Transcript Slide 1

Regional Session on Latin America
21 July - 2010
Lilián Abracinskas
Uruguay
The costs of not including care for PLHIV in comprehensive policies
on sexual and reproductive health and rights
Talking points:
1. Information about the situation in the region
2. Link between HIV, Violence and SRH: a
comparative study within MERCOSUR
3. Future challenges (Key actions)
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1. Some significant data
 Latin America is the region that:
 has signed the most international Human Rights treaties,
 has developed more public policies within the framework
of CEDAW, ICPD, UNGASS, MDG, among others.
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 It has experienced a 30% to 70% reduction in the
global fertility rate in the last 50 years.
 From 6 children per woman in 1960 to an average 2.5 in
2000 (CELADE; CEPAL; UNFPA, 2005)
 Use of Contraception Methods is the most important
factor determining the decrease in fertility (CEPAL, 2009)
 Behavioral changes make processes of secularization
and changes of values apparent.
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 Education plays a key role in reducing fertility
because:
 it boosts self-determination, develops women's ambitions
beyond maternity and promotes reflection and the
questioning of authoritarian traditions and practices.
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 In view of the reductions in fertility and mortality rates, it
is possible to speak of a process towards a second
demographic transition in many countries in the region.
 A particularly significant population structure is shaped;
DEMOGRAPHIC DIVIDEND – high concentration of the working
population aged 15 to 64 and especially 15 to 24 (UNFPA, 2006).
 GENDER DIVIDEND- massive incorporation of women into the
labor market in the last 3 decades; acknowledgment of the
discrimination based on the sexual division of labor:
reproductive and unpaid care tasks, pay gap, employment
flexibility and precariousness, among others.
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 Adolescent fertility has not dropped as much as the GFR, but
rather it has increased in some countries in the region.
Teenagers who have become mothers are characterized by higher
levels of social, emotional and health vulnerability. Generational
transmission of poverty and exclusion (ECLAC, CELADE, 2005)
 Population aging and increase in assistance and care
requirements. Women live longer, but that doesn't mean they
have a good health condition. Causes of disease among women
over 60 are connected with the behavior and living conditions they
had when they were teenagers or young women.
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 It is the most unequal region in the planet: 4 out of
10 people are poor and 1 in 6 live in extreme
poverty (UNFPA, 2007).
 Social and demographic lags among the poor,
indigenous and afrodescendant populations
which have a lower life expectancy, higher
fertility and growth rates with a population
structure in which children, adolescents and
women of childbearing age prevail.
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 2 million people living with HIV in the region, with a
significant increase in the number of infected people
(PAHO, 2008).
 LA: prevalence of infection 0.5%. Caribbean, 0.1 to 2.2%
(second most affected sub-region in the world).
 11 million births in the region, only 54% of the pregnant women
were tested for HIV.
 ARV prophylaxis for HIV-infected pregnant women was 54% in
2007.
 Women and children bear a great burden of disease and
indexes for new infections, related diseases and mortality from
HIV (55,000 children under 15 with HIV,
of which 6,000 died in 2007- the main cause was vertical
transmission)
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 Syphilis infection: 12 million newly infected each
year, more than 2 million in pregnant women.
Maternal syphilis in LAC is higher than in any other
region, 3.9% between 1997 and 2003 with variations
between Argentina (1.4%) Haiti (5.75%) and Bolivia
(5%) (PAHO-CLAP, 2010)
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 Almost half of all abortions in 2003 were performed under
unsafe conditions.
 World total 41.6 million abortions/year – 19.7% under unsafe
conditions
 LAC: 94% of induced abortions were unsafe with an average
rate of 33 abortions every 1,000 women aged 15 to 44
(Guttmacher Institute in The Lancet 2007).
 Reduction of maternal mortality: even though there is a general
trend towards decreasing maternal mortality, it remains
unacceptably high in most of the countries in the region. Maternal
mortality rate in Bolivia, Ecuador, Guatemala, Guyana, Haiti,
Honduras and Peru is 200 deaths per 100,000 live births
(ECLAC/UNFPA,2009)
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 Violence against women (UN, 2009)
 Half of all women who die from homicide are killed by
their current or former partners.
