Women and Girls and HIV Gender Equality

July 25, 2012

SECRETARY SEBELIUS: Well, good evening, everybody. I’m delighted to have a chance to join you tonight for this important discussion, and I want to start by thanking Lois Quam for her leadership in the Global Health Initiative on behalf of President Obama, and to acknowledge the fact that while the initiative has been underway for some time, the additional feature that Lois is bringing to the fore is the work around women and girls and maternal health and gender violence. That’s an important addition to the Global Health Initiative and one that we’re pleased about.

I know that you will enjoy this panel of expertise, national and international. I have to, though, particularly thank my colleague Tom Frieden, who is the CDC director and whose team does such an amazing job across the globe. And I know others are here from the CDC team. And recognize also that Dr. Nils Daulaire who leads our Global Affairs Office, who has been instrumental in helping to keep the HHS team very much engaged in the discussions that have taken place this year.

It’s a thrill to have this conference back in the United States after a 22-year absence, and I think it is part of the reason that the discussions have been optimistic and energetic. It’s a new day. It’s a new day in the science front. It’s a new day in the battle against HIV and AIDS. What has been done in the last decade is remarkable, and I think it has to go down as one of the great public health achievements of the past number of decades. And we are closer to the goal of an AIDS-free generation than ever before. Around the world, new infections are falling. The ranks of those on treatment are growing rapidly. And in countries where AIDS has taken its greatest toll, life expectancies are beginning to rise once again. A generation of new leaders is emerging who once would have been facing a death sentence.

But as we’ve fought this disease, one of the challenges that we’ve seen is the evolving face of the epidemic. What once was a disease affecting mostly gay men now affects women in increasingly large numbers. Globally, AIDS is the leading cause of death for women of reproductive age, the leading cause of death. And in Sub-Saharan Africa, women and girls currently represent 60 percent of the persons living with HIV. Right here in Washington, D.C., African American women represent 92 percent of the women living with HIV, and in some of the poorest districts here in D.C., the infection rate is running above 12 percent.

Now there are many reasons for these trends. We know that women are less likely to have the economic resources they need to get protection and care. Women often face a far greater stigma around HIV than men, and so are reluctant often to come forward for care. And if a couple has the disease, it’s often assumed wrongly that the woman is to blame. Women and girls are all too frequently victimized by domestic violence and sexual assault, which increases their risk of infection. We can’t possibly achieve our goal of an AIDS-free generation unless we also address the specific challenges that keep women from getting the support and care they need. And that’s exactly what we’re trying to do here in the United States.

For example, we’ve launched a new federal work group focused on HIV/AIDS, violence against women, and gender-related health disparities. This spring, the President’s Advisory Council on AIDS passed a resolution on the needs of women at risk and living with HIV, and it calls on our Department to focus our national efforts on reducing new infections among women and increasing access to care for women living with HIV, to update our national strategy. We’re studying the best programs that address these challenges and are looking right now for ways to bring them to scale. We’re in the process of training domestic violence counselors to incorporate HIV/AIDS risk reduction strategies into the very important work they’re already doing. We’re giving HIV/AIDS service providers the tools to spot signs of abuse and violence. And we’re engaging men and boys in meaningful conversation about the prevention, treatment, and care of women.

We’re also working to end the systematic discrimination against women here in the United States in the health insurance market, thanks to the historic healthcare law. It will soon be illegal for the industry to lock people out of the market because they are HIV-positive, pregnant, or a victim of domestic abuse, and that’s very important. (Applause.) Most plans will be required to cover key preventive care and recommended screenings like HIV testing with no out-of-pocket costs. And it will be illegal to charge women what is currently charged in the market, often 18 percent more than males pay for exactly the same coverage.

We’re also putting the same focus on women and girls in our work around the world. One of our major priorities has been ending mother-to-child transmission. And we know that by preventing new infant HIV infections and providing antiretroviral treatment to HIV-infected mothers, we can protect children from becoming orphans and help keep families together. Altogether, HHS has invested more than a billion dollars in that effort globally. And in the first half of this fiscal year, we reach more than 370,000 women with treatment globally, putting us on track to hit PEPFAR’s target of reaching an additional 1.5 million by next year.

We’re working hard to make health, safety, and well-being of HIV-positive mothers the centerpiece of our effort. Now, this has a cumulative effect. As more mothers on treatment return to health, HIV becomes known as a manageable chronic condition, and the stigma around the disease diminishes. That, in turn, increases people’s willingness to get tested and learn their own HIV status, creating a virtuous cycle that helps reduce new infections.

