Commission on the Status of Women

Fifty-third Session

15^th Meeting* (AM)

GROWING SCALE, SCOPE OF THREATS TO WOMEN’S HEALTH, ACCESS TO QUALITY HEALTH CARE,

DELIVERING ON PROMISES TO IMPROVE WOMEN’S LIVES, EXPLORED IN WOMEN’S COMMISSION

Stressing the perils of maternal mortality, female genital mutilation, the feminization of HIV/AIDS and a host of other medical-related challenges, health experts from the United Nations system today highlighted good practices and policy recommendations to improve health-care delivery for women and girls worldwide. 

Lynn Collins, Technical Adviser on HIV/AIDS for the United Nations Population Fund (UNFPA), said 10 women worldwide would die during the course of her statement to the Commission, of which 10 per cent would be young women.  Speaking during the Commission’s panel discussion this morning entitled “gender perspectives on global public health:  implementing the internationally agreed development goals, including the Millennium Development Goals”, she said 1 in every 26 women in Africa and 1 in every 7,300 in developed countries risked death during pregnancy or childbirth.  But, according to the World Bank, some 74 per cent of maternal deaths could be prevented with access to emergency obstetric care.  Strengthening health systems, many in dire need of repair, could go a long way to deliver on the global promises for improving the lives of women and girls. 

She said that was particularly true for Goal 5 -- reducing maternal mortality by three quarters and achieving universal access to reproductive health by 2015 –- which had the worst record among the millennium targets in terms of progress.  Providing universal access to contraception to avoid unintended pregnancies, as well as access to skilled care during delivery, and quality emergency obstetric care when needed would save millions of lives.  It would also help nations meet Goal 4 on child survival and Goal 6 on HIV/AIDS, including preventing mother-to-child transmission of HIV. 

But health-care workers, often overworked and underpaid, needed more incentives and better salaries to make that happen, she said.  Moreover, the broader health and development agenda must be addressed comprehensively through plans to end such harmful practices as female genital mutilation and child marriage, which often led to HIV and fistula.  More than 80 per cent of Governments had programmes directed towards women in their national AIDS strategies, but they allocated funds for only 50 per cent of them. 

The key to healthier women and girls, asserted Hernan Montenegro, Senior Regional Adviser on Health Systems and Services at the Pan American Health Organization (PAHO)/World Health Organization (WHO), lay in a renewed approach to primary health care.  Universal primary health coverage was needed, he said, noting that an estimated 25 per cent of the Latin American and Caribbean population lacked access to essential health services.  Health-care funding was inadequate and serious problems existed in health expenditures. 

He said that health reforms had been introduced in most countries of the Americas to address rising costs, inefficient and poor-quality services, shrinking public budgets and the changing role of the State.  But most had had limited, mixed or negative results.  What Governments needed to focus on was raising funds and reducing reliance on out-of-pocket payments where health needs were high and making more efficient use of resources.

Advocating service delivery reforms, he said those would reduce maternal mortality, through gender and culturally-sensitive models of care and sustainable human resources policies, which solved the problems of migration, he said.  Federal Governments should also consider legislating and enforcing measures that promoted gender equity across all sectors; setting up gender equity units within the central administration and supporting innovative Government management models that encouraged cooperation across different sectors.  They should also implement a formal mechanism for social participation in health at all levels; ensure that women and girls were fairly represented in social participation bodies; strengthen the “steering role” of health authorities at local, national and regional levels; and disaggregate health data by sex and variables such as age and ethnicity.

Agreeing with those recommendations, Anjana Bhushan, Technical Officer in the Division for Health Sector Development in the WHO’s Western Pacific Regional Office, said that gender was a strong determinant of health and access to social services.  That had been illustrated by the 2004 National Tuberculosis Programme in Viet Nam, which had set up a recording and reporting system for data disaggregated by sex -- key to making health systems gender responsive.  The data team found “striking” variations in trends in the male-female ratio of the disease, and women were likely to be constrained by distance and transport barriers in getting help.  Health systems must recognize and cater to those differences and include health concerns particular to women in clinical trials.  Systematic gender analysis using gender-sensitive methods was also needed.

