Adjournment speech, Tuesday 28 February 2012
I will now move on to the issue of population health. In December last year I was fortunate to travel to Bangkok to participate in the Asian Forum of Parliamentarians on Population and Development Focus Group on Population Policy Tracking and Monitoring. The participants of this focus group were a diverse group, ranging from academics to politicians from a number of countries, and were focused on one key outcome: to brainstorm and develop new ideas in monitoring and improving population policy geared towards managing HIV and population health. A key focus of the conference was the need to create new policy directions in managing population health and the spread of HIV. There is an increasing recognition of the need for policies that recognise the interconnection between HIV and other sexual and reproductive health issues, including gendered power inequalities such as violence against women. This message was reiterated in the formal part of the events I attended as well as in many of the one-to-one discussions and small group meetings I participated in.
According to the UN Family Planning Association, one-third of all illness among women aged 15 to 44 years in developing countries is related to pregnancy, childbirth, abortion, reproductive tract infections and HIV/AIDS. These health issues do not occur in isolation from each other. The push for greater integration of HIV related policies and access to sexual and reproductive health care comes 16 years after the introduction of the AusAID funding restrictions on family planning programs, championed by former senator Mr Brian Harradine. These restrictions, in place for 13 years, until 2009, forbade AusAID from funding any organisation that provided any form of education about abortion, even when a woman's life was at risk, and even restricted education about and access to some forms of contraceptives.
As a consequence of those restrictions, which echo a similar policy in the US, HIV awareness, family planning, and sexual and reproductive health were treated as separate issues, severely compromising women's ability to access comprehensive sexual and reproductive health care and advice. This meant that healthcare staff in countries already ravaged by HIV were being trained in reproductive health without also being trained in effectively understanding and dealing with HIV and the sociocultural factors contributing to its spread. The reverse was also true: people were being trained in HIV and AIDS treatment without a comprehensive understanding of sexual and reproductive health. The AusAID restrictions persisted for 13 years despite the fact that, according to the UNFPA, 70,000 women each year die from unsafe abortions, while many more suffer from infections and other complications. Although most of these restrictions were lifted in 2009, the effects of such policies in communities are ongoing.
We know there is clear evidence linking HIV to power inequalities between men and women. Gender based violence is both a cause and a consequence of HIV infection. Women living with HIV experience greater stigma and discrimination than men and are often accused of bringing HIV into the household. In sub-Saharan Africa, women are often reluctant to get tested for HIV or to share their results for fear of being punished with violence. Domestic violence also affects women's ability to negotiate safe sex or refuse unwanted sex, and to access and maintain treatment for HIV. These are just a few of countless examples of gender based power inequalities that act as drivers of HIV. Yet, largely as a result of the politicisation of population and development policies, such issues generally continue to be ignored as factors that must be addressed in order to combat the spread of HIV and improve women's sexual and reproductive health rights. Programs and policies addressing HIV, gender based violence and access to sexual and reproductive health largely continue to operate separately. This means the wellbeing of women who are affected by multiple issues, for example, a pregnant woman who is also HIV positive or a woman at risk of infection as result of domestic violence, is severely compromised.
While in Bangkok, I also met with the regional director and deputy of United Nations Women, and with Susan Paxton, the director of a HIV-positive women's network called Positive Response. The real-life stories that they related of women living with HIV illustrate the consequences of a lack of integrated health care. Positive Response had, for example, collected stories of women presenting at hospitals and clinics while experiencing difficulties in childbirth and being denied access because of their HIV-positive status. One story involved a doctor attempting to push a child back inside its mother during delivery for fear the mother's blood would 'contaminate' the ward.
Two stories published by UN Women illustrate the reality for many women. One is the story of Prema, a young woman who experienced isolation and discrimination as a result of her HIV status, and the other concerns a young Indian widow. Prema is a mother of two sons. Prema and her husband, Krishna, were content with two children and Prema asked the hospital staff who delivered her second child to perform sterilisation immediately after the birth. However after the nurse took a blood test, Prema was inexplicably asked to leave the hospital immediately. Her husband took her newborn son away from her and forbade her from breastfeeding or even holding him. He later told Prema that she had tested positive for HIV. The whole household kept their distance from Prema, including her husband. She was prevented from seeing her children, given no medical care and, as her health worsened, her husband told her that she would die soon.
When Prema's family was eventually informed of her condition, her brother came rushing to her side and took her away from the home. He had heard of the positive work that the local AIDS Centre was doing. There, the doctor was horrified at the treatment that Prema had received and that she had been tested for HIV without her consent and had been given no care or advice once her positive result came through. Prema's case illustrates the suffering experienced by HIV-positive women who are given inadequate health care steeped in ignorance, and the incredible difference there can be when they are given comprehensive sexual and reproductive health care and education, free of ignorance and stigma.
Another young woman in India tells the story of how she was treated when her husband died, having tested positive to HIV one week before his death. When she too tested positive, her mother-in-law ordered her to leave the family home and accused her of killing her only son. So she was forced to leave with her young daughter, after her in-laws told her they would have kept their grandchild if she had been a son. As a widow, this woman was denied any form of support from her in-laws and could not be provided for by her own family since her sister was shortly to be married and needed money for a dowry. She now lives in a shelter for widows where her daughter plays with the daughters of other HIV-positive women who have been abandoned by their families.
These women's stories illustrate the need to address the interrelatedness of HIV education, family planning and gender power imbalances in creating comprehensive sexual and reproductive health programs. To quote UN Women, at present:
... most national responses to HIV and AIDS see women through a public health lens: either as mothers of unborn children or as sex workers at high risk for sexually-transmitted infections.
We need to recognise the complexity of sexual and reproductive health issues faced by women if we are to get our policy settings right and thereby invest in the programs that really work.
I am glad to see that the heavy restrictions on Australia's funding of sexual and reproductive health services have been largely lifted. I congratulate all those who helped to return the aid policy to one based on an evidence based approach. However, there is still much progress to be made in the area of providing more integrated sexual and reproductive health services. Recognition of this urgent need for better services must occupy a key place in the future directions of HIV policy and I look forward to hearing about the progress AusAID makes in this area.