NGO and Governmental Response
All United Nations Member States have pledged to adopt measures for the achievement of the UN Millennium Development Goals (MDG), which include promoting gender equality, empowering women and combating HIV. However, basic facts of gender inequality, discrimination, and social stigma impede the effectiveness of most efforts to combat the spread of HIV/AIDS in women around the world.[1]  
 
In many communities where HIV infection of women is prevalent, violence against women is still considered acceptable behavior. As a result, there is a need for interventions aimed at changing societal norms.  These efforts, however, cannot stand alone; they must be implemented alongside effective laws.  Educating communities about safe sex and abstinence is part of the solution, but the burden must ultimately be placed on governments to enforce national laws that criminalize gender violence and abuse.  Furthermore, local law enforcement must be committed to enforcing these laws.
 
In the 2008 report Progress on Implementing the Dublin Declaration on Partnership to Fight HIV/AIDS in Europe and Central Asia, UNAIDS indicated that government responses to HIV/AIDS and its increasing association with women have varied across much of Europe.  Because men continue to be the largest infected population in every country in Europe, most countries’ efforts have been targeted at male groups who continue to be at greatest risk, such as men who have sex with men, and other target groups such as prisoners and injecting drug users (IDU).  Women and girls are not considered target groups in many countries, and in others, gender is not a central focus of efforts aimed at curbing the virus. 
 
Because of different approaches to addressing the problem, and because the available data from this region has not been disaggregated by sex, it is difficult to discern whether the various efforts have been effective in addressing the gender-related impact of HIV/AIDS.  Also, the numbers of Eastern European women believed to be IDU may be grossly underestimated; the figures range from 20% to 40% or higher in some regions.  Without a true knowledge of the extent of the problem, government response is limited in its effectiveness. However, some countries have implemented various initiatives to address this complex issue.
 
To address a direct link between violence and HIV infection, Europe has made available a post-exposure prophylaxis (PEP) and antiretroviral drugs to victims of rape.[2]  The treatment is offered to victims as soon as the rape is reported and lasts up to four weeks.  If administered in a timely manner, it is helpful in preventing HIV transmission.
 
For many years, there has been an active campaign to combat the spread of HIV using the Abstinence – Be Faithful – Use condoms (ABC) model. These efforts are ineffective in cases involving violence against women, as these (and many other) women cannot protect themselves from HIV infection by insisting on fidelity, demanding condom use, or refusing to have sex.  For the abused woman, whose partner is infected with HIV, the availability of a condom does little good, as it is not her decision whether or not her partner will use it.  She may even suffer physical violence for suggesting its use.  Likewise, for the woman who is raped or forced to work in sex trafficking, the availability of condoms or her desire to abstain from sex will not protect her. 
 
In 2010 the UN Development Programme launched the Global Commission on HIV and the Law to address these connections between legislation and HIV responses. The Commission analyses the impact of laws and law enforcement on the lives of people living with HIV; sparking public dialogue about the right-based legal responses to HIV; and providing recommendations for action. The Commission has called attention to the need to address discriminatory laws that disadvantage women affected by HIV: “where the law has guaranteed equal inheritance and property for women and girls, it has helped to mitigate the social and economic burden caused by HIV and AIDS”.[3]
 
Securing women’s land and property rights are an implicit part of achieving the MDGs. States are responsible for respecting, protecting and fulfilling the rights of all persons within their jurisdiction and must do so on the basis of equality and non-discrimination. These obligations to end violence, insecurity, and poverty are critical for women:
 
·         The obligation to respect women’s housing, land and property rights ensures that States do not create discriminatory legal frameworks that result in women’s disinheritance and dispossession of their property and assets.
·         The obligation to protect means that States must put in place a system of protection that prohibits private or third-party actors from violating these rights.
·         The obligation to fulfill means that States must take positive (active) measures that enable and assist women to enjoy their rights. This includes educating women about their human rights. [4]
 
There are numerous international efforts aimed at addressing the HIV epidemic, and several that focus particularly on its impact on women.  The United Nations partners with numerous organizations worldwide that are dedicated to responding to the HIV epidemic.  One such organization is the Global Coalition on Women and AIDS which was established in 2004 to respond to the increasing “feminization” of the AIDS epidemic and the growing concern that existing AIDS strategies did not adequately address women’s needs.  The Coalition is a “worldwide alliance of civil society groups, networks or women living with HIV, women’s organizations, AIDS service organizations, and the United Nations system, committed to strengthening AIDS programming for women and girls.”  It works to provide immediate relief to women infected with HIV, while addressing the underlying, systemic causes of HIV infection among women.  The Coalition aims to:
 
  • Support ongoing efforts towards universal education for girls
  • Secure women’s property and inheritance rights
  • Reduce violence against women
  • Prevent HIV infection by improving access to reproductive healthcare
  • Promote access to prevention options, including female condoms and microbicides
  • Ensure women and girls have equitable access to treatment and care
  • Support women’s work as caregivers within the household and the community
  • Promote women’s leadership in the AIDS response
Another noteworthy initiative is the International Community of Women Living with HIV/AIDS.  This UK charity is the only international network run for and by HIV-positive women.  It was founded “in response to the desperate lack of support, information and services available to women living with HIV worldwide and the need for these women to have influence and input on policy development.”  This organization has empowered HIV-positive women by giving them an opportunity to influence policy.
 
Also of note are the efforts of the World Bank which has provided US$240.5 million towards prevention efforts in Eastern Europe and Central Asia within the last nine years.  From: World Bank. (2009). HIV/AIDS in ECA: Overview.  The organization has funded tuberculosis and AIDS control efforts in Moldova, Russia, Ukraine, Uzbekistan, and Kyrgyzstan and reports positive outcomes as a result of this funding.  For instance, the World Bank reported a 30% decrease within one year (2005-2006) in HIV prevalence among IDUs in Moldova and a 11.4% decrease in the number of HIV-positive pregnant women in Russia since 2003.[5]  
 
The economic crisis, however, undermined the many efforts of NGOs and governments in HIV/AIDS prevention.  In a June 2009 report entitled Global Economic Crisis and HIV Prevention and Treatment Programmes: Vulnerabilites and Impact, the World Bank reported that the treatment programs in Eastern and Central Europe, Sub-Saharan Africa, and the Caribbean were the most vulnerable to having their prevention and treatment programs cut, as they lack the political clout that would enable them to continue receiving funding or antiretroviral treatment during tough economic times.  This reality leaves women, victims of sex trafficking, and injecting drug users at a greater risk of infection.  

[1] Joint United Nations Programme on HIV/AIDS, 2008 Report on the global AIDS epidemic: Executive Summary.
[3] Tools for change. Applying United Nations standards to secure women’s housing, land, and property rights in the context of HIV, UN Commission on the Status of Women, 2010. Page 49.
[4] Tools for change. Applying United Nations standards to secure women’s housing, land, and property rights in the context of HIV, UN Commission on the Status of Women, 2010. Page 41.
[5] World Bank. (2009). HIV/AIDS in ECA: Overview.