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The role of youths in nation building
About this event: National Youth Empowerment Summit
Related to country: Nigeria
About the book: "In Pursuit of Purpose"
Translations available in: English (original) | French | Spanish | Italian | German | Portuguese | Swedish | Russian | Dutch | Arabic

Best Answer - Chosen by Voters
Consider this as a vision for our society: A country where all citizens, young and old, are informed about and engaged in all major issues that affect their lives. A place where adults and young people are together at the table; debating, grappling with problems, crafting solutions and jointly deciding on how resources should be allocated. A robust democracy where all people, including youth, exercise their right to select those who should speak and act on their behalf and hold them accountable. Where young people have an equal opportunity to have a sustainable livelihood. Imagine adults and young people working together to build a thriving a society from the ground up – contributing to nation building from the community level up to the national level.
Herein lies the power behind the potential role of youth as nation builders through political participation. The term nation building is used here to refer to a constructive process of engaging all citizens in building social cohesion, economic prosperity and political stability in an inclusive and democratic way. It is a process through which all people have access to and control of structures and mechanisms that govern their lives. Admittedly, the vision sounds unattainable and lofty for two reasons. 1) few societies have found adequate ways to ensure that all adults fully participate in the political process, 2) even fewer have found adequate ways to ensure that young people share in the burdens and benefits of citizenship.

There are three frequently cited reasons for why young people are excluded from political participation.
1) Young people are perceived as lacking the skills and qualities
2) young people are not afforded the opportunities to share power with adults, and
3) young people are portrayed as lacking the motivation

Young people are often viewed as lacking the skills needed to become part of the political process. These perceptions are often backed by popular theories on childhood development and adolescence, many of which define youth as social group that is in the ‘stage of becoming adults”.
“Young people are the last group we are allowed to systematically exclude.”
young people are not afforded the opportunities to share power with adults in part because they are viewed as lacking the requisite skills. Consequently, they are not invited to the table. The very idea of “youth citizenship” – young people participating as equals – is a stretch for many adults. The irony is, however, that once at the table, young people are often viewed as a threat to adult power. Rather than work with young people to build the skills, adults either abdicate power or work to control it. This tendency to exclude young people has been well-substantiated in international
Therefore ‘youthfulness’ has become a major justification for excluding young people from decision making. It is also important to emphasize that these ideas are also present all major social institutions; from the family, the school, the community; religious institutions etc. It is not a surprise that there are not expectations, and processes that facilitate the political participation of young people within their communities as well as at the national level.

One of the more frequently used justifications excluding young people is the entrenched myth of youth apathy - young people are frequently portrayed as lacking motivation to become involved. This myth is captured most aptly in the media hype about Generation X syndrome which describes young people as a socially inert, self-absorbed group with little or no interest in the political process.

However, recent research reveals that young people are far from apathetic. It is true that many young Americans over 18 do not vote or show interest in the conventional modes of political expression via political parties. Yet young people are showing great interest in political issues and are constantly searching for different ways of expressing themselves.
It would be a grave mistake to assume that youth do not participation in the political process at all. There are innumerable activities that seek to mobilize young people politically in neighborhoods and cities across the nation - activities initiated by young people and some initiated and supported by adults committed to youth empowerment. These initiatives cover a very broad spectrum. Examples include: organizing young people in their communities; educating young people to use the democratic process; advocating for and training young people to be part of governance structures of civil society organizations and through local government; monitoring and advocating for changes in the legislation at city and state level and many other such areas. These initiatives are unique because young people play a central role in the determination and execution of strategies.

Many agree that this rich tapestry of localized youth action holds the promise of expanding the possibility for young people as equal and active stakeholders in the political process. However, such initiatives tend to be limited to the micro level and rarely transcend the neighborhood and city level.
The idea of tackling this subject arose at the International Development Conference: Global Meeting of Generations held in Washington DC in January 1999. At this forum, young people from across the world grappled with the role young people should play in the governance process of their societies as well as international bodies such as the United Nations.

