our partners in the region and the continent. During the Women in Partnership Against AIDS Summit, which was held in August 2003, women from all over the SADC region committed themselves in combating HIV and AIDS through prevention, care and support, the provision of leadership and guidance to the younger generation and to strengthen their partnership with other stakeholders.

It is critical to ensure that young women's reproductive health is a partnership responsibility because their health is a population, education and poverty issue. Programmes targeting young women be stepped up, which focus on prevention, early education and basic skills.

Investing in the next generation and preparing young women to be architects of the future benefits all generations, all races and all genders. Such investment will lead to education and development which in turn will benefit all levels of our communities by increasing awareness for issues such as low contraceptive use; increasing STDs/HIV/AIDS infections; increasing adolescent pregnancies and unwanted pregnancy and pregnancy related complications.

We are increasing our campaigns to support the girl child movement, which is focusing on girls' education. The theme of the World Aids Day in 2004 is "Caring for our Women and Children". This is so appropriate, given the economic vulnerability and the demand for sexual services that are significant factors in promoting HIV. As a majority of women are unemployed, homeless and landless and thus living below the poverty line, many women and girls exchange sex for material benefits in order to survive. This is especially evident in situations where young children are orphaned when their parents die of AIDS and young girls are left heading the family and selling sex as a source of income.

The dialogue now needs to shift to not only behavioural change but also to taking action. There is a need to focus on gender inequalities and power relations between men and women.

South Africa has a strong history of partnerships and solidarity on social issues and many others. We must harness this energy and direct it towards creating a strong movement of solidarity in the face of HIV and AIDS. This must encompass all aspects of the epidemic, including fighting stigma and discrimination, gender based violence, poverty and marginalisation. The implementation of the comprehensive plan for care, management and treatment of HIV and AIDS needs the participation of all. We must continue to focus on the critical issue of prevention, supporting those who test negative to stay HIV free, as there is as yet no cure and existing treatment requires a lifetime commitment.

The new culture of "Vukuzenzele" promoted by the President has instilled renewed commitment to moral regeneration and a culture of volunteerism. Emerging from those will be a sense of responsibility for young people, which can readily translate into healthier and safer sexual practices.

The challenges are huge of mobilising and bringing together communities previously divided along class, race and gender. Positioning South Africa as a credible competitor in the global arena and addressing the needs of millions of previously disadvantaged people and at the same time respond to the insidious threat posed by the silent epidemic of HIV infection is no mean feat. Efforts made by Government to provide basic amenities, create employment, provide housing and build infrastructure are ways of responding to the broad challenges. All these decrease the vulnerability of individuals and communities to ill health and infections among which we have HIV infection.

Children in distress - DIKHUTSANA - is a term used to describe a child who has been orphaned, abandoned or displaced and whose primary need for physical, social, emotional and intellectual development needs are not met. These children often grow into dysfunctional adults, they may be alienated, unable to live peacefully and work productively. The first step is to define to them the extent of the problem and to find ways of identifying those children.

Communities have to find ways of creating safety nets to catch these children in distress. Examples of strategies that are in place in some countries include:

* Caring for children by family members
* Creating community-based structures, which enable children to be brought up in familiar surroundings
* Economic empowerment of care givers
* Residential facilities, foster parenting as well as cluster foster care.

There is direction, but no single clear path on how to raise the orphan generation. Children have individual needs and need to be understood within the context of their families, culture, religion and community. A network of interventions linking Government agencies and individuals will maximise resources and build strength.

A simple, inexpensive intervention of simply just being there - a constant trusted source of human contact - may be the most valuable support to women and children deeply traumatised by the profound, silent disorder of the AIDS epidemic and the scourge of violence and sexual abuse against them.

We have to speak for those that cannot speak for themselves.

Let our voices not be silent. We must step up the fight for the total eradication of violence against women and girls; ensure greater access to HIV prevention and treatment. We must advocate for comprehensive and sustained campaigns that aim to build a culture of no violence against women and girls. We must make our communities a safe place for all. Working together in partnership and in coalitions we can ensure that our policies and laws are responsive to the interlinking issues of poverty, gender based violence and HIV and AIDS. We must fight for the eradication of poverty as part of the campaign against HIV and AIDS, remembering that an action against HIV and AIDS that does not confront gender inequality is doomed to failure.

As I conclude, I wish to leave you with the words of Rudolf Virchow a historical figure in medicine. He said, "It is the curse of humanity that it learns to tolerate even the most horrible situations by habituation". He also said, "The physicians are the natural attorneys of the poor, and the social problems should largely be solved by them." When he was sent to Upper Silesia (Poland) to report on an epidemic of what was then termed famine fever, now called relapsing fever, Virchow found a region impoverished by absentee landlordism, where people, mainly Polish, lived principally on potatoes and vodka and suffered from endemic malaria and dysentery. In his report to the German government, he wrote that abysmal social conditions, which the government had fostered and done nothing to relieve, had caused the epidemic. His prescription for curing Upper Silesia was "full and unlimited democracy."

This meant, among other things, establishing Polish as the official language, taxing the rich instead of the poor, getting the church out of the business of government, building reads, reopening orphanages and investing in agriculture.

I thank you.

Issued by: Ministry of Health
8 September 2004

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