Sexual health, reproductive rights and HIV: a gender perspective.

The author is a women's rights activist and coordinator of the ten-year-old Grupo Pro Derechos Reproductivos (GPDR, Reproductive Rights Group) in Puerto Rico. This article was originally presented at the conference "Sexual and Reproductive Health: The Challenges in Facing HIV/AIDS," sponsored by the Proyecto Demostrativo de VIH/SIDA (PRODES, HIV/AIDS Pilot Project), Medical Sciences Center, Universidad de Puerto Rico, June 7, 2002.

In the 1980s, just as HIV/AIDS began to attract the attention of health authorities, hundreds of feminist organizations around the world were mobilizing to stop abuses in the realm of sexual and reproductive health. Their efforts eventually culminated in the preparatory meetings for the International Conference on Population and Development (ICPD) and the successful lobbying campaign at the Conference itself, which took place in Cairo in 1994. From the Programme of Action approved at that conference emerged the key definitions of the issues which concern us:

Reproductive health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity in all matters relating to the reproductive system and to its functions and processes. Reproductive health therefore implies that people are able to have a satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so.

Sexual health is related to the development of personal relationships throughout life and not merely to consultations and treatments relating to reproductive matters and sexually transmitted diseases. (1)

The ICPD Programme of Action changed the focus of what previously had been population control programs concentrating on family planning. After Cairo, merely meeting the demand for contraceptives was no longer enough; in addition, providers had to consider criteria such as autonomy and physical integrity, informed consent, access, availability, quality of care and a broad supply of safe and efficient methods appropriate for each stage of life. A broader and more comprehensive agenda was opened up that included childhood, adolescence, menopause and the incorporation of men into responsibilities related to reproduction. Despite the tremendous brouhaha caused by the issue of abortion, this agenda also embraced reproductive tract infections, including sexually transmitted diseases and, above all, HIV/AIDS.

Beyond these practical aspects, the transcendental meaning of the ICPD Programme of Action is its recognition of reproductive rights as fundamental human rights. The following year, the Fourth World Conference of Women in Beijing incorporated sexual rights -- the right of women to have control over and make decisions on issues related to their sexuality, including sexual and reproductive health, free from coercion, discrimination or violence. (2) From that point on, promotion of reproductive rights had to underlie government and community-based policies and programs in the sphere of reproductive health, including sexual health and family planning. (3) In this new paradigm, maternal and child health is no longer the exclusive objective; gender equity and sexual health also appear as components of sexual citizenship to strengthen the participation of women in development.

In relation to HIV/AIDS, the ICPD Programme of Action recognizes that already by the middle of 1993, four-fifths of all those infected with HIV, principally through heterosexual relations, lived in the developing countries and that new cases were rising more rapidly among women. (4) Today, even the popular press now recognizes that the causes of AIDS and the causes of the pandemic are two very different and difficult things to treat. (5) AIDS is a disease produced by a virus whose transmission is aggravated by conditions of vulnerability which arise, above all, from poverty. (6) Therefore, while the disease is a health issue, the epidemic is a gender issue. (7)

At the risk of repeating something my audience already understands, it is important to recall that sex and gender are not synonymous and that both are marked by a diversity of factors that go beyond differences of genitalia. The gender perspective is a suggestive perspective in the sense that it offers models for cultural change. (8) In the AIDS pandemic, we women are on the front lines due to the conditions of inequality that generate greater political, social, economic and even biological vulnerability. (9)

Political vulnerability stems from facing systems and governments dominated by violence and fear. Even in the proudest democracies, we women are still second-class citizens. We remain outside the levels of decision-making, not because female figures are absent but because these spheres of power still lack a gender perspective. All the conferences in the world mean nothing if governments do not respect the agreements they sign on policies, laws and budget allocations and if women do not vigilantly defend our conquests again and again with each new administration. At the beginning of this year in Puerto Rico, we learned of a proposed law which railed against "ambiguous expressions such as gender equity, gender consciousness and gender perspective" and insisted that "women are creatures with organs to be fertilized." (10)

This example not only represents an attack on our sexual citizenship, but also ignores the United Nations General Assembly Special Session on HIV/AIDS in 2001 . At this meeting, the delegates once again recognized gender inequalities as the detonator of the epidemic. And if HIV entails a series of prohibitions for all our citizens, for women it increases the violations of our rights to work, to property, to marriage, to physical integrity and to access to comprehensive and reproductive health services. (11) Social inequality, according to the final document of this meeting, blocks women's access to information and medical care while at the same time we remain responsible for caring for the sick and dying.