In our today’s youth forum we bring you a very critical topic on the role of youth in nation building.
The term - nation building - is usually used to refer to a constructive process of engaging all citizens in building social cohesion, economic prosperity and political stability in an inclusive and democratic way. It is important to note that the priceless resource of any country is its human resource. There is no other resource that matches the human being, because mankind is the foundation or the corner stone of any development and civilization. Out of the human intellect a nation is built. This can be confirmed by the fact that many countries are able to attain steady growth and development with limited natural resources through the intelligence of their people and the labour force. Young people are a crucial segment of a nation’s development. Their contribution therefore is highly needed. Young people are social actors of change and as the saying goes "youth are not only the leaders of tomorrow, but also the partners of today. ’’
As scholars have stated, "time is not evaluated by what has been harvested, but what has been planted". The government and society at large have equal responsibility to provide the youth with suitable grounds and thereby bringing about a matured and responsible population for the coming generation to lead a better life. As such the establishment of the a Department of State for Youth, the development of a comprehensive National Youth Policy, the establishment of National Youth Service Scheme,

Meanwhile, it is good to have these structures in place but if the youths do not make the best use of them no beneficial result will be realized. As young people we must be ready and willing to take advantage of any opportunity that comes our way. It’s important to note that we can’t all work in offices, therefore some of us would have to train ourselves to be welders, plumbers, electricians, carpenters, craftsmen, farmers and so on. It’s wise to note that traveling to Europe does not serve as a solution for youths as others might take it for granted. Much more by illegal means, which has made this country, lost a lot of able-bodied men over the past few years.As the rain season is fast approaching, the youth should embrace and adhere to the call made by the Gambian leader for youths to go back to the land as agriculture is the backbone of the country’s economy. It is interesting to know that the issue of migration, both within and outside the country, has also had a negative impact on the country’s agricultural productivity. The rural urban migration and the seeking for pasture to the European countries through fatal means has had had a serious implication on the agricultural sector and the country’s economy. No foreign aid would develop this country for us; we must therefore work to develop our nation and ourselves by engaging in the production sector of our economy like agriculture. I must therefore stressed that if this country is to develop, then the youth must go back to the land.

March 6, 2009 | 2:39 PM Comments  0 comments
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POVERTY REDUCTON IN NIGERIA, THE WAY FORWARD
Related to country: Nigeria
About the book: "In Pursuit of Purpose"
Translations available in: English (original) | French | Spanish | Italian | German | Portuguese | Swedish | Russian | Dutch | Arabic

POVERTY REDUCTION IN NIGERIA: THE WAY FORWARD

1. INTRODUCTION
The description of Nigeria as a paradox by the World Bank (1996) has continued
to be confirmed by events and official statistics in the country. The paradox is
that the poverty level in Nigeria contradicts the country’s immense wealth.
Among other things, the country is enormously endowed with human,
agricultural, petroleum, gas, and large untapped solid mineral resources.
Particularly worrisome is that the country earned over US$300 billion from one
resource – petroleum – during the last three decades of the twentieth century. But
rather than record remarkable progress in national socio -economic development,
Nigeria retrogressed to become one of the 25 poorest countries at the threshold of
twenty-first century whereas she was among the richest 50 in the early-1970s.
Official statistics show that in 1980 the national (average) poverty
incidence was 28.1 per of the population. The distribution of the incidence across
the states of the federation showed a maximum of 49.5 per cent recorded for
Plateau (and Nassarawa which was excised from Plateau). This meant that every
state had a poverty incidence below 50 per cent. By 1985, the national (average)
poverty incidence had risen to 46.3 per cent, with the maximum of 68.9 per cent
recorded in Bauchi (and Gombe which was carved out of Bauchi). As at 1996,
the national average stood at 65.6 per cent with Sokoto, Kebbi and Zamfara (all
Prof. Mike I. Obadan is the Director General, National Centre for Economic
Management and Administration (NCEMA), Ibadan.
CBN ECONOMIC & FINANCIAL REVIEW, VOL. 39 N0. 4
old Sokoto State) recording the highest incidence of 83.6 per cent; followed by
Bauchi and Gombe with 83.5 per cent. As at 2000, the incidence of poverty was
believed to have risen to 70 per cent at the national level.
The increasing incidence of poverty, both within and among locations,
was in spite of various resources and efforts exerted on poverty-related
programmes and schemes in the country, thus suggesting that the programmes and
schemes were ineffective and ineffectual. In the light of the present government’s
deep concern for the widespread and scourging poverty, this paper reviews
previous and current initiatives at poverty alleviation/reduction in Nigeria, and
examines some pertinent issues on the way forward. Accordingly, Section 2
overviews some poverty alleviation policies and programmes prior to the advent
of the present administration while Section 3 presents highlights of current
poverty reduction efforts. Section 4 addresses some pertinent issues on the way
forward. Section 5 concludes the paper.