She also suggested gender-responsive approaches in health financing to ensure that resources were maintained –- and not reduced -– during economic crises, and that gender-responsive budgeting ensured adequate resources to make services affordable for women.  The skills of health workers should be strengthened, and workforce policies should recognize women’s contributions in formal and informal care.  In the area of leadership and governance, health policies must promote intersectoral action for gender equality and involve the private sector.  WHO’s conceptual framework to strengthen health systems comprised financing, health workforce, information, medical products and technologies, service delivery and leadership, and governance, while its gender mainstreaming strategy aimed to focus attention on gender in all health policies and programmes.

In opening remarks during the panel, Sylvie Lucas, President of the Economic and Social Council, worried that, despite progress in increasing women’s and girls’ access to health care and services over recent decades, their full and equal access to quality health care remained a challenge in many parts of the world.  Efforts to improve health equity must take gender equality into account.  Gender discrimination led to many health hazards, including violence and sexually transmitted infections, such as HIV/AIDS.  The Millennium Development Goals would not be reached if the health needs and priorities of women and girls were not comprehensively addressed through health system reform.

Participating in the interactive discussion that followed the panellists’ statements were the representatives of South Africa, Czech Republic (on behalf of the European Union), Republic of Korea, Indonesia, Saudi Arabia, Gabon, China, Egypt, Japan, Eritrea and Guinea.

Representatives of the International Organization on Migration and the Medical Women’s Association also spoke.

Commission Chairperson Olivier Belle ( Belgium) moderated the panel.

The Commission will reconvene at 10 a.m. on Friday, 13 March, to conclude its fifty-third session.

Interactive Panel

Launching the panel, Commission Chairperson OLIVIER BELLE ( Belgium) said evidence suggested that gender inequality reduced women’s potential for worldwide access to health care and achieving the best possible level of health.  Discrimination against women led to various health hazards -- including sexual violence and HIV/AIDS -– and was often rooted in socio-cultural factors that included unequal power relations between women and men.  Effective health systems were critical to achieving the Millennium Development Goals related to health.

He said improving global health required a multisectoral approach in which public policies, in such sectors as education and employment, and policies on gender equality and social inclusion contributed to health outcomes for women and men.  While women-specific targeted interventions were needed to improve women’s health, mainstreaming gender perspectives into health policies was critical.  Moreover, a stronger focus on gender-sensitive research and data collection on women’s health was needed to inform policy development.  Increased attention also should be given to gender-responsive budgeting processes in the health sector, particularly in the context of the global financial crisis.

SYLVIE LUCAS, President of the Economic and Social Council, said that, despite progress in increasing women’s and girls’ access to health care and services over recent decades, their full and equal access to quality health care remained a challenged in many parts of the world.  According to the World Health Organization (WHO), the main barriers were the costs of seeking care; lack of information and knowledge; lack of empowerment; inaccessible and poor quality services; and unresponsive service providers.  Efforts to improve health equity must take gender equality into account.  Gender discrimination led to many health hazards, including violence and sexually transmitted infections, such as HIV/AIDS.  The Millennium Development Goals would not be reached if the health needs and priorities of women and girls were not comprehensively addressed through health system reform.  Global maternal mortality dropped by less than 1 per cent annually between 1990 and 2005, far below the 5.5 per cent annual drop needed to reach the millennium target on maternal mortality.

Every day, 16,000 women and more than 10,000 newborns died from preventable complications during pregnancy and childbirth, she said.  The HIV epidemic remained particularly devastating for women, especially young women.  In 2007, an estimated 15.5 million women aged 15 years and over were living with HIV worldwide.  But women and girls continued to have different and unequal access to the use of health resources for HIV/AIDS prevention, treatment, care and support.  During food crises, nutrition-related conditions, such as anaemia and other micro-nutrient deficiencies, increased, particularly among women and girls.  Without an adequate global response to the food crisis, the malnutrition, child and maternal mortality and communicable disease would rise.