This social vulnerability is the consequence of the taboo which restricts the expression of female sexuality to coitus and procreation at the cost of thousands of lives every year. This cloak of silence and submission makes it difficult for us to reject sexual relations without a condom, the best option for contraception and prophylaxis. Therefore, the AIDS epidemic has revealed once again the reigning double moral standard in our society. The rates of transmission among married women and through sexual relations within the stable, heterosexual couple confirm that, despite all the love songs and happy endings in the Hollywood films, monogamous love and domesticity are increasingly dangerous for women.

Economic vulnerability -- synonymous with the feminization of poverty -- affects both sex workers and women who inject drugs, as well as "housewives." The lack of opportunities and access to resources goes hand in hand with relations of dependence, sexual abuse and domestic violence. The impact of the epidemic in the population and whole regions is so serious that at this point AIDS is not just a matter of public health but a development problem, whose effects will be seen in coming years. (12) Despite our political relationship with the United States and our illusion of being a developed country, we cannot ignore that our geography, history and culture makes us part of the Caribbean, the region with the second highest rate of HIV/AIDS incidence in the world.

Biological vulnerability refers to the greater risk to which women are exposed due to the physiological characteristics of our genitalia, the greater concentration of virus present in semen, and the longer period which semen remains in contact with the vaginal membranes. In a similar fashion, lesions in the vaginal walls and the presence of other sexually transmitted infections increase the risk of contagion. But of course, our anatomy is not synonymous with contagion. What really facilitates HIV transmission is the lack of information, power to negotiate sexual relations, and access to effective barrier methods of protection.

In recognition of these risks, the ICPD Programme of Action calls for information, education and orientation about responsible sexual conduct and prevention of sexually transmitted infections to be included in all sexual and reproductive health services. (13) How have the different sectors alluded to in the Programme of Action responded? What are the key challenges and the steps to be taken to bring us closer to gender equity?

Challenges

Among the first problems we face are globalization and neoliberalism. One needn't be an expert to realize that "development" policies have resulted in an increase in inequalities: the rich are richer, and the poor are poorer. This outcome cannot be explained away with reference to overpopulation or resource shortages, but rather is due to misplaced priorities which undermine the victories of civil society.

Thus, behind the so-called welfare "reform" in the United States lurk attempts to control the sexuality of the poorest women. Just a few weeks ago, the U.S. House of Representatives approved the spending of 300 million dollars by the states to promote marriage and stable unions. (14) These tactics obviously complicate the options of women facing domestic violence, in which their immediate survival and that of their children takes priority over the threats to their sexual, physical, mental and emotional health.

Furthermore, the attempts to push women into the labor market stem from the undervaluing of domestic work and reproductive labors, including caring for children. These pressures not only fail to guarantee women the job stability and fair wages that would bring them real independence, they also lead to the double workday in which women receive no support services for domestic work and child care. As a result, women are subjected to additional risks - from harassment to environmental toxins and added stress, which are then manifest in unhealthy habits such as lack of exercise and poor eating, which affect their sexual and reproductive health and their overall welfare.

At the same time, privatization of the health sector and Health Sector Reform attack one of the historic conquests of humanity: the definition of health as a human right, reducing it instead to the category of a consumer good. The changes in the role of health ministries have resulted in fiscal crises, loss of national patrimony and serious consequences for working women and users of public services. Despite all the news reports, we lack precise information about the consequences of the reforms and their impact in crucial areas such as prevention, quality of care and data collection.

This is the context of the Puerto Rican Health Department's 1997 Sexual and Reproductive Health Policy, a document that drew from work presented at a Reproductive Health Workshop held by the Felisa Ricon de Gautier Foundation. Despite its strengths, however, the policy did not really incorporate the vision of the workshop but is instead one more example of cosmetic changes to the mother-child perspective. This is evident in its focus on women of reproductive age and the gross omission of girls, menopausal women, lesbians and bisexual, transsexual and trans-gendered women.

In addition, despite our advances with regard to legal abortion, this issue is not even mentioned in the text of this policy, nor is abortion included in the primary health services covered by the Health Sector Reform, a clear violation of the Cairo accords and U.S. laws. Similarly, it fails to mention domestic violence as a serious threat for the health of women and the entire society, sidestepping the monopoly that the courts and the news media maintain over the issue.