II. OVERVIEW OF PREVIOUS POVERTY ALLEVIATION
PROGRAMMES AND POLICIES
II.1 Poverty Alleviation and National Development Plans
Unit.l The inauguration of a Poverty Alleviation Programme Development
Committee (PAPDC) by the Nigerian government in 1994, all efforts at poverty
alleviation were essentially ad-hoc. It was generally the case that poverty
alleviation programmes and strategies were not crystallised and consolidated
within the nation’s overall development objectives. This view is borne out of a CBN ECONOMIC & FINANCIAL REVIEW, VOL. 39 N0. 4 perusal of the various National Development Plans over 1962-85 period, and National Rolling Plans from 1990. The particular significance of the National
Development/Rolling Plans hinges on the fact that they provided/provide much of the framework for the pursuit of development objectives since the attainment of
political independence in 1960. It can be observed from the Plan documents that “the primary goal of economic planning in Nigeria is the attainment of rapid increase in the nation’s productive capacity with a view to improving the living standards of the people”. This statement suggests some concern with poverty reduction which entails
improved standard of living. However, poverty alleviation objectives were tangential and not explicit objectives of all the plans. The poverty-related objectives during 1962-85 included:

(a) increase in per capita income;
(b) more even distribution of income;
(c) reduction in the level of unemployment; and
(d) increase in the supply of high level manpower.

In a related vein, the First National Rolling Plan had, among other things, the objectives of:

* Creating ample employment opportunities as a means of
containing the unemployment problem; and

