MALE SPEAKER 1: Good morning. United Nations Population Fund, UNFPA, and I’m pleased to moderate this press conference focusing on HIV prevention and, in particular, on women. The United Nations Population Fund, UNFPA, is launching our new publication. The first here to speak will be Dr. Piot from UNAIDS, followed by Dr. Suman Mehta, the HIV/AIDS coordinator from UNFPA, and finally, a youth perspective from Benjamin Ralepsapsi, of the Botswana Family Welfare Association.
PETER PIOT: Good morning, everybody, I hope you can hear me. UNAIDS is an organization which includes eight UN system organizations and the Secretariat. So we are a coalition of agencies, and UNFPA is one of the founding agencies of UNAIDS from six and a half years ago. For this year, UNFPA has the chair of the various agencies. That’s why I’m very pleased to be here. The report that is being launched today is one that is not only illustrating what UNFPA has been doing and is planning to do, but is for us also a critical component of the action by UNAIDS, particularly in terms of three things: one, is prevention, mainly with women; secondly, working with young people, particularly adolescents; and, thirdly, pushing very hard a strong gender perspective. And I will go very briefly over all these points.
From the UNAIDS report last week and from the report of the prevention working group that was co-chaired by Gates and Kaiser Family Foundation, we know that HIV is spreading still relentlessly. But also, when you analyze the figures, it is clear that this is becoming more and more an epidemic of women on a worldwide scale, and particularly young women, not to say even girls in many countries. That only increases the biological vulnerability. We know that male-to-female transmission of HIV is more efficient than female-to-male transmission, and that’s for biological reasons. But also, it is particularly a group with continuing gender bias with inequality between men and women, and by the fact that in many cultures, older men tend to have sex with younger women and girls. And that’s not only consensual sex; there’s a lot of coerced sex there. Just, particularly, when you look at Africa, there are far more women infected than men, and particularly when you look at teenage girls -- 15, 16 year olds -- they are far more infected than boys at their age. So they are not infected by the boys of their age group, they’re infected by older men. And that is one of the major driving forces of HIV in young people in Subsaharan Africa.
The second thing I said is that that about adolescents. Within UNAIDS, we have the division of responsibilities, like when it comes to treatment and care for HIV, WHO is the premier agency. When it comes to working with adolescents, it is UNFPA. And this is a great challenge. We have at this conference I think more satellites and sessions on young people and youth than in previous conferences, and I think that is absolutely right. (MS?) And I think that’s a positive development, because we know that wherever, on a large scale, we have seen successes on declining the number of new infections, it has to be among young people, particularly adolescents.
And, lastly, the last area the UNFPA has the lead in our system is in condom procurement, condom programming. As you know, we stick to what we call the “A-B-C” of prevention. We strongly believe that you need combination prevention, a multiple approach, and when it comes to prevention of sexual transmission, it’s “Abstinence, Be faithful, and Condoms.” And condoms are lifesaving tools -- lifesaving commodities, as some people call them -- which are still not accessible to all those who need them.
So this report is about various aspects, and, as I said, we’re very pleased to be associated with it and this will be an important tool for staff in the various countries we work.
SUMAN MEHTA: I have come here to this conference for one thing, to launch our new publication, as was flagged by Peter -- (MS?) “Preventing HIV Infection, Promoting Reproductive Health” (MS?) a response for 2002. I would also like to ensure that you hear the message that is, clearly, women, especially young women and those of child-bearing age, are still highly vulnerable, are becoming infected at an increasing rate, and are also suffering a disproportionate burden of the epidemic. And, as I said, it is becoming like an epidemic of the women. The work of the past (MS?) UNFPA has learned that along with necessary commitment and leadership, the effectiveness of prevention, fair treatment and support, then we are all in this together. We know what to do, but we must do it for our daughters’ sake, across communities and across countries. The basis that we need to do more is in the numbers. 5 million more infections in 2001 -- 75% through the sexual mode. Half of these infections among young women. Half of them are among young people, and most of them among young women, if you look at new infections. In some countries, young women are almost six times more likely to get infected than their counterparts, the men in the same age group.
Therefore, the message is very clear. We must act immediately to prevent more infections. To halt the epidemic, to save lives, it is imperative that we reach all persons at risk of the infection, and especially young people, with the information, knowledge, skill, and means to protect themselves from the infection. For UNFPA, “HIV Infection” is an integral complement to ensure reproductive health and rights. Secondly, programming for prevention, which presents the four areas of our work against the epidemic in about 140 countries where we have programs. Our new publication presents the front for three areas: prevention among young people, prevention among pregnant women, and comprehensive condom programming as part of sexually planned pre-infection prevention.