In regard to adolescents, the reforms emphasize prevention of pregnancy, obscuring the vulnerability youth face from sexual violence and other, even more serious risks. We cannot lose sight of the fact that statistics on HIV/AIDS mortality in Puerto Rico suggest that many women are infected in adolescence.

Nor can we forget that in recent years new AIDS cases showed a greater increase among the 40-and-older age group. Therefore, in addition to the factors which place our health at risk, age-based discrimination also appears: the sexual taboo is even greater when dealing with this population. This factor also results in the lack of prevention, confusion of symptoms, late detection and incompatibility of medicines, which already consume a large part of the budgets of the elderly.

The topic of medication raises the issue of how the pharmaceutical industry fails to research and create treatments which respond to the needs of women and their ability to control their own well-being. This industry and its accompanying model of health care continues to operate through a hierarchical structure based on medical authority and profit.

It is well known that the exorbitant drug prices, especially those of HIV/AIDS treatments, generate high profits for the pharmaceutical companies. For example, for the year 2000 the industry spent an estimated 200 million dollars on publicity and donations to political campaigns, more than any other industry. (15) We already should be preparing ourselves for the day in which a vaccine against HIV/AIDS is finally discovered. Will it be, once again, the privilege of a few, or will we be able to declare it the property of all humanity and guarantee universal access?

Although here in Puerto Rico medicines for people with HIV/AIDS are covered by the Health Sector Reform, we must still guarantee access to regular treatments, based on the needs of each person and without restrictions due to catastrophic coverage limits. Despite these difficulties, we cannot deny that in comparison with other countries our situation with respect to treatments and services is relatively privileged. Precisely for this reason, we have an additional responsibility to support international efforts to negotiate a reduction in the prices of these medicines, as was recently achieved by the countries of the Caribbean, as well as the broader perspective of the Women's Global Network for Reproductive Rights'6 in its Call to Action for May 2B, the International Day of Action for Women's Health, for 2001.

Fundamentalisms are another serious concern. In our region, the Cairo agenda is meeting tenacious opposition from the Catholic Church and ultraconservative sectors within governments. These sectors continue to preach a morality which subordinates sexuality to procreation, subject to a family model based on paternal authority, condemning sexual preferences which do not fit heterosexual norms, as well as two health alternatives essential for saving lives: abortion and condoms.

One of the most recent displays of this opposition to sexual citizenship occurred at the UN Special Session on Children in New York in May 2002. On this occasion, as at the ICPD, Beijing and their five-year follow-ups, the U.S. delegation worked very closely with the Holy See. As on the previous occasions, the delegation promoted abstinence-based sex education programs and fought to provide couples and individuals only information on family planning, but not contraceptives. Naturally, they didn't miss the chance to try to redefine reproductive health with the aim of excluding abortion. But despite all these pressures, the final documents of the meeting confirmed the Cairo and Beijing agreements and the conclusions of their respective follow-up meetings.

Experiences and Suggestions

Despite such victories, we still face immense challenges and enormous levels of human suffering on all sides. But if we look around, we can see inspiring examples everywhere, want to share the experience of the Grupo Pro Derechos Reproductivos (GPDR, Reproductive Rights Group) a coalition which formed to defend abortion rights but soon broadening its agenda to include HIV/AIDS and other issues such as reproductive tract infections, emergency contraceptives and menopause. In GPDR we address the needs of women in different stages of the life cycle and of different sexual preferences, using gender, human rights and comprehensive health perspectives.

In recognition of the importance of building alliances, we have joined forces with government agencies, academics, private foundations, non-governmental organizations and networks, and international campaigns. One example is our participation in this conference "Sexual and Reproductive Health: The Challenges in Facing HIV/AIDS," which we see as a response to the call issued at Cairo to incorporate NGOs into the implementation of the Programme of Action. In addition, it is a step towards incorporating the reproductive rights perspective into HIV/AIDS work, despite the obstacles that experts on the issue have noted to achieving this integration. (17)

In an attempt to reduce our political isolation and reinforce our Caribbean and Latin American identity, the GPDR belongs to the Latin American and Caribbean Women's Health Network and takes part in the September 28 Campaign for the Decriminalization of Abortion in Latin America and the Caribbean, which unites social and political activists and academics and provides constant opportunities for learning and growth.