* enhancing the level of socio-political awareness of the people and further strengthening the base for a market-oriented economy and mitigating the adverse impact of the economic down-turn on the most affected groups. CBN ECONOMIC & FINANCIAL REVIEW, VOL. 39 N0. 4 Although not direct statements of concern with poverty alleviation, the foregoing have implications for poverty. For example, if there is an increase in per-capita income, simultaneously with more even distribution of income, such would
lead to poverty reduction. Reduction in the level of unemployment is conceivably a necessary condition for realization of increased income per-capita. The closest
direct statement of concern with poverty is contained in the Third Plan (FRN, 1975:29):
…development is not just a matter of growth in per capita income. It is possible
to record a high growth rate in per capita income while the masses of the people
continue to be in abject poverty and lacking in the basic necessities of life,
particularly in a situation as in Nigeria today, where the momentum of growth
derives from a sector whose direct impact on the bulk of the population is small.
An important objective of the plan, therefore, is to spread the benefits of
economic development so the Nigerian would experience a marked improvement
in his standard of living.
Nonetheless, in the same vein as concern with poverty alleviation was a derived
and not a direct objective, the strategies in the plan were not lucidly direct and
explicitly specific.
Generally, the priorities and strategies enunciated in virtually all the Plans
under reference show that agricultural production was always accorded the
highest priority (FRN) (1990:17); FRN (1981:37); FRN (1970:35) – although, the
Third Plan emphasized the mutual development of agriculture and industry for
balanced growth (FRN,1975:30). Even in the structural adjustment programme
document, agriculture was considered one of the critical sectors whose
CBN ECONOMIC & FINANCIAL REVIEW, VOL. 39 N0. 4
rehabilitation would be crucial to the success of the programme (FRN, 1986:8).
A concomitance of agricultural development, or its apanage, is rural development.
Against the background that the poor are preponderantly located in rural areas,
and are mainly engaged in agriculture, the accord of highest priority to agriculture
in the plan documents would suggest favourable disposition towards poverty
alleviation.
From the foregoing, two distinct approaches to poverty alleviation could
be said to have featured prominently in Nigeria’s national development plans and
planning. These are the economic growth strategy that presumes the trickling
down of the benefits of growth to the poor, and the strategy of rural/agricultural
development. Indeed, rural development could be viewed as having been central
to Nigeria’s poverty alleviation strategies. And the center -piece of the rural
development policy has been agricultural development, complemented by social
and economic infrastructure. For a long time now, the growth performance of the
country has not been satisfactory, with negative growth in the first half of the
1980s and very low growths since 1992 (an average of 2.5 per cent from 1992-
1999). Even in periods of economic growth, Nigerians did not experience
considerable or commensurate poverty reduction. In 1985-1992, there was a
slight increase in GDP and per capita income, and there was a slight drop in
aggregate poverty headcount level (from 46.3 to42.7 per cent), but inequality
worsene d and the core-poor did not share in the growth as the depth and severity
of poverty did not improve significantly. This suggests the need for a strategy of
growth with equity for poverty reduction.
In sum, within the framework of the National Development Plans, the
implicit thinking was that a positive relationship existed growth in the GDP and
CBN ECONOMIC & FINANCIAL REVIEW, VOL. 39 N0. 4
increased welfare for the general citizenry. And so, the approach to poverty
alleviation as expressed in the fundamental objectives of the Development Plans
did not involve policies and programmes which directly targeted the poor. The
poor were implicitly expected to benefit from the “trickle -down efforts” of the
overall process of development. But this has not been the case. And so growth
must be accompanied by a deliberate policy of targeted interventions.
II.2 Government Programmes and Policies Related to Poverty
In the light of the government’s concern for poverty reduction, numerous
policies and programmes have been designed at one time or another, if not to
meet the special needs of the poor, at least to reach them. The advent of the
Structural Adjustment Programme in1986 brought out more forcefully the need
for policies and programmes to alleviate poverty and provide safety nets for the
poor. This emphasis arose from an awareness of the unintended negative effects
of structural adjustment policies on the vulnerable groups in the society. While
structural adjustment had its salutary effects on economic growth, it lacked
emphasis on development and also accentuated socio-economic problems of
income inequality, unequal access to food, shelter, education, health and other
necessities of life. It indeed, aggravated the incidence of poverty among ma ny
vulnerable groups in the society.
As a result of the continuous deterioration of living conditions in the late
1980s, several poverty alleviation programmes came on board. They were
designed to impact positively on the poor. By the end of 1998, there were sixteen
poverty alleviation institutions in the country. In 1994, the Government set up a
broad-based Poverty Alleviation Programme Development Committee (PAPDC)
under the aegis of the aegis of the National Planning Commission. The primary
CBN ECONOMIC & FINANCIAL REVIEW, VOL. 39 N0. 4