First I will speak about women. Roughly 47% of the 1,500 new infections every day are in women of childbearing age. Women are biologically susceptible to HIV and other sexually transmitted infections. This is compounded, of course, by the social culture and the economic circumstances that often make it difficult for women to have control over their sexual lives. The majority of pregnant women – it is estimated there are about 200 million women which become pregnant every year – 99% of them, globally, are HIV negative. We came here obligated to ensure that this 99% remain HIV negative, for their own sake, and for the sake of their partner, as well as for the sake of the children that they will be bearing.
Since pregnancy provides an occasion for accessing health services, it is a good opportunity to provide information and counseling on HIV prevention and to provide condoms for HIV prevention. (MS?) prenatal, antenatal, (MS?) and postnatal services, as well as midwife for treatment and care for those that need them.
Moving on, there are about 34 countries where we are supporting prevention in pregnant women, and one example is the Dominican Republic, where we support prevention efforts through provision of information, counseling, prevention, and access to condoms through an expanded and improved maternal health care program. We also help to increase access to reproductive health services in conflict situations in many parts of the world. Young women, and men, especially those who are not married, share access values. Stigma, embarrassment, community, prevent them from reporting to sanitary clinics or standard medical committees specifically for sexual and reproductive health services. Alternate approaches and strategy for more youth friendly environments, such as schools, youth centers, are required to ensure that they have access to information to protect themselves. UNFPA supports hundreds of projects in over 100 countries that focus on youth and peer education as well as more gender equity, equality, and empowerment, both for young men and young women to protect themselves.
All of which brings me to the issue of our final program. And this is provision of quality condoms as a binary process which requires infrastructure and effective programming to address forecasting of needs, production of quality condoms, in sizes and styles acceptable to the user, procurement from certified manufacturers, logistics and management to ensure condom (MS?). Simply making condoms available does not guarantee that they will be used, for this is one side of the story, and that they will be used correctly and consistently. The needs and preferences of users must be taken into account to ensure easy access to condoms and to ensure their correct and consistent use. And this is both relevant for male and female condoms. Quality products must be supplied, not only in a timely manner, but also in appropriate quantities and in places that are accessible, at prices that are affordable, for the users of these products.
In Nigeria, UNFPA is proposing a baseline study to identify socio-cultural barriers to HIV prevention. (MS?) misconceptions about condoms abound, and many traditional healers dismiss the threat of HIV and our efforts to prevent its transmission. These (MS?) are important to the successful planning of ensuring prevention programs. Some of you, I can see that this is -- last evening when we had a session on addressing myths and misperceptions, where we shared more than 200 myths and misperceptions that are prevalent in the countries that we have programs in.
Stigma, misinformation, and denial impede the response to the epidemic, and this must change. Gender inequities, especially the social and cultural norms that result in women’s inability, or severely limited ability, to protect themselves from infection to compose a sexual and reproductive life -– this must change as well. UNFPA is looking forward to these changes. We are contributing to making this happen. Using effective HIV prevention approaches, we can make this possible, we can save lives, we can prevent the undo burden on families and communities, and we can rebuild the continent. We can show you how the epidemic can be, reverse the epidemic, and in doing so we ensure our future. To make this possible, we all must act together. Thank you very much.
MALE SPEAKER 1: Thank you, Dr. Mehta. As you have heard, prevention efforts among young people is one of the areas of focus of the UNFPA. UNFPA is proud to be a partner in the African Youth Alliance, which is an effort in poor African countries to scale up prevention efforts that work. It was established with funding from the Bill and Melinda Gates Foundation. One of our partners in this effort, in Botswana, is the Botswana Family Welfare Association. Benjamin Ralepsapsi.
BENJAMIN RALEPSAPSI: Good morning, ladies and gentlemen. My name is Benjamin Ralepsapsi. I come from Botswana. I am from Botswana Family Welfare Association. This is an NGO, nongovernmental organization, that has recognized that youth are very important and are the future of our nation, and why Botswana Family Welfare Association addresses youth on issues of sexual and reproductive health through youth centers, which are (MS?) and youth centers for education and (MS?). Ladies and gentlemen, I fear for the young people of Botswana and in the world. In the time that I speak to you, 50 young people in the world will be infected by the HIV virus. We must stop this flood and put an end to the dying of the young people. Over half of all the people in the world are under 25 years of age, and half of all new infections is among this group. Do you know that the majority of the young people with HIV don’t even know that they are HIV positive? And of those who know where to get tested, are too scared to do it. I’m here to tell you that children and youth of the world are desperately in need of information, and (MS?) to reach full potential and become the (MS?) of tomorrow.