Due to the influence of religion in our culture, we deeply appreciate the courageous work of the National Ecumenical Movement of Puerto Rico and of Catholics for a Free Choice, headquartered in Washington, and Catolicas por el De-recho a Decidir with branches in Spain and various Latin American capitals.

Without giving up their faith, these women fight against prohibitions of abortion and defend condom use through the Condoms4Life campaigns and the movement against the representation of the Holy See in the United Nations.

Along with these efforts at solidarity, gender, human rights and comprehensive health perspectives promote one of the pivotal aspects of our work and a fundamental tool for confronting the HIV/AIDS pandemic: prevention and education. For decades, feminist organizations in Puerto Rico have been demanding appropriate sex education at each stage of life to encourage responsibility and self-esteem, beginning with knowledge of the body as the first ecosystem and sanctuary and inspired by that important, non-academic term pleasure. For children, this approach is consistent with one of the fundamental objectives of all education: fomenting our capacity for critical thinking.

The new focus agreed to at the ICPD also changed the role of those responsible for providing health services. In addition to respecting confidentiality and providing dignified treatment, this new role requires sensitivity and awareness to facilitate better control by women over their sexuality in a relationship of mutual learning and growth.

Therefore, the criteria used to evaluate health services and quality of care cannot be derived from the mercantile vision now dominant -- to provide this or that method or pill so that the client is not tempted to "go elsewhere where they will treat her better." The clients we serve are not being sold a product or a service: we are honoring their rights in the same way we honor their humanity. This does not mean ignoring norms of efficiency and quality control, but rather adjusting them to the new paradigm.

We know that prevention and education are important components of many novel and successful NGO initiatives, such as those of the Fundacion SIDA (AIDS Foundation), the Asociacion Puertorriqueno Pro Bienestar de la Familia (Puerto Rican Association for Family Welfare) and the women's health collective Taller Salud, just to name those with which I am most familiar. Nonetheless, beyond these limited efforts, a gender perspective remains absent throughout the health system, both in its academic content as well as in the provision of services.

This is hardly surprising, given that incorporating a gender perspective implies a radical transformation of the system, its institutions and the centers of economic and political power linked to them. Given the difficulty of this task, it is important to recognize the efforts at curricular renovation undertaken by the Women Studies Project of the Colegio Universitario de Cayey along with the Medical Sciences Center, in addition to efforts such as this conference.

Undoubtedly, Puerto Rico's approach to prevention has celebrated creativity and flexibility in the face of the challenges that it faces from our machista culture and condom-phobia. But how do we reconcile the current high rates of sterilizations with the need to prevent HIV/AIDS? How do we respond to the sexual and reproductive health needs of bisexual, lesbian, transsexual and transgendered women? How do we facilitate access to emergency contraceptives, the female condom and microbicides? How do we validate reproductive choices such as abortion, fertility treatments and safe motherhood for all women, including minors, HIV-positive women and those who do not conform to heterosexual norms?

A fascinating challenge in responding to these and other questions involving sex education and prevention programs is how to redefine female sexuality to incorporate its sacred or spiritual dimension, to accentuate its playful and adventurous aspects, to reinvent and nourish our own vocabulary... This challenge goes far beyond simply insisting on inclusive language!

Similarly, to honor our feelings and the marvelous gift of our sexual energy, we must prepare for another, much more agreeable task: to rescue the unity of pleasure and spirituality as a sign of sexual health. We will not be inventing anything new; the Costa Rican anthropologist Anna Arroba explained that the ecstatic experience and erotic images have formed part of all western and eastern religions. Religious images that sanctify pain rather than pleasure are another legacy of the patriarchy. (18)

As we incorporate the agreements from Cairo and the other conferences of the last decade, we erect a new civilization which supersedes the patriarchy with its burden of sacrifice and suffering. Each person can add indispensable ingredients to the new, holistic culture of peace. We do not need to return to classical comedy or read Umberto Eco's captivating novel The Name of the Rose to understand the transforming capacity of joy because without it we women would never have survived all the pain which surrounds us. As Colombian psychologist Maria Ladi Londono puts it: "We have a fundamental responsibility to try to make our lives as happy as possible." (19) In conclusion, I want to share her invitation to accompany "the consciousness of our sexual rights [with] an understanding of eroticism as a responsibility" and to make room for the revolutionary force of laughter and pleasure to improve our well-being and strengthen us in all the work ahead. (20)

Notes

(1.) Family Care International (1994). Action for the 21st Century Health and Reproductive Rights for All. New York, p. 12.