She said that addressing violence against women from a public health perspective was crucial for developing an adequate multisectoral response.  The current financial crises could have serious implications for women and girls since cuts in public spending in health further reduced their access to basic services, thus increasing their caregiving burdens.  It was essential to address health care from a gender perspective in order to secure women’s and girls’ access to affordable care and social safety nets, and to adopt gender-responsive budgeting processes to ensure adequate resources for women’s and girls’ health, particularly during economic crises. 

Taking the floor as the first panellist, ANJANA BHUSHAN, Technical Officer in the Division for Health Sector Development in the Western Pacific Regional Office of the World Health Organization (WHO), said “gender is a strong determinant of health and access to social services”.

To make that point, she discussed the National Tuberculosis Programme in Viet Nam, conducted in 2004.  The Programme had adopted a key recommendation for making health systems gender responsive:  its routine recording and reporting system was set up to collect and report data disaggregated by sex.  Despite that, data was not routinely analysed for trends or variations across space and time.  Thus, the first lesson was that data must be analysed from a gender perspective and a broader equity perspective.  Once that was done, the team found “striking” variations in trends in the male-female ratio, and an increase in that gap over nine years.  The second lesson concerned the weak evidence base for gender-responsible health policies.  The observed differences between men and women needed to be explored through gender-sensitive methods.

Continuing, she said that, while there were no differences in the amount of time men and women had taken to seek care for their disease, women were likely to be constrained by distance and transport barriers in getting help.  As such, the third lesson was that health systems must recognize and cater to those differences.  Fourth, women might not be diagnosed as promptly as their male counterparts.  Research on health conditions failed to account for crucial differences between men and women.  As such, women and their particular health concerns should be included in clinical trials.  In a related finding, service providers and health systems might need training to recognize and cater to such differences.  Women also faced distinct cultural barriers in access to services, which might not be obvious.  There was thus a need for systematic gender analysis using gender-sensitive methods.

Moving beyond tuberculosis, she said gender was a crucial consideration vis-à-vis other aspects of the health system.  Gender-responsive approaches in health financing could seek to ensure that resources were maintained -– and not reduced -– during economic crises, while gender-responsive budgeting could help ensure adequate resources for the affordability of services for women.  As for the health workforce, she said the skills of health workers should be strengthened, and workforce policies should recognize women’s contributions in both formal and informal care.  In the area of leadership and governance, health policies must promote intersectoral action for gender equality and involve the private sector.

In closing, she said WHO’s conceptual framework to strengthen health systems involved six building blocks:  financing, health workforce, information, medical products and technologies, service delivery and leadership, and governance.  Its gender mainstreaming strategy aimed to focus attention on gender in all health policies and programmes.

HERNAN MONTENEGRO, Senior Regional Adviser on Health Systems and Services at the Pan American Health Organization (PAHO)/WHO, said important progress had been made in health and human development in the Americas region.  Average values for nearly every health indicator had improved in almost every country in the region.  Infant mortality had decreased by about one third; all-cause mortality had dropped 25 per cent in absolute terms; life expectancy had increased, on average, by six years; deaths from communicable diseases and circulatory system diseases had dropped 25 per cent; and deaths from perinatal conditions had fallen 35 per cent.  Still, challenges remained, with some infectious diseases, particularly HIV/AIDS, remaining a significant health concern in nearly all countries and non-communicable diseases on the rise.  Widespread social and economic shifts had caused worsening health inequities.  In health system performance, there was progress in key interventions, such as immunization, attended deliveries and antiretroviral treatment, and increased expenditures.

Many countries, however, had poorly performing health systems and were ill-equipped to deal with current and future challenges, he said.  There were unacceptably low levels of coverage in many areas, a weakened or absent steering role of national health authorities, unacceptably low levels of available funding for health and very high levels of out-of-pocket payments, severe shortages of health workers in some countries and inappropriate skills mix, and a lack of prevention and promotion.  Health reforms had been introduced in most countries of the Americas for a range of reasons, including rising costs, inefficient and poor-quality services, shrinking public budgets and the changing role of the State.  However, despite considerable investments, most had had limited, mixed or negative results.

