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.
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