Last year on my travels, I was in a Coptic hospital in Kenya, where I met, among the other patients I talked to, an HIV-positive woman. She had unknowingly transmitted her virus to the first child. But then she got involved with care and treatment, and she had a second pregnancy. Her second child was born healthy. The mother is now healthy, too. And as she told me her story, it was so clear how proud she was to have not only found her own path to care and treatment, but given her daughter a healthy start. And we’re working to make sure more moms have just that feeling.

We also are increasing the work we do around the world to confront gender-based violence. We know when it comes to prevention, there is no single answer. A key intervention that helps a woman prevent an infection may be an education campaign that promotes gender equality. It may be access to sexual and reproductive health services. It may be protection from an abusive partner. And it might be economic empowerment that allows women to independently access HIV services. And I think we need to be ready to take an all-of-the-above approach both here in the United States and in our work across the globe.

In South Africa, we’ve seen a microfinance program reduce gender-based violence and HIV risk by incorporating HIV education and gender equity into its mission. And now, we’re bringing that approach back to the United States to support similar microfinancing programming and HIV risk reduction for at-risk African American women.

Too often, gender-based violence is shrouded in silence, making it even harder for victims to reach out for help. By recognizing it, calling it out, and responding with support and care, we can begin to end the devastating cycle. So part of what’s so exciting about this work and our commitment across the Global Health Initiative is the huge payoff that all of us get when we invest in women’s health. Women are the gateways to their communities. Around the world, women are primarily responsible for managing water, nutrition, household resources. They’re responsible for finding and accessing health services for their families and educating their children. And many of them are actually involved with providing healthcare for those around them.

Healthy women lead to healthy communities. Not long after PEPFAR began, a pregnant woman named Stella joined a group for HIV-positive women supported by the program in Abuja, Nigeria. And thanks partly to the group, she was able to get the right antenatal care and have a healthy child. Later, she had a second healthy child, and by this time, Stella had become a leader in the group. She was able to turn and educate many of her peers about the steps they needed to take to protect themselves and their children, advice that was, frankly, must more effective coming from Stella than it would have been from another worker. So by educating one woman about how to be healthy, we were able to improve the health of dozens of Nigerians. That’s a return on investment that any business would envy. There’s a Stella in every neighborhood in the world, in every village, in every community. We need to reach them one at a time and break down the barriers preventing them from getting the care they need. And if we do that, we’ll have taken a huge step toward our ultimate goal of an AIDS-free world. Thank you. (Applause.)

(Video shown.)

MS. GIBSON: I want to start by introducing the great hero of the film, Mandisa. (Applause.) This wonderful video is produced by Global Girl Media. For those of you that don’t know much about it, please go to their website. It is such an impressive initiative, training young, teenage girls around the world to be digital journalists and teaching them how they can harness digital journalism to inspire and affect social change. One of those journalists is now Mandisa. And I want to ask you, Mandisa, for all that you’ve gone through, I think your resilience is probably the most incredible part of this story. What led you, from this horrific experience, into journalism, and how has journalism allowed you to spread the information you want to about HIV and AIDS?

MS. MADIKANE: Firstly, I would like to thank PEPFAR, and secondly, I would like to thank the founders of Global Girl Media, because I think also what I produced and the community where I come from, we look at such opportunities that Global Girl Media gives to us, and when that opportunity came to me, I grabbed it very fast, and it’s an opportunity I don’t want to let go, because I speak for young girls who do not have voices out there. So my experience with Global Girl Media is one of the amazing things, because I think my message is getting – it’s out there very fast, globally, and I’m very surprised that my story’s been shown very far from home. So I would like to thank you all. (Applause.)

MS. GIBSON: Does it – what does the practice of journalism do for you personally? Does it give you purpose?

MS. MADIKANE: It does. It made a big impact into my life, because I never thought of journalism. I was one of those girls at school who wanted to do (inaudible) accounting. But because of at home we do not have money to do those things. And when Global Girl Media came to us as a way to – and when I was introduced to Global Girl Media, I never knew anything about camera, first of all. I never knew anything about journalism. I wasn’t interested in journalism, but when they tell us that we give training and the training was for three weeks, and for that three weeks, I have managed to do all the things. We’ve learned how to use a camera. We’ve learned how to interview people, which is something that I was never interested in. But the knowledge that I have and the knowledge that Global Girl Media does produce through young people, I’ve managed to do things like this. (Applause.)

MS. GIBSON: Your story, in so many ways, touches on all the issues that we’re going to deal with here tonight. I want to go onto an issue that your story sadly illuminates, which is the direct connection between gender-based violence and the insidious spread of HIV and AIDS. And I want to move onto other members of our esteemed panel tonight to talk about this. Ambassador Melanne Verveer, in fact, I had the honor of traveling with her recently to Burma and one of the most memorable stops on that trip was to an AIDS shelter. Wasn’t it, Melanne? I think we’ll never get over it. I’d love to hear from you about what the State Department is doing with respect to gender-based violence, specifically.