He said a renewed approach to primary health care was necessary for several reasons, including the recognition that many conditions that had led to the goal of “health for all” still existed.  The rise of new epidemiologic challenges that primary health care must address included globalization, armed conflict, migration and domestic violence.  The need to correct weaknesses in some of the widely divergent approaches to primary health care, and a growing recognition that primary health care had considerably improved health in many countries, were also factors.

Turning to proposed reforms to strengthen primary health coverage, he focused first on universal coverage reforms, saying that an estimated 25 per cent of the Latin American and Caribbean population lacked access to essential health services.  In general, there was a lack of financial resources for health, and serious problems in health expenditures.  While changes in health financing must be tailored to the history and traditions of each country, principles to guide any approach should include raising funds where health needs were high; reducing the reliance on out-of-pocket payments where they were high; and improving the efficiency of resource use.

He said service delivery reforms were also important, particularly for reducing maternal mortality.  Key reforms to consider included implementing gender and culturally-sensitive models of care and developing sustainable human resources policies, particularly directed at solving the problems of migration.  In the area of public policy reforms, countries should consider legislating and enforcing measures that promoted gender equity across all sectors; setting up gender equity units within the central administration and supporting innovative Government management models that encouraged cooperation across different sectors.  Finally, leadership reforms were needed, as the ultimate responsibility for organizing primary health care-based health systems belonged to Government.  Initiatives to pursue should included implementing a formal mechanism for social participation in health at all levels; ensuring that women and girls were fairly represented in social participation bodies; strengthening the “steering role” of health authorities at local, national and regional levels; and disaggregating health data by sex and variables such as age and ethnicity.

LYNN COLLINS, Technical Adviser on HIV/AIDS, United Nations Population Fund (UNFPA), said that, as she spoke, 10 women worldwide would die, of which 10 per cent would be young women.  Sexual and reproductive ill-health accounted for an estimated one third of the global burden of illness and early death of women of reproductive age, and 20 per cent of all people worldwide.  In Africa, it accounted for more than 40 per cent of the disease burden.  The risk of dying as a result of pregnancy and childbirth differed significantly according to economic status, from about 1 in 26 in Africa, to 1 in 7,300 in developed countries.  Even within countries, there was a marked difference in access to skilled birth attendants, a key intervention to improve maternal heath, by a magnitude of six times between the lowest wealth quintile and the upper quintile.  The same difference occurred in terms of family planning.  Not only a right, family planning was essential for improving maternal mortality, reducing unintended pregnancies and limiting recourse to abortion, and lowering the chance of high-risk pregnancy. 

She said that health systems could substantially help alleviate poor health, but they were in dire need of strengthening to effectively deliver on the global promises for improving the lives of women and girls.  Millennium Development Goal number 5, related to reducing maternal mortality, had the worst record in terms of progress.  Three well-defined steps could have the most impact in reaching most health goals.  In terms of maternal health, a simple triad could save women’s lives:  universal access to contraception to avoid unintended pregnancies, access to skilled care during delivery, and rapid access to quality emergency obstetric care when required.  The World Bank estimated that 74 per cent of maternal deaths could be prevented with access to emergency obstetric care. 

The problem was largely due to the lack of adequate health services, she said.  Human resources must be strengthened in number and quality.  There were too few health providers, and many were overworked and underpaid, or not paid at all.  Tasks were being shifted to lower levels of health workers.  Lobbying was needed to give health workers better salaries.  Better deployment of staff was needed to increase coverage to under-served areas, as was capacity-building to train health providers to address, among other things, judgmental and stigmatizing attitudes that some health providers exhibited towards people living with HIV and marginalized communities.  Health services, already overstretched, must cope with the consequences of violence against women, a completely preventable phenomenon.  Violence compromised a women’s ability to negotiate safer sex and prevented her from accessing HIV information, testing, counselling and prevention.  Women must have access to condoms and be able to negotiate their use by their male partners.  Community outreach helped women to access services and know their rights. 