(2.) Family Care International (1995). Commitments to Sexual and Reproductive Health and Rights For All: Framework for Action. New York, pp. 16-17.

(3.) Family Care International (1994), p. 12.

(4.) Ibid., p. 26.

(5.) Klesius, Michael. "In Search of a Cure," in National Geographic 10:2, February 2002, p. 43.

(6.) Galvao. Jane (1998). Women and the AIDS Epidemic in Brazil: Facing the Challenges," in Women, Vulnerability and HIV/AIDS: A Human Rights Perspective. Women's Health Collection 3, Adriana Gomez and Deborah Meacham, eds., Santiago: LACWHN, 1998, p. 48.

(7.) Urdang, Stephanie. "Gender Inequality is Fatal," in Women's Health Journal 1/2001, January-March, p. 12.

(8.) Bianco, Mabel and Maria Ines Re, "AIDS and Women's Human Rights in Latin America and the Caribbean," in Women's Health Journal 3-4/99, July-December 1999, pp. 22-24.

(9.) IWTC, Women's Global Network no. 172, July 10, 2001.

(10.) Free Associated State of Puerto Rico, 14 Legislative Assembly, 3rd Regular Session, 2034, Representative from Castro Font, January 8, 2002.

(11.) Bianco, Mabel. "VIH/SIDA en ninas y mujeres: Asuntos criticos en America Latina y el Caribe," in Desidamos 9:1, October 2001, p. 15.

(12.) Diouf, Jacques. "VIH/SIDA, pobreza y hambre," in Desidamos 9:1, October 2001, p.9.

(13.) Op. cit., p. 25.

(14.) IWTC, Women's Global Network no. 1. 2002.

(15.) Barry, Patricia. "Drug industry spends huge sums maintaining prices," in AARP Bulletin 43:5, May 2002, p. 3.

(16.) Women's Global Network for Reproductive Rights, 15th International Day of Action for Women's Health, International Trade Agreements and Women's Access to Health Care, May 28, 2002.

(17.) Bianco and Re, op. cit., p.71.

(18.) Arroba, Anna (2000). 'The Archaeology of the Orgasm," in Women, Sexualities, Rights: Utopia Within Our Grasp. Women's Health Collection 5, Adriana Gomez and Deborah Meacham, eds., Santiago: LACWHN, pp. 26-36.

(19.) Londono, Maria Ladi (2000). "Taking Another Look at Human Sexuality," in Women, Sexualities Rights: Utopia Within Our Grasp. Women's Health Collection 5, Adriana Gomez and Deborah Meacham, eds., Santiago: LACWHN, p. 12.

(20.) Ibid., p. 11.

RELATED ARTICLE: UNIFEM 

Empower Women, Halt HIV/AIDS

While HIV/AIDS is a health issue, the epidemic is a gender issue. Statistics prove that both the spread and impact of HIV and AIDS is not random. It disproportionately affects women and adolescent girls who are socially, culturally, biologically and economically more vulnerable.

The figures are alarming: 18.5 million of the 37 million adults (aged 15 to 49) living with HIV are women. In North Africa and the Middle East, 54% of the HIV-positive adults are women; in the Caribbean, the proportion has reached 52% (UNAIDS, Report on the Global HIV/AIDS Epidemic 2002, July 2002).

Globally, the incidence of HIV/AIDS among women has risen at a shocking rate. In 1997, 41% of HIV-infected adults were women, and this figure rose to 49.8% in 2001 (UNAIDS, Report on the Global HIV/AIDS Epidemic 2002, July 2002).

Women's empowerment is one of the only AIDS vaccines available today. As the only women's fund at the United Nations, UNIFEM is determined to ensure that gender equality does not remain a lofty ideal but becomes a guiding principle in the fight against HIV/AIDS.

Call to Action

The international community is increasingly recognizing that the gender dimensions of HIV/AIDS can no longer be ignored. A critical turning point was the UN General Assembly Special Session (UNGASS) on HIV/AIDS in June 2001 where 189 countries signed a Declaration of Commitment acknowledging that "gender equality and the empowerment of women are fundamental elements in the reduction of the vulnerability of women and girls to HIV/AIDS."

UNIFEM calls upon the global community to work collectively to recognize women's human rights and mirror them in all policies, plans, legislation, decision-making and representation needed to meet the targets set forth in the Declaration of Commitment on HIV/AIDS.