AMBASSADOR VERVEER: Let me first of all say I have never seen a more extraordinary profile of from pain to power as Mandisa represents. So thank you so much for making that transition and saving so many other girls in the process. This is a really difficult topic, because it is a global pandemic. It is one that extracts a tremendous toll. You saw one example of it. And when it comes to HIV/AIDS, the risk of HIV for women is three times greater for those who have been subjected to sexual gender-based violence. And we have to do a better job, in my view, of connecting this issue, which is sometimes siloed, sometimes isolated, sometimes pushed to the side from the bigger discussions that we have. And I’m glad we’re discussing it tonight for that reason, because it’s a very serious public health issue along with all of the other negative consequences that we see from it.

Adolescent girls are extremely vulnerable, and just as listening to Mandisa now, I remember several years ago being with a group of young women from different countries in Africa who had come together, and they discussed how vulnerable they are every waking moment of their lives and even when they’re not awake – in school, at home, walking from place to place and what they have to do to protect themselves and to be safe and really to conquer this evil that is all around them. And I think the kinds of interventions that can be made to help adolescents to ward that off is critically important. Thanks to Dr. Goosby’s great leadership, he has seen the connection all too often between the HIV infection and gender-based violence and we have a program together focused on small grants made available to NGOs who are doing extraordinary work in the context of prevention, care, and treatment.

There’s another program that some of you heard about, know about, that has engaged private partners and Gary Cohen is here from BD, as well as CDC, and you’ll hear more about it – called Together for Girls, which, again, does intensive work on the ground serving the magnitude of the problem. And you might think, well, that’s a waste of time. Well, it’s not. Because once that exercise is demonstrated to leaders, they can do nothing but begin to address a problem that many of them have frankly ignored.

Shortly, the White House will announce a strategy, a global strategy, to deal with violence against women and girls that will focus on prevention, protection, as well as accountability, the need to prosecute what happens in these instances. But I would just make a plea – and I look at this extraordinary audience of people, all of whom could be on this stage tonight, because many of you have made just a Herculean effort in this regard.

And I was struck again – I was just in East Asia last week – and I had first had a meeting with a wonderful group in Cambodia – Somaly Mam’s work that she does to help victims of trafficking and other violence. And so many of the adolescent that she was dealing with who now have safe harbor, who have, changing their lives, were being able to live, were HIV, are HIV infected. And just listening to what they have gone through was very searing.

And then I had a discussion with a group of extraordinary health practitioners, all in the field of HIV/AIDS, and nobody, for the longest time, discussed gender-based violence – sexual violence, which is so connected to what everybody here is trying to deal with in one way or another. So I think this is a very important connection that’s being made here today.

MS. GIBSON: You mentioned the CDC. Dr. Frieden, I think intuitively those of us that don’t follow this every day, think of gender-based violence as a cultural piece, but the CDC is very directly involved here, isn’t it? I’d love to hear from you. I saw something about clinical platforms and post-rape care. How is the CDC involved in attacking gender-based violence?

DR. FRIEDEN: I think, first, we have many different areas where we need to address the problem, because it’s not going to be solved in any one part of society. It involves many different groups working together. So one of the key aspects is to tell the truth, to bear witness as this very moving video did and as we’re doing with surveys in multiple countries is very difficult to do – not simple – very important that it’s done in a way that preserve the safety of everyone responding.

But those surveys have shown a light that is glaring and disturbing – that one out of three women – girls, has experienced sexual violence before the age of 18, that many boys in one country – one out of seven boys has experienced sexual violence before the age of 18, and that many or most of those who experience the violence, never told anyone.

So I think the first function of public health is to bear witness, to tell the truth. And that leads to the need to make sure that we use our clinical platform – the doctors, the nurses, the outreach workers – to ask about gender-based violence, to prevent gender-based violence, and to provide services for people who have experienced gender-based violence. And in each of those areas, PEPFAR has been a game-changer, as it has been in so many other areas in our ability, for example, for women who are pregnant to encourage partner testing. And you might think, well, if the partner finds out they’re positive, that’s going to make it even worse for the women, and of course, there are very difficult situations. But overall, we find that when partners are more honest with each other, gender-based violence decreases, the likelihood of a curative treatment dramatically increases, and women can live a freer life.