However, strengthening health systems was not enough, she said.  The broader health and development agenda must be addressed comprehensively through plans to end maternal mortality, female genital mutilation and child marriage, which had large consequences for HIV and fistula.  Gender-based violence must be addressed through legal structures and attitudinal changes to promote responsible behaviour among men.  Women and girls often suffered disproportionately during economic downturns, when funding for health services decreased.  More than 80 per cent of Governments had programmes directed towards women in their national AIDS strategies, but they allocated funds for only 50 per cent of them.  That must change.  Family planning was also hugely under-funded.  The health millennium targets 4, 5 and 6 were inextricably linked.  Investing in programmes to reduce maternal mortality by three quarters and achieve universal access to reproductive health by 2015 -- target 5 -- would help achieve target 4 on child survival and target 6 on HIV/AIDS, including preventing mother-to-child transmission of HIV.

Interactive Discussion

In the ensuing discussion, delegates focused their comments on national measures to counteract the negative impacts of the global financial crisis, improve women’s access to affordable -– and quality –- health-care services, fight HIV/AIDS and achieve the Millennium Development Goals, especially those closely related to women and girls.

Questions centred largely on the public health impacts of the global health crisis; specific areas in which to include a gender perspective in international development policies; and what countries could do to develop adequate social safety nets, particularly for women, given the unfolding global financial crisis.

The representative of the Czech Republic, speaking on behalf of the European Union, said the Union, the world’s largest aid donor, attached great importance to effective distribution of development assistance, including public health assistance.  He asked panellists about any health-related gender-sensitive education programmes that could address the problem of women’s access to education and information.  He also asked about areas of public health where the gender-sensitive educational deficit was particularly alarming.

The representative of Saudi Arabia outlined national measures to address violence against women, and asked about health-care initiatives that would take into account socially and religiously sensitive norms.

The representative of Gabon said the maternal mortality rate in her country had risen, particularly because women relied on men’s resources and lacked access to health care.  She asked for more information to address such issues.

The representative of China wondered about public health literacy:  in what way could that contribute to gender-responsive public health policies?

The representative of the International Organization on Migration wondered how health systems could take into account migration as an emerging issue in social welfare.

The representative of the Medical Women’s Association cited a WHO report showing an increased HIV/AIDS prevalence among post-menopausal women, and asked about future strategies to address those issues.

In response, Mr. MONTENEGRO, focusing on the impact of the global crisis on women’s health, said WHO had held a special meeting in January on that issue.  The crisis would expose households in poor countries to increased hardship.  The effects would depend on Government policies and actions.  Potential impacts could include reductions in public and private health spending; reductions in donor financing for health systems; and increased prices of medicines and supplies, due to currency devaluations, which in turn, would lead to increased demand for public services, possibly overwhelming those services.  In terms of health outcomes, one could expect “very bad news”, for example, in increased mental health complications, infant deaths and communicable diseases, among other things.  The emergence of those problems, however, depended on Government responses.

At the same time, he said crises could be used as opportunities to transform health systems and promote fairness for women and girls.  That had been the case in countries including Thailand, the Republic of Korea, Mexico and the United States, where the new Administration was focusing on those issues.

He said public health literacy was “very important”, as it was part of health promotion and disease prevention strategies.  It might be approached through the education sector, the health sector or by taking a whole Government approach.  Regarding financial schemes to protect women, many countries must expand health coverage.  Primary health care was all about universal coverage.  The other dimension was equity:  those with the highest need must receive the most resources.