The Declaration established a set of targets to be met by 2003 and 2005, which constitute a road map for governments seeking to translate words into action. Women are central to a number of these targets:

By 2005, National Strategies should empower women to have control over and decide freely and responsibly an matters related to their sexuality to increase their ability to protect themselves from HIV infection.

Many women have been socialized through religion, cultural taboos and other social mechanisms to accept sexual subordination and even sexual oppression. Therefore, they are often precluded from the most basic means of prevention: safe sex. Lack of knowledge and bargaining power with their sexual partner is one of the many factors preventing many women from negotiating the use of male and female condoms, which can effectively prevent the transmission of HIV/AIDS.

UNIFEM calls for:

* Community training programs to enhance women's ability to negotiate safe sex;

* Wide distribution of affordable female condoms, the only current female-controlled barrier method, with information for women on how to use them;

* Increased funding for microbicides, an HIV/AIDS prevention method that kills the virus.

By 2005, make significant progress in implementing comprehensive care strategies to strengthen family and community-based care.

Worldwide, women's and girls' unpaid labor, such as childcare, household maintenance and care for the sick and the elderly, has enabled economies and societies to function. According to the Human Development Report, women's unpaid or underpaid work account for 11 trillion dollars of the global economy each (1995 Human Development Report, UNDP, 1996, pp. 97). When HIV/AIDS enters the household, this work becomes untenable. Yet women have no option but to continue to care for their sick and dying family members, even when sick themselves. In too many countries women fill the vacuum left by inadequate and unaffordable healthcare and support services at the family level. Additional public resources need to be allocated to ensure the provision of such services and alleviate the tremendous strain on women. In addition, women's work needs to be recognized in National Systems of Accounts and their contribution to the economy and to society valued.

UNIFEM calls for:

* The investment of public resources in care, such as social protection mechanisms, pensions and other benefits, for families that are caring for AIDS patients and/or orphans;

* Programs to counter the widespread withdrawal of girls from school to support the increased tasks and responsibilities in the household;

* Innovative measures to transform gender relations so that men participate in the provision of care for people infected with HIV/AIDS within the household;

* Provision by employers for workers to take time off to attend to sick relatives, participate in funerals and attend clinics without endangering their jobs and livelihoods.

By 2005, ensure the implementation of policies to promote and protect women's human rights and the reduction of their vulnerability to HIV/AIDS through the elimination of all forms of discrimination and all forms of violence against women and girls, including harmful traditional and customary practices, abuse, rape and other forms of sexual violence, battering and trafficking in women and girls.

Violence against women is fueling the spread of HIV/AIDS. Rape and sexual abuse are used as weapons of war and are putting millions of women at risk of HIV infection. Women who disclose their HIV/AIDS status are also subjected to physical and psychological violence. The Convention on the Elimination of All Forms of Discrimination against Women is a critical tool for assisting all of us to understand what gender equality and the elimination of discrimination will require. It is a powerful mandate for bringing about concrete changes to realize women's human rights. Adopted in 1979 by the UN General Assembly and ratified by 169 governments, CEDAW sets up an agenda for national action to end gender-based discrimination. CEDAW can be applied in designing responses to HIV/AIDS in order to protect the human rights and fundamental freedoms of women and their families.

UNIFEM calls for:

* Ensuring that all efforts to address HIV/AIDS stigma and discrimination are included in government reports to illustrate how states are meeting their obligations under the CEDAW convention;

* Using of CEDAW as the framework to review laws that provide a legal basis for stigma and discrimination against women living with HIV/AIDS;

* Introducing new laws and strengthening implementation of existing laws against gender-based violence and harmful traditional practices.

Source: UNIFEM website, www.unifem.org

Abstinence: Not Much of a Choice

When it comes to sex education for adolescents, the Bush administration favors abstinence campaigns. And as this official position is paraded at international meetings like an ostrich dressed in evening clothes, the congressional shears are being taken to financial aid promised to organizations that work with a more realistic vision of family planning and the true needs of sexual and reproductive health.

Given the reality of many young people, abstinence is not much of a choice: a third of pregnant teens receiving prenatal care at a Cape Town clinic stated that their first sexual relation was forced, and four out of ten adolescent women in Kenya admitted receiving money, gifts and other favors in exchange for sex. Such situations are not restricted to African countries; they are part of the sexual experiences of many young people throughout the world, from La Havana to Bangkok to New York.

Source: Based on information transmitted on the Gender-aids listserve.