(Inaudible) speaks about freedom and about violence, and we have many ways in which women experience violence in all of our societies. And in Africa, until we really begin to reverse that, we’re going to have a great deal of difficulty dramatically improving the situation with the spread of HIV. One out of three girls experiencing gender-based violence is just unacceptable, and by shining a light on that, we’ve enabled society to come together in Tanzania, in Swaziland, in Kenya, we’ve done surveys, we’ve involved community leaders, we’ve involved political leaders, and ultimately, to be able to say this is unacceptable and it’s a crime, and not only are we going to do something about it, but we’re going to track whether we’re successful in reversing it not only in terms of prevention, but also in terms of the care that victims get in healthcare facilities. In Mozambique, we’ve worked with the Ministry of Health to make sure that every victim of gender-based violence gets a comprehensive package of services, including post-exposure prophylaxis, including counseling. And in the society more broadly, saying how can we prevent? How can we identify structural factors?

And I want to highlight alcohol among others. Alcohol is not an excuse for anyone’s behavior. At the same time, we know that more alcohol means more violence, and particularly binge drinking. It’s a driving force behind the HIV epidemic in this country and globally. And there things we can do to reduce harmful alcohol use, there are things we can do to reduce the social acceptability of any form of violence, and that’s what begins with surveillance or monitoring or bearing witness and ends with accountability to all of us for whether we’re reversing that.

MS. GIBSON: Wow. I would love to spend a day with you on this, how you attack the alcohol piece of this, that’s absolutely a fascinating connection to me. I also just want to ask you briefly, you mentioned boys. And this is something we need to underscore. Again, Mandisa, sadly, her story illuminates the child issue here, the child violence – the stats as I understand them, they’re a little bit (inaudible), but 150 million girls and 75 million boys are victimized by sexual violence before they even reach the age of 18.

I want to move on, quickly, but I did want to ask you, that must be particularly hard – you alluded to this – to get the data from children who are oppressed to begin with, who have been, by definition, been oppressed in this act, and who are probably ostracized. It must be very, very difficult getting those numbers with regard to violence against children, isn’t it?

MR. FRIEDEN: The Together for Girls program, which Ambassador Verveer mentioned earlier, has as one of its core principles, getting systematic information, what’s actually happening, and we’ve been able to work closely with USAID to incorporate a subset of those questions into the wonderful demographic health surveillance surveys, so that we’ll be able to track – because ultimately we need to all be accountable for whether we’re bringing the world’s children into the world in a safe and healthy place.

MS. GIBSON: Dr. Shah, I think most people in here know what PEPFAR means, but I’ll say it again just so everyone does know: The President’s Emergency Plan for AIDS Relief. Talk to me about gender-based violence and PEPFAR, and the specific initiatives that apply to PEPFAR for gender-based violence.

MR. SHAH: Sure. Thank you. First, let me just say it’s an honor to be on this panel and to be with Mandisa and so many others who have fought hard to make this issue visible and under very tough and personal circumstances. Under this Administration, we’ve tried to focus on women and girls and the full range of things we do in development and global health. And PEPFAR’s been a shining success story in that effort. I believe funding over the last two years for gender-based violence within PEPFAR overall is up to $155 million. There are specific programs, including a very innovative $48 million effort in the Great Lake states and in Sub-Saharan Africa to support gender-based violence programming.

And I’ll just say, having the chance to be with some of our grantees and partners that had beneficiaries of those resources, you get to see the impact on a moment-by-moment basis. I was with a group of women and a wonderful Mothers to Mothers program, and I know many of you here have had a chance to have a similar experience. But in a group of 12 new women who are part of this support effort and had just been diagnosed positive with HIV and were pregnant. It was incredible the number of personal stories that had gender-based violence at their roots. And it’s sometimes hard, I think for people who aren’t in – doing this work day to day to fully appreciate the extent and scale of the challenge.

In the camps that formed after the Haiti earthquake, for example, despite the best efforts of an entire international peacekeeping force, there were thousands of cases of rape and gender-based violence. And it highlights the reality that it is precisely in vulnerable populations at their time of greatest vulnerability that you see big spikes in gender-based violence. And it’s why, in addition to the funding and excellent programming through PEPFAR, we’re also in our support for refugee camps and displaced persons camps supporting safe spaces for women, better lighting, better security, better basic management logistics practices that have been shown to reduce that kind of violence by more than 50 percent in those post-traumatic or post-conflict settings.

It’s why, even in our agriculture programs, which will seem very far from the subject of HIV, we actually measure women’s empowerment, because we know every dollar of income earned is just better spent if it goes to women. And it’s true in these areas of work, and it’s true across the board, that a real focus on women, on girls, on the most vulnerable and an honest discussion based on the data that Tom was talking about, about the extent and scale of this problem, is the first step to really make real gains.

