HHS Secretary Sebelius on Empowering Women and Girls


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.

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