As a member of the African Youth Alliance in Botswana, I’ve seen the impact of HIV/AIDS on these young people. I’ve seen young people come to our schools, particularly those with STDs, and young people coming to our schools with a secondary STD. Why? Because there is fear to go to a clinic that provides those special services, because of the stigma when you talk about sexuality -- and we know that HIV/AIDS infections, most of the infections, are through sexual involvement. Without education and access to information, the young people of my country who won’t grow up to see their grandchildren. So many of us will die before we are 40. In order for our generation to grow old, we must educate young people now.
We must educate, talk about condoms, and educate them about how they can protect themselves from the HIV virus. We must let them be open and talk about sex so that we can prevent more infections in the next generation. If educated women can recognize the matters of health care and know how to treat both themselves and their children, I believe women and girls might be able to (MS?) the disease. This will help our community identify those infected with the virus and more people. Many young people are having sexual relations. Many times, the young people who are having sexual relations don’t even know how to contract HIV. (MS?)
They have nowhere to go, and no one to help them or educate them about the risk of HIV/AIDS. At African Youth Alliance, we try to reach the young girls with girls who they can relate to. (MS?) For example, we use videos, peer (MS?). We try to help our peers (MS?) so they can help stop it themselves.
Young people need, want, and have the right to reproductive health services, including HIV education. But, as you know, (MS?) we must encourage youth to (MS?). It is my hope that every country will issue AIDS awareness center to educate youth about the issue. Thank you for letting me speak today. I know that I speak for my friends and fellow youth alliance members who aren’t informed as well as me, there must be a global (MS?) youth to the fight against HIV to a new generation, and to slow its path for future generation. Whether or not we develop vaccines or more effective treatment for the virus, the next generation must at least be given the opportunity to become scientists, presidents, doctors, mothers, fathers, or whatever they choose to be.
This is our (MS?) today. There are three. To empower youth today with tools and knowledge that will help them to prevent the virus (MS?). Thank you very much.
MALE SPEAKER 1: Before I take your questions, let me make another correction and apologize to Benjamin. We have spelled his name incorrectly. Benjamin’s name is Ralepsapsi – R-a-l-e-p-s-a-p-s-i. Thank you. Now, to take your questions. Yes?
FEMALE SPEAKER 1: (MS?) for the Associated Press. You say that many of the young women are having sex with older men. With the idea of condoms, how often is it that these older men, who obviously have the upper hand in the relationship, want to use condoms and are their ways for these young women to take control themselves? (MS?)
SUMAN MEHTA: Thank you for that question. I think that’s one of the challenges that we are facing: how to reach out to the older men, because it’s not an identifiable group, and therefore one of the ways we can empower young women with the necessary information and education and the need for -- the female condom, in this instance, could have a role to play. They, themselves, are in the right age to use that. Another opportunity which has been used in some settings is, many of these older men are going to younger women in an environment of commercial sex, where commercial sex workers themselves are in their teens, and therefore, if you are reaching out to them, instead of doctors, which has been successful in many countries in Asia, it’s also being tried in Africa. So there are various types of opportunities that one needs to explore and that are being explored. But I think the challenge is to scale up, because these are all small things, projects, except in Thailand where it has been done on a nationwide basis.
FEMALE SPEAKER 2: How does the female condom work in prevention of HIV, and how widespread is its use? And what about the diaphragm?
SUMAN MEHTA: Well, the data that are available, that female condoms effectively prevent HIV is very good, however, these data are only laboratory data. Since we don’t have that information still in hand, it is a random clinical trial, which is the most global evidence of how well it works, but meanwhile this product is available through UNFPA itself as providing female condoms to over 37 countries over the world. Again, and this is on a small scale basis, because cost is an issue. And I don’t know, it’s sort of the chicken and the egg issue -- if you have a wider use the cost will come down, but you can’t have a wider use if the product is expensive. However, again, there are other countries who are going to pick up manufacturing of female condoms in developing countries, and once that happens the cost will come down, and we can make that available on a wider reach. The (MS?) within UNFPA and (MS?) is not (MS?) and therefore we can do so much as is possible.