MS. GIBSON: I want to bring into the conversation the Deputy Prime Minister of Zimbabwe. We are so honored to have you here. Deputy Prime Minister Khupe, your country – it’s interesting to me because I was in Zimbabwe in 2003. It was a very difficult time for your country; you and I were discussing this. Since then, your country has taken a fascinating lead in prioritizing issues of women and girls with respect to HIV. Why don’t you explain to all of us how that could be, and also whether that could be replicated. Because my understanding, I believe in fact Secretary Sebelius said this, across Sub-Saharan Africa there is 60 percent of those living with HIV are women and girls. What are you doing in Zimbabwe that is so specific and useful for women and girls, and could it be replicated across Sub-Saharan Africa?

DEPUTY PRIME MINISTER KHUPE: Thank you very much. First of all, I’d like to take this opportunity to thank the U.S. Government for the support they’ve given to my country to try and end HIV. And I’d also like to share with you – and I think this is what is happening in all the countries – that women constitute 52 percent of the population. In my country, women contribute more than 80 percent of the gross domestic product in my country. Half of the food consumed in my country comes from a woman’s hand. Women work 10 times harder than men. Women are creators of wealth. (Laughter and applause.)

But if we try to interrogate to say, what is it that the benefit at the end of the day? What is it that we are rewarded with? HIV wears the face of a woman. Poverty wears the face of a woman. Discrimination wears the face of a woman. Inequality wears the face of a woman. In Zimbabwe, currently 1.2 million people are infected with scourge of HIV and AIDS; 600,000 – out of the 1.2 million, 600,000 are women and 150,000 are children. So it is a clear indication that HIV wears the face of a woman. And this is the reason why as a country we’ve come to understand that women are a force to reckon with, and this is why we have made them our focus in our AIDS response.

Currently Zimbabwe reported improved awareness as a result of massive educational programs which have led to behavior change. We also recorded an increase in the use of condoms, and the use of condoms have paid a dividend, and coupled behavior change our prevalence rate reduced from 28 percent to 14 percent. We have more than 500,000 people at the moment who are receiving ARV treatment, but out of the 1.2 million.

And our major focus as well is elimination of new HIV infections among children and keeping the mothers alive. We have made sure that we increase the number of sites for PMTCT from 960 to 1,560. So now women able to go to those areas, and 86 percent of the women received ARV prophylaxis, thereby making sure that there’s no vertical transmission.

So we have done all those things. At the same time as a country, we have introduced (inaudible), It was introduced in 1999. And last year alone, it managed to generate 26 million, and this year we are expecting that it’s going to generate 30 million. So this is the money which is also used to make sure that people, especially women, have good access to ARVs.

But at the same time, I think it is important that when we talk about HIV and AIDS, let’s talk about it within the context of poverty. Because as much as we are giving our women ARV prophylaxis, ARVs, as long as these people do not have food, the medication will do more harm than good. You’ve got – you’re supposed to take that medication with food. So we give them those ARVs. We go out to the villages. Because they do not have food, they end up not taking that medication.

But on the other hand, you are saying, oh, we are assisting Zimbabwe. We are giving them ARVs, but you don’t know that most of the people in the villages are not taking that medication because they do not have food. And I would like to plead, especially with the U.S. Government and other development partners, to say as we give people ARVs, let’s also give them food hampers for the period of the treatment. That’s the only way I think we can try and end HIV.

And at the same time, I strongly believe that it is important that all the men get tested for HIV, because once they’re tested and they start taking medication, they will reduce the viral load, and thereby making sure that we do not have more HIV infections. And if all those things were to be done, believe me you, we will get to zero.

In Zimbabwe again we started the program with male circumcision. As we all know, research shows that HIV – I mean male – men who are male circumcised, they go to 60 percent chance of not getting infected by the scourge of HIV. So in Zimbabwe right now, 50,000 men have gone going through male circumcision. Our target is 1.2 million by the year 2015, and we’re hoping that by then all those men would have been tested. As long as we do all those things, I strongly believe that we can definitely turn the tide and end HIV. (Applause.)

MS. GIBSON: Deputy Prime Minister Khupe, could you explain the GlobalPOWER Women Africa Network and the Harare declaration? Because this is about the global unified approach. I want you to – if you can keep it quite short, I’ve been told that we don’t have that much time – but I would love you to explain what that network is and what the Harare declaration is.

DEPUTY PRIME MINISTER KHUPE: First of all, our touchstone for the GlobalPOWER Women Network is the excellence of Joyce Banda, the President of Malawi, and she has done fantastic at the work to make sure that this network becomes strong. GlobalPOWER Women Network is a network which brings in women from all walks of life, women parliamentarians. And it means that because we realize that our leaders in Africa who have been penning signatures, in so far as (inaudible) are concerned for (inaudible) declarations. But when it comes to implementation, they have done absolutely nothing.

