A. PREAMBLE

Building on the commitments and recommended actions of the Kampala Declaration on Gender and HIV & AIDS, 2001;

Recognising the international and regional commitments to gender and HIV & AIDS as well as the imperatives of the Millennium Development Goals (MDGs);

Noting that the National AIDS Commissions / Councils and their key partners in Kenya, Uganda and Tanzania have committed themselves to gender sensitive principles in their policies, strategies and programmes, and that the purpose of coming together in Arusha was to focus on strengthening and translating policies into practice;

Noting that more women, and especially girls, continue to be more vulnerable to infection as evidenced by our prevalence statistics (Kenya, 50%, Uganda 51%, Tanzania %) and who bear the brunt of HIV/AIDS impact;

Deliberated, exchanged views and shared good practices from our countries and organisations, and found:

B. KEY ISSUES

Policy, legal and decision making Issues

1. Legislation in all three countries is inadequate and is not protecting women and men infected and affected by HIV/AIDS.
   
   
2. There is a need for National AIDS Councils / Commissions (NACs) to provide leadership to gender mainstreaming initiatives.
   
   
3. There is inadequate involvement and participation of PLHAs and HIV/AIDS affected people.
   
   
4. There is inadequate sex disaggregated data, analysis, indicators and M&E, gender sensitive indicators. Little operational research has been done, and what is done is usually not shared. Best practices are not well documented.

Social, economic, cultural context issues:

5. Poverty and unemployment makes women, boys and girls highly vulnerable and forced to engage in risky sex; and people infected or affected by HIV/AIDS increasingly end up in a poverty trap;
   
   
6. There are elements of traditional culture directly responsible for the spread of HIV/AIDS, such as wife inheritance, widow cleansing, FGM. property grabbing, child marriages etc
   
   
7. The silence on HIV/AIDS remains, because stigma makes it extremely difficult for HIV positive people to disclose their status.
   
   
8. Stigma and discrimination is forcing HIV + women out of their homes, excluded from their communities, isolated from their children, denied legal rights to property, and no effective access to justice.
   
   
9. There are inadequate partnerships with traditional and cultural institutions and leaderships, such as cultural leaders, traditional healers, who play a critical role in community attitudes, behaviours and support structures.
   
   
10. Community mapping has found that places which should be ordinary environments for socialisation, learning and productive work have become risky e.g. schools, wells, forests, places of worship.
    
    
11. Women, boys and girls are highly vulnerable to HIV/AIDS in situations of conflict and emergency.

Prevention Issues:

12. Female condoms are inadequate and inappropriate to the context and culture of sexual practice in East Africa, and have been largely unsuccessful in offering an effective female control prevention method.
    
    
13. Whilst gender friendly commodities to increase women's sexual control and decision making remain unavailable, male condoms remain the most effective tool for HIV/AIDS prevention. To this end, it is critical to involve men actively in all HIV/AIDS efforts.
    
    
14. Sex workers are able to protect themselves better than housewives because they are more empowered to insist on safe sex. Social norms dictate that men have multiple partners and yet refuse to wear condoms within marriage. Some women are also resistant to condom use in the marriage.

Treatment, Care and Support Issues

15. Voluntary Testing and Counselling is not packaged to address:
    1. gender sensitive / specific interventions
    2. stigma and discrimination
    3. access to treatment
    4. provision of support to families as a whole
    
    
16. The elderly, who are the primary HIV/AIDS care-givers, are not getting adequate support, including social safety net relief to deal with poverty impacts; psychosocial support; appropriate knowledge, and commodities to care for infected family members.
    
    
17. There is limited and inadequate accessibility, availability & affordability of drugs.
    
    
18. Prevention of Mother to Child Transmission (PMTC) interventions tend to be targeted only to protecting to the unborn child and not the parents.