PETER PIOT: If I may add, I think that (MS?) is a variety of options for women to protect themselves. Female condom is one of them, but I think the dramatic situation of high infection rates in young women and girls also stresses the need to invest far more in the development of so-called “microbicides,” you could call the chemical condom, which should be cheaper and women should be able to use without the men even noticing.
MALE SPEAKER 2: (MS?) from “The Boston Globe.” I have two questions. One for Peter Piot. With two-thirds of all infections being young women, what are the demographic implications of that? And a question for Benjamin after that. With 40% of adults in Botswana infected with HIV, is abstinence becoming a more message that is received better now?
PETER PIOT: So, I’ll start while Benjamin takes in the information. The demographic consequences of the infection in young women – and you’re absolutely right to say that it’s two-thirds of all new infections in the region are young women – is many-fold. One is that you see two population deficits. When you take the AIDS pyramid, there is a hole in it that we’ve only seen in the past in times of war. But in times of war, you have a whole generation that’s going, and that’s mostly men. In this case, it’s men and women, but particularly in that age group it’s women. That’s not just a graph for demographers. The implications of that are science-based. We have implications on reproduction, because it will of itself have an effect on the birth rates, because the women will die before their full potential as mothers. Those children that are born will be orphans -– this is one of the most dramatic effects. And it is also -– studies from Zimbabwe and a multi-country study that UNAIDS has supported and was published already last year in Kenya, Cameroon, and in (MS?), shows that it’s there that it reaches the greatest age differential in terms of sex partners -– again, the older men and younger women -– that in itself is a major factor in the spread of HIV. We are also trying to model specifically the demographic effect, as we call it -– of the fact that it’s young women who are first being affected. But the major consequences that we’re seeing at the moment has to do with the reproductive function and its impact and consequences, and the number of orphans.
BENJAMIN RALEPSAPSI: My last look at the statistic for Botswana (MS?)—40% of families, 50%. Coming from the youth, I think it’s a (MS?) message to the young people. Young people are still having sex. So if young people are still having sex, what do you do? Then you should utilize –- they should have options.
PETER PIOT: If I may add something (MS?) -- we’re going into a situation where there will be societies where, in a certain age group, there will be far more men than women. And that, in itself, is going to make the spread of HIV even worse, because if you look at in economic terms of sex, the imbalance of heterosexual sex, the imbalance between men and women -- so there will be more men who will have sex with the same female partner. And to restore this impact of AIDS on those generations, that is going to take generations. When we think of -– that’s one of the reasons that I’m saying now that we’re only at the beginning of the AIDS epidemic. That’s not only in terms of spread of HIV, but also the impacts. That’s the kind of things that will have an impact that is going to last -– well, I don’t want to put a figure (MS?).
SUMAN MEHTA: I think we need to recognize the fact the cohort of young people that is in Botswana or wherever is not a homogeneous group. There are some of them who are at the stage that abstinence may work, for some time, but there are sexually active adolescents and young people as well. Therefore, no one strategy is relevant for a cohort of young people. And, secondly, the needs of young people also vary over time. If today they have sexually not started their lives, so maybe abstinence sometimes may work, but in due course of time, over months and years, they are going to become sexually active. And, therefore, it’s the combination of A, B, and C which works best for young people: Abstinence – voluntary abstinence for some time if they are not sexually active; Be faithful if you are sexually active; and use Condoms wherever and whenever possible.
BENJAMIN RALEPSAPSI: I’d also like to add that one of our chief strategies is that we recognize that young people will get sexually active at some point. One of our strategies is to push the age of sexual onslaught from (MS?). Sometimes, some people start at 13, some people start at 14. (MS?) -- to make a decision?
MALE SPEAKER 3: (MS?) Somebody said that there were rumors of men and women, older men and commercial sex rings. Is that the primary
[break in audio]
SUMAN MEHTA: -- but also, it is culture, in some parts of the world, in some countries, where they think they can exploit young women. And it’s also true that some HIV positive men feel that if they have sex with virgins they can be cured of the virus. So, again, it just highlights the need for better information, better awareness of what causes and what does not cause this kind of infection to transmit. So you can visualize the challenges there to reach out to various constituencies and to various subgroups of the population.
PETER PIOT: When I look at the evidence of (MS?) what one could call (MS?) sex, which for an example is teachers and students. That’s something that exists. It is about power relations as well. And then, of course, with AIDS – but all these things are not new. But with AIDS, there is the factor indeed that it is objectively safer, in men’s minds, to have sex and so on with younger. But I’m not sure that’s really the primary cause. I think it just reveals that practices which have been going on for quite a while are now becoming lethal for the women.