For instance, if you look at the Abuja declaration, they set in 2001 in Abuja and we agreed that we were going to lead from the front to end HIV and that we were going to make sure that 50 percent of their budgets were towards health so that we so that we end HIV. Up to now, very few countries have done that. So we want to hold them accountable. We want to make sure that we transform those signatures into action.

So women who are in the executive where policies are made, where budgets are discussed, will make sure that there is no budget which is passed as long as if it doesn’t take into consideration the needs of women. In parliament as well, women parliamentarians will ensure that no budget is passed, no law is passed, as long as if it doesn’t take into consideration the needs of the women. So this is what GlobalPOWER is all about. We want to hold our leaders accountable, and we will definitely do that to make sure that they transform their signatures into action.

MS. GIBSON: Let’s go to the other side of it. That’s the global power of women. But you must engage – correct me if I’m wrong – men and boys, that this is the piece that sometimes gets overlooked. It’s something at Women in the World we have become – it is now a permanent theme for us is engaging men and boys.

Melanne, I’d like to go to you first and talk to you about what the State Department is doing to engage men and boys.

AMBASSADOR VERVEER: Well, first of all, I love hearing about the global power for women that is getting organized more significantly. But the truth of the matter is the guys have most of the power and they are a big part of the solution to this problem. And fortunately, we have begun to spend more and more effort in bringing in the men and boys to help address an issue.

So many times in a room like this filled with women, this issue will come up. And inevitably, somebody will raise her hand and say, “Why are we discussing this with the women? We know what the problem is, but the men are the solution to this problem.” And I think we are increasingly recognizing that and focused on that in a variety of ways.

Some of those ways involve community awareness, where efforts are made to engage young men in the process of changing the behavioral patterns, that norm of, well, this is just what’s done, to really recognizing that it is not the right thing to do. And I, on subsequent trips to India, began to be followed by this group of young men who were very active and very proud of what they were doing, because they were engaged in their community, they were doing skits, they were bringing men together into this issue. And in the process, the women all said that they were much safer and things had changed dramatically, but the men said they felt proud of themselves and they felt that they were going to behave differently. They saw change in themselves.

I think also because of where the power lies, we really need to persuade through statistics, through hard data, through all of the realities of the by-products of this awful issue, what the consequences are in terms of productivity, in terms of public health, in terms of justice systems. Much more needs to be done by those in power, who need to see this as a power issue. And I really think much of what the business community has done in the United States, for example, BD, tonight’s engagement in this issue and Together for Girls, is an example of that.

I’m not sure we would have passed the Violence Against Women law in the United States ultimately until the business community became engaged at the end after everybody else was in, persuaded some of those who had not yet been persuaded that this was also an economic issue and that there were other high stakes. If they weren’t considering those, they might consider these. And it began to change the equation and it began to change the debate.

So I think we need to do more of that, and we need to model a different kind of behavior for boys. And part of that is going to come with educational systems. There are wonderful modules that are being developed that are part of school systems now in many places where a different model of behavior is what is being presented. And I think that is also critically important.

And additionally, I would just say that these are not cultural issues. These are not private matters. These are crimes. And until the impunity is dealt with seriously by justice systems and perpetrators pay a price for what they’ve done, if there’s no price, it will go on. So there’s a lot we need to do with men and boys. They’re a huge part of the solution. And we need to work it in all of the ways we can, and that’s what we’re trying to do.

MS. GIBSON: I’ve been told this is going very, very fast and we have very little time left. I do want to ask, Deputy Prime Minister Khupe, about this men and boys issue in Zimbabwe. Is there a – would you say that this is exactly the kind of plan that you would like to incorporate there to engage men and boys about what is happening to their sisters and their daughters?

DEPUTY PRIME MINISTER KHUPE: We are definitely doing that right now, and this is evidenced by the fact that men use condoms more. Zimbabwe recorded the highest use of condoms in the whole world. So it is clear that men now understand the magnitude of this problem, because as long as they now understand when women negotiate for safe sex, they will understand where they are coming from. So I think – I mean, we are also (inaudible) just to make sure that the men and women – I mean men and boys to be comfortable in this role (inaudible).

MS. GIBSON: I want to get into – before we do have to wrap up – institutionalization of these issues, and let’s go to you first, Dr. Shah. If you want to address the men and boys piece you can, but I’d like to know more about – it’s called the Female Empowerment and Gender Equality part of PEPFAR. Could you take us there in terms of how you are institutionalizing these initiatives?

ADMINISTRATOR SHAH: I think the goal, as you’ve heard from the whole panel, is to really make sure that in every effort, in every program, in every attempt to collect data or information, we are making women and girls central to the task. And this is often called gender mainstreaming, which is probably the least effective label for that term, because it’s really about ensuring that resources we spend to help bring about an AIDS-free generation actually achieve that result, or resources that we spend to collect data on – through the demographic and health surveys actually collect the data we need to make management determinations that will help improve health system performance in countries.

