The 53rd session of the annual United Nations Commission on the Status of Women is focused on the theme “The equal sharing of responsibilities between women and men, including caregiving in the context of HIV and AIDS”.
The meeting provides a critical opportunity for governments and civil society to generate proposals that might address the enormous and debilitating physical and emotional burden of care borne by women and girls across the world, especially in countries which are hard hit by HIV and AIDS, like South Africa.
The disproportionate burden of care has a crushing impact on women and girls. In South Africa, a national time-use survey found that women carry out eight times more care work (for all illnesses) than men and surveys show that over two-thirds of primary caregivers for people living with AIDS are women. Orphan care is also highly gendered; in households where the mother has died, only 30 per cent of surviving fathers are present, whereas in those where the father has died, 71 per cent of surviving mothers are present. In addition to the physical and emotional toll of care work, women who have to stay at home to perform care work are less able to seek other forms of paid work, and if they are already employed, they face enormous difficulties juggling their care duties with their work obligations and sometimes have to give up their jobs. This weakens them economically and leaves them more dependent upon their husbands, thereby strengthening gender inequality in the household.
Sadly, the pronouncements made on behalf of the South African government delegation to the 2009 UN CSW by Manto Tshabalala Msimang, the former Minister of Health and now the Minister in the Presidency, have once again undermined South Africa’s credibility in the international community and stand in stark contradiction to the priorities laid out in the National Strategic Plan on HIV and AIDS.
Her destructive role at the CSW also serves as a reminder of how important it is that the ruling party follow through with their commitment to getting rid of cabinet members who fail to deliver on their mandate. We’ve seen this week what it costs the country when loyalty trumps competence.
The South African delegation arrived in New York with its work cut out for it. The 2007-2011 National Strategic Plan on HIV and AIDS sets clear and ambitious prevention and treatment goals aimed at reducing the care burden. The NSP commits government to 1) “reducing the number of new HIV infections by 50% and 2) reducing “HIV and AIDS morbidity and mortality as well as its socioeconomic impacts by providing appropriate packages of treatment, care and support to 80% of HIV positive people and their families by 2011”. The NSP also resolves to “recruit and train new community care givers, with emphasis on men”, and sets a numeric target of increasing men’s involvement by 20% by 2011.
Despite the ambitious targets set in the NSP, both the treatment backlog and the burden of AIDS care continue to grow. According to a report released in October of 2008 by the South African National AIDS Council “there has been an 87% rise in the number of deaths reported between 1997 and 2005 and deaths among those aged 25-49 has risen by 169%, surging from contributing 30% of all deaths in 1997 to 42% by 2005. This can only be explained by the HIV epidemic.” The document also reports that only 28 percent of people who need access to treatment currently have it and this, the report points out, is “below the global average for low- and middle-income countries”. The report also argues that “from a national perspective, South Africa has largely failed in the prevention of mother to child transmission (PMTCT) of HIV due to the very uneven access women enjoy to both HIV testing and to the PMTCT services that should follow .” At the end of February 2009, the province of the Free State had stopped enrolling new patients on treatment due to a stock-out of ARVs with predictable consequences on those providing AIDS related care and support.
Instead of using the CSW as an opportunity to find solutions to these problems, Minister Tshabalala-Msimang has used every opportunity to resurrect her now thoroughly discredited positions on treatment toxicity, and “alternative remedies”, urging the international community “to invest more resources into basic science research” and “affordable alternatives such as complementary and traditional medicines, as well as nutrition” and raising concerns about “drug surveillance and pharmacovigilance capacity” which she exhorted “surely must be our comprehensive and collective shared responsibility between men and women of conscience”. Here it’s worth keeping in mind that the most reputable academic journal on HIV and AIDS, The Journal of AIDS, indicates that her department’s failures to implement effective treatment strategies cost 330,000 people their lives.
Her intransigence not only infuriated members of the South African delegation who wandered the halls in a mix of disbelief and quiet fury, it also meant that critical opportunities were squandered. Throughout the CSW proceedings the US stock market plumbed new lows. Instead of using the CSW to strengthen commitments to foreign aid made by the US and other governments prior to the financial collapse, we watched as Manto distracted the delegation from it work.
Manto has indicated that she will not remain in office after the elections. Given her role at the CSW, she can not be allowed to. Instead civil society will have to work hard to ensure that the Department of Health and the Office on the Status of Women provide real leadership to implement the conclusions that will emerge at the CSW on the care economy. After years of focusing on treatment and prevention, it’s time we paid equal attention to AIDS care and to alleviating the tremendous burden borne by women and children.
This will entail following through on the commitments agreed to in the NSP especially in three priority areas:
1) strengthening the capacity of the health sector;
2) implementing effective HIV prevention and treatment strategies, including integrating a focus on risk reduction and gender equality into male circumcision strategies and then rolling male circumcision out as part of a comprehensive HIV prevention strategy and
3) implementing the various strategies South Africa has committed to increase the involvement of men and boys in achieving gender equality, including full participation in AIDS related home and community based care.