Introduction

The AIDS Accountability Rating Initiative
AIDS Accountability International (AAI) is an independent non-profit organization established to increase accountability and inspire bolder leadership in the response to the AIDS epidemic. AAI does this by rating and comparing the degree to which public and private actors are fulfilling the commitments they have made to respond to the epidemic. Its assessments are presented in the form of Scorecards that identify gaps between stated commitments by governments and key actors, and their actual performance.

In adopting the Millennium Development Goals and the United Nations 2001 Declaration of Commitment on HIV/AIDS all countries have committed to respond to AIDS effectively, and to comply with the monitoring process through which governments may be held accountable for the results they do or do not achieve. National governments submit progress reports regularly to the Joint United Nations Programme on HIV/AIDS (UNAIDS). The AIDS Accountability Scorecards evaluate and rate these country responses to AIDS, and present the self-reported data provided by governments in a transparent and politically relevant fashion that allows stakeholders to compare responses on key issues across countries.

Greater accountability, and the need to ensure that authorities explain publicly how they are carrying out the responsibilities they have been entrusted with, is essential to stimulating progress towards the Millennium Development Goals and the Declaration of Commitment on HIV/AIDS. Without this reporting and evaluation, there is no means to encourage those who are succeeding, put pressure on those who are failing, or stimulate debate about how the factors driving the epidemic can be best addressed in different settings.

The AIDS Accountability Scorecard on Women presents an analysis of the degree to which countries are fulfilling their commitments to respond to the needs of women in the context of the AIDS epidemic. The Scorecard has been developed through a consultative process involving globally acknowledged experts from civil society, UN agencies, and research and public health institutions. It follows on from AAI’s first Scorecard, the AIDS Accountability Country Scorecard, which was the first independent global rating of country performance in the response to AIDS. The Country Scorecard was issued in advance of World AIDS Day 2008.

Why a focus on women?
Globally, HIV/AIDS is the leading cause of death and disease in women of reproductive age.

The 2001 Declaration of Commitment on HIV/AIDS acknowledges that women are disproportionately affected by AIDS in the global context and must be given priority in the response. Some 50% of adults living with HIV are women, the vast majority of whom are in sub- Saharan Africa. In the most severely affected countries, three young women are infected for every young man. Whereas the ‘feminization’ of the epidemic is most pronounced in sub-Saharan Africa, women’s vulnerability to HIV is unacceptably high in all epidemiological settings.

While there are biological reasons why women are at greater risk of HIV infection than men, the major drivers of increased risk for women are social and cultural factors, in particular the inequality and disempowerment that come from being female in different contexts. The majority of women who become infected with HIV do not voluntarily engage in high-risk behaviour. Instead, they are vulnerable as a result of the behaviour of others, or because they lack the tools, information and resources needed to protect themselves.

Gender norms and HIV risk
The concept of ‘gender’ refers to norms within a society about appropriate male and female attributes, behaviour, and roles, which in turn define how men and women interact with each other. ‘Gender inequality’ exists where men and women’s opportunities, influence, rights and responsibilities are unequal and depend on their sex. In the context of AIDS, such inequality may, for example, deny women the opportunity to negotiate safe sex, or force women and girls into abusive transactional sexual relationships in order to obtain food and other necessities. Other dimensions of gender such as norms that define masculinity, or the human rights and public health needs of people with different sexual orientations, are also central to an effective response to AIDS. In 2010, AAI will be launching a new gender rating initiative focused on sexual diversity.

For the purposes of this Scorecard, however, country responses to the AIDS epidemic can be said to have a ‘gender dimension’ if policies are formulated on the basis of an understanding of women’s and girls’ specific vulnerabilities, and if government actions seek to counter such inequities by helping women gain control of their lives and set the conditions of their sexual relationships.

In adopting the 2001 Declaration of Commitment on HIV/AIDS, all United Nations Member States committed to a set of time-bound targets and targeted actions to empower women to protect themselves from HIV infection and to promote and protect their rights. The goals agreed to be met by 2010 include a global reduction in HIV prevalence among young women by 25%, and ensuring that at least 95% of young women have access to the information, education and services needed to reduce their vulnerability to HIV infection.

Progress towards these goals should form part of the regular monitoring and reporting on national responses to AIDS. In reality, however, country reports fail to capture many of the interventions required to address women’s needs in the context of AIDS. The urgent need for more and better indicators to monitor progress on reducing the impact of HIV/AIDS on women and girls is discussed below. Because of the almost total lack of data on girls’ vulnerabilities and their access to treatment, care and prevention services, this is a scorecard on women, and not on women and girls, as was first intended.

The sections below briefly present the AIDS Accountability Scorecard on Women and summarize its general conclusions and findings. A full technical report, as well as country-specific information, is available on the AAI website: www.aidsaccountability.org. The information on the website also allows for the individual generation of issue- and country-specific versions of the Scorecard.