So it’s an effort that across the board is allowing us to do a better job of measuring impact on women, doing evaluations of programs that preferentially assess are the benefits accruing to women. A lot of this – a lot of what has been said here has been known for some time, that women are very much the solution, that there are these power imbalances, violence is a huge challenge and a very important problem. But this giant industry that does health and development around the world for decades hasn’t always done a great job of taking that and operationalizing the focus on women. And that’s why we still have many of these problems and some of the inadequacies of how programs are implemented.

So the gender mainstreaming effort is designed to make sure that we’re always measuring impact and understanding impact for women specifically, that we’re designing tools and strategies to reach women, that we’re prioritizing the training of health workers who are women, and doing that across every activity.

MS. GIBSON: I know, Melanne, Ambassador Verveer, you could give us a long answer on this, because the Secretary’s great legacy, I think among many great legacies, will be the institutionalization of policies on behalf of women and girls around the world. And we know about the QDDR, which was unprecedented, calling on all the embassies to basically show what they’re doing. Could you tell me in brief what the legacy is in terms of institutionalization?

AMBASSADOR VERVEER: Well, I think Raj said it well, and the Secretary has made women a critical cornerstone of foreign policy, development, diplomacy. And this has been manifested, as he said, in a very integrative way, both as Raj has done at AID and as is being done at the State Department. And it literally covers every facet of programmatic and policy endeavor, and that the goal is to really ensure that this occurs so that we can make more effective results in whatever we’re doing.

And I’ll just – quickly, one example is in the whole area of women, peace, and security, where President Obama recently promulgated a national action plan for the United States as well as an executive order to accompany it so that we, across our government, from the Defense Department to Homeland Security to HHS, State, and AID, are working to ensure in all the ways that we engage in areas that are in-conflict and post-conflict situations and grave political transitions that we’re factoring in the role that women play.

And one critical area is protection, because as he said with respect to Haiti, women are most vulnerable. And today, in many, many combat activities where the armed groups are engaged, rape as a tool of war is a purposeful strategy and it is a successful strategy. And unless we factor in how to address that and we – which we have been doing in many places now, we’re not going to be able to help address what the victims are going through, those who are besieged by this problem, as well as forcing justice systems to do what they need to do, and to ensure that security sector reform takes place as well. So that’s just one way, but it is across the board.

MS. GIBSON: And CDC is integral to this, isn’t it, the work of the CDC?

DR. FRIEDEN: I think on the one hand, in terms of sustainability and what can ensure that we’re working consistently for a safer world, particularly for women and girls, making sure that the health systems are serving women and girls effectively, whether that’s prevention of mother-to-child transmission and the so-called B-plus regimen, which means that for a woman who is pregnant and HIV-positive, she will receive antiretroviral treatment immediately and for life. This is a game-changer. It protects her, it protects her children, it protects her partners, it protects her community. And getting this accepted as the core policy in more and more countries makes a huge difference.

Expanding access to family planning is crucially important. We know that there are millions of women who do not want to have more children and who do not have the wherewithal to avoid future pregnancies. But beyond the issue of health services is the healthcare system as advocates – not only as advocates for individual patients, but as advocates for social change – change in laws, change in enforcement of the laws, and change in social norms. And that ultimately is the sustainability when the social norms change from this is an acceptable behavior to it is a loathsome and criminal behavior.

MS. GIBSON: We have to wrap it up, but I want to give our journalist and our hero Mandisa the last word. Either as a journalist or as someone who has experienced so much of these issues, how would you – what do you think the headline from this conversation is, Mandisa, if you were to write about it tomorrow or talk about it?

MS. MADIKANE: If I have to write about it, I would say that things are happening, people are aware, and I think we all push. And when I say comes from push, I say perseverance where some things happen, and this is what is happening now. So if I have to write it, you’ll just have to log into my blog, and you will hear everything. (Laughter and applause.)

MS. GIBSON: I’ll be reading you and watching you. I admire you. As an old journalist, I truly admire your work.

I now have the honor of introducing Ambassador Eric Goosby. Most of you know his role. He has, for the past three years, been our United States Global AIDS Coordinator. He directs the U.S. strategy for addressing HIV around the world. And he lead’s President Obama’s PEPFAR on implementation. He has been involved for 25 years on the frontlines in fighting AIDS and HIV. As a medical doctor, he was there at San Francisco General Hospital. Some of you here might be old enough to remember when it was the true frontlines, when this crisis was exploding in the early ‘80s. And I haven’t had a chance to meet Ambassador Goosby, but I believe I – as a Nightline producer covering AIDS back in the early ‘80s, I interviewed you, actually, at San Francisco General all those years ago.