C. RECOMMENDATIONS

1. The three National AIDS Councils / Commissions should meet bi-annually to review progress on the Arusha Commitments, and strengthen gender and HIV/AIDS policies and practices by sharing best practice and learning from each other's experiences.
   
   
2. There is a need to develop tools and instruments that will enable/facilitate the NACs to mainstream/engender the current National and sectoral AIDS policies and plans to enhance practice, and engender any new policies and plans.
   
   
3. Coordination of gender sensitive HIV/AIDS interventions should be strengthened, enhancing partnerships between national and community level structures and stakeholders, with an urgent need for identification of roles and responsibilities and accountable ownership at each level.
   
   
4. Building on on-going efforts, country efforts should now be focused on community level action through consultation and participation of all stakeholders, using methods such as community mapping, social inquiry, social mobilisation.
   
   
5. HIV/AIDS treatments must be reduced in cost, to become more affordable and accessible, as a matter of urgency. There is a critical need for people living with HIV/AIDS to be given access to ARVs and drugs for opportunistic infections.
   
   
6. Gender and HIV/AIDS focal points should be appointed in all NACs to facilitate and coordinate capacity building on the gender dimensions of HIV/AIDS and mainstreaming at all levels of the national response on HIV/AIDS.
   
   
7. Urgent actions must be taken for immediately addressing issues of legal protection related to the gender dimensions of HIV & AIDS. These include law reform, legislative audits, sensitisation and capacity building of the judiciary and the law enforcement authorities. Sex work should be decriminalized.
   
   
8. Parliamentary Committees/Associations on HIV & AIDS should receive training on gender dimensions of HIV & AIDS, way of auditing and guiding on the national efforts as well as ensuring that there are resources centrally and sectorally. Training and capacity building of Parliamentarians on gender dimensions of HIV & AIDS.
   
   
9. Essential commodities for care and prevention should be made widely available to care givers and facilities as a matter of urgency in each of the three countries, especially gloves and disinfectant.
   
   
10. PLHAs and those directly affected by HIV/AIDS must be actively included and involved in decision-making at all levels.
    
    
11. Urgent interventions are needed to address the extreme vulnerability to HIV/AIDS faced by women, boys and girls in situations of conflict and emergency.
    
    
12. Men must be included in all HIV/AIDS interventions, and must be seen as critical partners in addressing gender and HIV/AIDS issues.
    
    
13. The centrality of culture must be addressed more rigorously in each of the countries recognising that culture needs to transform if the HIV & AIDS complex pandemic halted, noting at the same time some of the positive resources and opportunities that culture presents.
    
    
14. Behaviour change communication materials and programs should be reviewed to promote partnerships between men and women. Gender specific messages are required for prevention, care and support.
    
    
15. The media have a key role to play in HIV/AIDS prevention and mitigation.
    
    
16. Capacity should be built in national and regional training institutions to develop training modules on gender and HIV & AIDS .
    
    
17. The East African Community should address HIV & AIDS as a multi-sectoral issue and not as a health issue. The East African Legislative Assembly should establish a multisectoral standing parliamentary committee on HIV/AIDS, and capacity should be built on the gender dimensions of HIV/AIDs.
    
    
18. There is an urgent need for improved surveillance, collection of sex disaggregated data, research and analysis, indicators, monitoring and evaluation for purposes of informing and strengthening policy development, planning and programming.
    
    
19. Best practices and lessons learned should be shared amongst the three countries in innovative approaches to gender and HIV/AIDS, such as in gender budgeting, retention of children in schools, especially girls.

Contact

• Joseph Amuzu, Commonwealth Secretariat, amuzuj@commonwealth.int
• Nyaradzai Gumbonvandza, UNIFEM Regional Office for East Africa, nyaradzai.gumbonzvanda@undp.org
• Dr. Ominde Achola, Commonwealth Regional Health Community Secretariat, oachola@crhcs.or.tz
• Cindy Berman, ILO/UNIFEM Programme, bermanc@ilo.org