 For women between the ages of 15 and 44, violence is
the main cause of death and disability.
 More than 80% of the victims of human trafficking are
women.
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2. Study: HIV-Violence and SRH in MERCOSUR.
Multicenter study: "Violence against women and feminization of
HIV-AIDS. A quantitative and qualitative approach," on the
intersection between violence against women and HIV/AIDS in
Argentina, Brazil, Chile and Uruguay. Survey of 400 women over
18 years with HIV (FEIM , 2009/10).
 83.7% of women surveyed were employed at some point, while only
33.1% is currently employed. This indicates that the frequency of
employment has dropped by 49.7% among these women, resulting in
a loss of economic autonomy in their current life.
 96.6% can read and write, 62% completed general or basic education;
31% has a secondary or middle level of education. 3% claim to have
had no access to any level of the education system.
 Almost half of women surveyed are the main sources of family
income; taking second place after husbands/partners and before
parental figureS
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 The first intercourse took place, on average, at 16 years of age.
 For 88.4% the first intercourse was consented/wanted, and for
the remaining 11.6%, it took place under duress; whether
through physical violence (9.1%), threats (1%) or manipulation
through games (1.5%).
 61.4% of women are sexually active today.
 Among sexually active women, 86 % use some BCM, but the
number drops to 62% for those using double protection.
 On average, women were diagnosed with HIV at the age of 30, for
the youngest one was at 14 and the oldest one at 69.
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MERCOSUR Study- III
 78.1% of women surveyed suffered some form of violence
during their lives.
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69.9% situations of psychological violence
55.6% physical violence
36.5% sexual violence
32.8% sexual abuse during childhood
75.7% of cases, violence was committed by their partners.
VIOLENCE WAS A CAUSE OR CONSEQUENCE OF
CONTRACTING HIV
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3 - Future challenges – Key actions
 To promote public policies concerning the equality of
opportunities and rights with a generational, gender, ethnic
and racial dimension, with comprehensive services
(promotion, prevention, care, treatment and remedy) in BC,
HIV, Abortion, Violence against women and gender violence,
Sexual abuse, pleasurable sexual lives, responsible
parenthood, among others.
 To reactivate social welfare policies not exclusively based on
employment in order to move forward towards protecting
Human Rights under the broadest and most inclusive
conception, especially addressed at the neglected
majorities.
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 To promote CO-RESPONSIBILITY among families,
community, State and market for adequately present and
future needs of care.
 To overcome the SEXUAL DIVISION OF WORK, promoting
a redistribution of power, resources and time, especially in
highly unequal societies.
 To allocate ECONOMIC AND FINANCIAL RESOURCES
beyond vertical interventions and that take into account
the necessary complexity for approaching these issues.
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 Including a GENDER APPROACH for health financing and
care for all is pressing and essential.
 National budgets and FINANCIAL RESOURCES (national and
international) must be understanding and sensitive to the
differences between what is invested in the health of men and
women, as well as in the various programs and policies.
 Unless THE INVESTMENT (or expenditure) GAPS AND
DIFFERENCES FOUND between regions, countries, target
populations and actions are overcome, existing inequities will
not be overcome.
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 It is necessary WORK ARTICULATED between various
organizations (Feminist, SRR, HIV, Human Rights, Sexual
diversity, development, Youth, Unions and associations) .
 Promoting actions of political advocacy and enforceability of
rights generating SYNERGIES between the different agendas
and on an international, national and local level.
 INFLUENCING FOR TRANSFORMING:
 Public policy contents and structures
 Social relations in the public and private spheres
 The world of symbols in order to rebuild the relationships
between society and State with innovative policies
that restore the social and gender justice paradigm.
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IT IS NOT EASY
BUT
IT IS POSSIBLE
Thank you
Lilián Abracinskas
Director
MYSU – Women and Health in Uruguay
www.mysu.org.uy
[email protected]
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