So since that time, Ambassador Goosby has been not only a medical doctor treating AIDS patients, but of course, formulating AIDS policy for the United States and around the world. And it is my honor to introduce Ambassador Eric Goosby. (Applause.)

AMBASSADOR GOOSBY: Thank you so much. It’s wonderful to have a panel that is full of friends, colleagues, mentors, and to have learned so much from all of you in this discussion. It was very revealing, and thank you for the candor and willingness to share the emotional connection to all of it, and I think we all felt that. I also want to recognize our Representative Jan Schakowsky who just came in during the discussion. Please acknowledge her. Thank you. (Applause.) Thank you, Representative.

Well, I missed Secretary Sebelius, but I caught her as she walked out of the discussion. But my really good friends Tom Frieden and Raj Shah and, of course, Ambassador Verveer who has been just wonderful on this issue, Lois Quam who is in the audience. I sat next to her when we came in. I also would like to thank the Deputy Prime Minister – really profoundly inspiring energy and your commitment and your knowledge and your, I think, clarity of vision, and that’s, along with what you said, it was really inspiring to hear. And our wonderful reporter and someone who has given true testimony to these terrible issues.

I also want to acknowledge representatives from PEPFAR and its implementing agencies – of course, USAID, CDC, Department of Defense, Peace Corps, who contribute really daily, hourly, to PEPFAR’s successes. This is about us all coming together to make this program go to ground, and it is all through our implementing country partners that we are able to realize these services. I’d like to recognize our friends from Becton, Dickinson and Company for contributing to this effort in the global sense, but also for the exhibits that they’ve put here tonight to highlight women and girls’ health issues.

As you’ve heard this evening, HIV/AIDS is not just a health issue. It’s really a social issue that impacts men and women differently, and it’s an issue linked with and affected by gender inequity. Our success in fighting this epidemic is tied to our ability to recognize, and most importantly, to respond to this reality. As Secretary Clinton stated on Monday, women want to protect themselves from HIV and they want to access adequate healthcare. PEPFAR is an integral part of our government’s comprehensive effort to meet the health needs of women and girls working across the government and with our partners on HIV, maternal and child health, and reproductive health, including voluntary family planning.

I’m proud that PEPFAR has been a global leader in trying to address these issues, working to integrate a gender lens into our prevention, care, and treatment programs. PEPFAR remains committed to preventing and responding to gender-based violence which fosters the spread of HIV by limiting one’s ability to negotiate safe sexual practices, disclose HIV status, and access services. As you’ve heard from the panel, we’ve responded by integrating gender-based violence prevention and response into our HIV programs. Over the last two-and-a-half years, PEPFAR has invested over $155 million, as Raj was saying, in this area, and that investment continues to grow as we learn more about how best to address these issues within our clinical and community activities.

And we’re starting to have an impact on the programmatic level. In FY11, PEPFAR supported post-exposure prophylaxis to prevent HIV infection for survivals of violence to over 47,000 people, nearly 34 percent of them the year before, an increase. That’s a staggering number, a shocking number. Though the national surveys on violence against children in Tanzania and Swazi undertaken by the Together for Girls partnership that Melanne referred to are also learning about the nature and extent of sexual violence experienced by girls and boys, this data makes it clear that our programmatic efforts need to be better tailored to respond to the needs of young people.

So this evening, I am pleased to announce new PEPFAR funding to support the Together for Girls partnership. PEPFAR will provide $5 million to support programming in response to the data produced by Together for Girls surveys. Our goal is to help partner governments and communities develop and strengthen their response to gender-based violence against girls, recognizing the special needs of these populations, and the complex challenges involved in meeting them.

While we’re on the topic of good news, let me also state that PEPFAR has also funded the re-launch of the What Works for Women website. This website provides strategies and evidence on a wide range of HIV programming for women and girls, especially across HIV technical areas. After nearly three decades of reviewing the evidence, the What Works team has identified and documented numerous HIV prevention care and treatment interventions that work and that are focused or specific for women and girls. Computer kiosks are located here tonight to display this website and I urge you all to use this valuable resource.

It’s my hope that the What Works for Girls website, as well as PEPFAR support for Together for Girls partnership, will improve health for women, men, boys, and girls so that all can harness and fulfill their full potential. Tonight, in the presence of representatives from countries all over the world, from government and UN agencies, civil society and the private sector, we celebrate all that we’ve accomplished in improving the health of women and girls and commit that there is much more to be done.

I hope that tonight’s event helps to reaffirm the commitment we need to achieve the Obama Administration’s commitment to an AIDS-free generation. I want to truly thank you all for the engagement on this vital issue tonight, and I hope that you’re able to enjoy the evening. Thank you very much. (Applause.)

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