Ms. BHUSHAN, on the likely public health impact of the global financial crisis, reminded delegates that there were “still a lot of unknowns” about how the crisis would unfold.  Analyses were being continually revised.  Trends could be anticipated, including those mentioned by Mr. Montenegro.  She advised WHO partner countries not to reduce public health spending, which was often inadequate in developing countries.  She recommended that countries examine where Government money was being spent, and prioritize social sector spending.  That would cushion the poverty impacts.

Equally important would be to give higher priority to conditions affecting the poor, and to public health programmes that had a strong public health impact, she said.  There was scope to look at health financing mechanisms that promoted demand for health services, including vouchers.  On social protection, Governments must strengthen programmes to cushion impacts of the crisis on health care.  She urged collection of “rapid evidence” that could inform evidence-based policymaking.  Also, gender-responsive budgeting by Governments would help to ensure a gender-sensitive response to the crisis.

Regarding gender-sensitive education programmes and public health literacy, she said education policies ranged from supply-side to demand-side responses.  There was also a “second generation” set of issues related to gender-responsive curricula, which would avoid the use of stereotypes, for example.

Regarding information for women, she said health promotion often bypassed women, possibly because they had systematically lower access to communication means, including newspapers and radio.  Women’s literacy was typically lower than that of men’s.  Interpersonal communication often was effective in targeting women.  As such, health messages must be effectively targeted.  Regarding migration, she agreed there had been a feminization of migration.  Primary care, with universal access as a core principle, held potential for guidance.  WHO had developed a model code of practice on the migration of health workers, which provided guidelines for both sending and receiving countries.

Ms. COLLINS, on the education sector, said it was no coincidence that two thirds of the 230 million children not in school were girls.  That phenomenon stemmed from their general lower status among families and communities and a direct “logistics” problem.  In some cases, girls could not attend school safely:  they were often attacked and raped.  The economic side of the problem must also be examined.  She also urged an examination of the impact of eliminating school fees, among other things.  As girls entered puberty, they did not have an environment in schools to address menstruation, which could impede their access to education.

She urged doing more to lobby for effective curricula that addressed gender and sexual reproductive health issues.  On issues that were often sensitive to tackle, she focused on female genital mutilation, which was carried out in some 30 countries.  Successful programmes to eliminate it must be firmly rooted in addressing the reasons it was being performed in any given culture.  At times, it was related to a rite of passage; at other times, there was a cost-incentive to perform it, in which case, she urged finding other ways to empower practitioners.  Safe havens must be created for girls who escaped, and programmes to inform boys must be implemented.

Regarding financial empowerment, she said the links between poverty and sexual and reproductive health were clear.  Financial empowerment led to gender-based empowerment.  Health services could reorganize to “hit the lower quintile of women” who needed them the most.  Microfinance programmes had shown promise, as had income-generation projects to prevent HIV/AIDS among girls.

Regarding migration, she said about half of all migrants were women and, fortunately, there had been improvements in employment opportunities.  However, there also was an increased burgeoning of slums, which had implications for basic public health facilities.  In cases where migration was due to conflict or natural disasters, more had to be done to protect women.  “Pregnancy goes on”, she said, and her organization had worked with WHO to address emergency deliveries, as a way to prevent maternal mortality.

Noting that HIV had “been around since 1981”, she said there was a need to increase awareness among all public health specialists of risks associated with post-menopausal women.  They must assume that women of post-menopausal age were having sex and caution them that their vulnerability to the disease continued.  Engaging couples in raising awareness was another trend, and she particularly urged involving men in such issues.  Gender-responsive budgeting was also needed.

Japan’s representative asked the panellists to elaborate on good practices in gender training of medical professionals.  That input would benefit Japanese medical personnel at home and those working abroad on official development assistance (ODA) programmes.

Eritrea’s representative asked them to comment on the fact that mega-corporations were not allowing developing countries to own or produce different medications, particularly to treat HIV/AIDS. 