MALE SPEAKER 4: (MS?) of India. (MS?)
SUMAN MEHTA: I’m sorry, I did not get the last part of your statement, so I can’t respond to it.
MALE SPEAKER 4: (MS?)
SUMAN MEHTA: Well, even if cities or towns facilities are not there, we are fortunate that we have cleaning and diagnostic tests which are available, which are very cheap -- cost a dollar or less than a dollar. The results are available immediately, so not having city or town facilities is not a big issue. If it’s available somewhere in the country, where people can be (MS?) for confirmation tests. However, the bigger issue is that of trafficking of women and of migrant workers that leave the country and then go back and have sex there and infect their partners. The (MS?) cross-border trafficking, where young girls who traffic and go to India are brought back and rehabilitated with their families. Again, I think the challenge is to upscale and to make that on a national basis, (MS?) and NGOs both working together from Nepal and India. But we need to have a better program which has a very wide basis.
FEMALE SPEAKER 3: (MS?)for Dr. Piot. Could you please talk about the availability of access to microbicides and the effectiveness of that?
PETER PIOT: Actually, there is access because there is no microbicide yet. I think the good news is that, after having wasted a lot of time by not investing more in microbicides, there is now funding coming from a variety of agencies, including in Canada, the UK, NIH, and so on. So now it’s the long and difficult work of the clinical trials to evaluate the 30-plus products that are in the pipeline and that show promise. As I mentioned before, I’m really convinced that could make a difference; that that would be a revolution in prevention against sexual transmission, and particularly to protect women. But it’s going to take years before we have the results, because the products (MS?) of such a large scale we need to know two things: one, that it’s absolutely safe. And trials have shown that one product that was tested, the only one Monoxidyl 9, has negative side effects which could increase the risk. And secondly, of course, that it protects. And that is going to take time. But at least now we are tackling the problem. It’s like with vaccine research. We wasted so much time, it goes back a whole decade, that we could have started most of the trials that will start now, and soon, hopefully, because these are not very new products, these are older products that are now being tested. Same thing for microbicides.
MALE SPEAKER 6: I think this conference is (MS?) any number of social-economic factors that influence the pattern of HIV/AIDS. And one of the factors mentioned by almost all the speakers is the issue of poverty. I would like to ask you, Dr. Mehta, what your organization is doing to ensure that at least there are some available economic support lines that are making accessible to our young women and other members of society (MS?).
SUMAN MEHTA: Thank you for asking that question. As I said earlier, we have programming in over 100 countries for young people, both men and women. We are very conscious of the fact and give more preference to countries which we call (MS?), which means they are in more need of assistance. And, secondly, even within those countries and other countries, we try to make sure that we have available a program more for youth who are either more vulnerable or youth who are away from the urban cities, are in rural areas, who need information and education facilities. We do that (MS?) We do that through television serials. There are a number of radio and television serials that are supported by the UNFPA for youth in these countries. There is (MS?) for Kenya that is so successful it has been replicated in other parts, as well as (MS?) -– and radio stations in some countries so that they can do peer education through their own network.
BENJAMIN RALEPSAPSI: I think also, to add to that, coming from (MS?) There are problems in teaching young people, especially young girls, skills for economic empowerment and skills to access different skills (MS?) and other factors.
FEMALE SPEAKER 4: Can you please clarify that in some societies there will be more men than women and the threat of HIV will be worse. Did you mean worse among women because they’re sleeping with many more men, or worse in general because men will turn to sleeping with men because there aren’t enough women?
PETER PIOT: Women will die at an earlier age from AIDS than men. When you float that out, there will be, in the younger age bracket at least, and always going up all the time, more women than men, and far more. Sorry, more men than women. And when you think in terms of the heterosexual market, to use that term, there you have an imbalance. So there will be more men having sex, intercourse, with less –- so the women will be exposed to more male contacts. That’s all statistical; I’m not saying that it’s due to happen. But we’ve seen situations like that after major wars. I remember in the 19th century there was an incredible war in Paraguay which decimated a major part of the male population. And for some time, well, it was the other way around, polygamy was thoroughly tolerated in Paraguay, which was totally against the practice. So societies adapt to this kind of indulgence. So that means, really, for the (MS?) virus, that there is again an amplification, a more efficient spread, and more opportunities for this virus to spread to more people, and faster.
MALE SPEAKER 1: That’s all we have time for. I want to thank you for coming, and I want to thank our speakers.