In response, Ms. COLLINS said health providers often experienced “burnout”.  Long hours, the large number of patients and insufficient supplies were de-motivating factors.  Low salaries led to brain drain, with doctors in developing countries seeking better-paid jobs in the industrialized world.  She lauded the “facilitated supervision technique”, in which supervisors, rather than criticizing a health provider’s individual performance, discussed what issues in the provider’s job were affecting it.  Psychological counselling was also extremely important, as was training health providers to understand people’s gender-related attitudes and judgements.  A reproductive rights-based approach went a long way in addressing social attitudes, as it enabled patients to understand their rights and health providers to help them exercise those rights.  Assumptions made by health professionals must end.  For example, they could not assume that post-menopausal women were no longer sexually active and, therefore, not at risk for HIV/AIDS.

Ms. BHUSHAN said that, although much information existed on gender mainstreaming in general, little of it was specific to health.  WHO had devised three packages in that regard.  Its three-day gender mainstreaming package targeted health practitioners and policymakers, encouraging them to conduct gender analysis in specific health conditions and areas.  WHO’s “transforming health systems” package provided a three-week training on gender in reproductive health rights.  The sexual and reproductive health module targeted health professionals with a “what, where and how” approach, which documented what evidence linked issues at hand with poverty and gender, what the benefits were from a health perspective, and how health-care professionals could address those issues in their work.  But the evidence based on the “how”, in terms of the impact in reducing health inequities, was still too weak.

In terms of HIV/AIDS drugs, she said that high-level international negotiations with pharmaceutical firms had led to a drop in drug costs per patient, from tens of thousands of dollars to just a few hundred dollars annually.  The same thing must be done with drugs for important health conditions.  WHO had developed a list of essential medicines and it was working with countries worldwide to set up national medicine policies to try to keep prices affordable and supplies available.  The Office of the Special Rapporteur on Health and Human Rights had done groundbreaking work in that regard and had devised a code of practice for pharmaceutical companies.

Mr. MONTENEGRO said universal coverage for medicine was needed to address equity issues.  He pointed to the case in the United States whereby an elderly man froze to death because his local utility company had cut the electricity supply during a harsh winter.  Universal access to coverage would have prevented that.  In terms of gender training for health professionals, Governments in Cuba and elsewhere in the region worked closely with universities.  But many did not.  It was necessary to work together to improve the competence level of health-care professionals.  A virtual course was being developed for the region for that purpose.  The health crisis provided an opportunity for countries to reform their health systems.  The Americas had a rotating fund to negotiate better prices with pharmaceutical companies so countries could really benefit by being able to procure larger volumes of medication.  But they still faced strong opposition from some drug makers.  

Guinea’s representative asked the panellists to elaborate on the fact that women often shouldered the blame for HIV infection and were physically abused and stigmatized for it, particularly by their male partners.  Fearing retribution, women often hid their HIV status from men, who infected their wives and went on to infect other women. 

Ms. COLLINS said indeed the international community had not yet been able to tackle such issues effectively.  The concept of stigma and discrimination must be addressed so that people were not afraid to come forward out of fear of being attacked, refused a job or a date, or thrown out of their homes.  That also required better access to antiretroviral drugs so that HIV-positive people could lead normal lives.  The “stigma index” was designed to discuss with people living with HIV their experiences and to address legal issues, such as obtaining visas.  Their input could then be used to devise programmes to address that stigma and discrimination.  HIV/AIDS testing and counselling programmes must be better integrated into all health programmes.  She also recommended transparency, whereby women were told about their HIV-positive status in the presence of their male partners and the men were encouraged to support them.

Ms. BHUSHAN said WHO had started a “provider-initiated counselling and testing programme”, in which providers began counselling immediately after a person tested positive for HIV.  The fact that women took the blame for HIV and, as a result, were reluctant to disclose their HIV status, was a women’s empowerment issue.  The challenge lay in improving women’s awareness about risk and transmission and improving women’s status within the family.  The burnout that was felt by girls and women for caring for relatives with HIV/AIDS was particularly well-documented in Africa and was linked to the shortage of health-care workers in Africa.  WHO was working to improve the situation and reduce the shortage of health-care workers across the continent. 

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*     The 14^th Meeting was closed.

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