objective of the PAPDC was to advise the government on the design, coordination
and implementation of poverty alleviation programmes. Its work contributed
immensely to the emergence of a new approach to the design and organisation of
poverty alleviation programmes culminating in the establishment in 1996 of the
Community Action Programme for Poverty Alleviation (CAPPA). CAPPA is a
community based approach which adopts a combination of social funds and social
action strategy. The CAPPA document drew largely from the past experience on
poverty reduction efforts in the country and attempts to ensure that the poor are
not only carried along in the design and implementation of poverty projects that
affect them but that the poor themselves actually formulate and manage the
poverty projects. Various agencies (Government, Donors and NGOs) involved in
poverty alleviation in the country have embraced the CAPPA strategy. Also, in
1996, a draft National Poverty Alleviation Policy document was produced by the
Government through the National Planning Commission. Its thrust is the
improvement in human welfare in the immediate and distant future.
Specifically, a number of government programmes initiated in the past,
have aimed at improving basic services, infrastructure and housing facilities for
the rural and urban population, extending access to credit farm inputs, and
creating employment. Most of the programmes were, however, not specifically
targeted towards the poor, though they affect them. There are specific multisector
programmes (water and sanitation, environment, etc) as well as sectorspecific
programmes in agriculture, health, education, transport, housing, finance,
industry/manufacturing and nutrition. (Box I contains some government
programmes related to poverty). Some achievements have been recorded by these
poverty-relation programmes in the areas of food crop production, agricultural
CBN ECONOMIC & FINANCIAL REVIEW, VOL. 39 N0. 4
and industrial extension services, primary health care, education enrolment, mass
transit programme and financial sector services through the People’s Bank of
Nigeria and Community Banks. However, the fact that the incidence of poverty
remains very high, the existence of the various programmes notwithstanding,
points to the ineffectiveness of the strategies and programmes. A number of
factors have contributed to the failure of past poverty-related programmes and
efforts. Some of them are:
(i) lack of targeting mechanisms for the poor and the fact that most of the
programmes do not focus directly on the poor.
(ii) Political and policy instability have resulted in frequent policy changes
and inconsistent implementation which in turn have prevented continuous
progress.
(iii) Inadequate coordination of the various programmes has resulted in each
institution carrying out its own activities with resultant duplication of
effort and inefficient use of limited resources. Overlapping functions
ultimately led to institutional rivalry and conflicts.
(iv) Severe budgetary, management and governance problems have afflicted
most of the programmes, resulting in facilities not being completed,
broken down and abandoned, unstaffed and equipped.
(v) Lack of accountability and transparency thereby making the programmes
to serve as conduit pipes for draining national resources.
(vi) Overextended scope of activities of most institutions, resulting in
resources being spread too thinly on too many activities. Examples are
DFRRI and Better Life Programmes which covered almost every sector
and overlapped with many other existing programmes.
CBN ECONOMIC & FINANCIAL REVIEW, VOL. 39 N0. 4
(vii) Inappropriate programme design reflecting lack of involvement of
beneficiaries in the formulation and implementation of programmes.
Consequently, beneficiaries were not motivated to identify themselves
sufficiently with the successful implementation of the programmes.
(viii) Absence of target setting for Ministries, Agencies and Programmes.
(ix) Absence of effective collaboration and complementation among the three
tiers of government.
(x) Absence of agreed poverty reduction agenda that can be used by all
concerned – Federal Government, State Governments, Local
Governments. NGOs, and the International Donor Community.
(xi) Most of the programmes lacked mechanisms for their sustainability.
Box 1
Some Government Programmes Related to Poverty
Multisectoral Programmes include: the National Directorate of Employment,
which consists of four main programmes: the Vocational Skills Development
Programme, the Special Public Works Programme, the Small Scale Enterprises
Programme, and the Agriculture Employment Programme; the Directorate of
Food, Roads and Rural Infrastructure, which supports mainly rural infrastructure
projects; and the Better Life Programme, which supports a multitude of
programmes targeted at women, including agriculture and extension services,
education and vocational training, cottage industries and food processing, primary
health care delivery and enlightenment/awareness and cooperatives. The last is
now replaced by Family Support Programme.
CBN ECONOMIC & FINANCIAL REVIEW, VOL. 39 N0. 4
BOX 1 CONTD.
Agriculture Sector Programmes include the Agriculture Development
Programmes; the National Agricultural Land Development Authority, the
Strategic grains Reserves Programme. The Programme for Accelerated Wheat
Production, as well as the development of artisanal fishery, small ruminant
production, pasture and grazing reserves. These programmes promote utilization
of land resources through subsidized land development, supply of farm inputs and
services and credit extension to farmers, and institutional support for produce
marketing cooperatives.
Health Sector Programmes include the primary Health Care Scheme, which
aims at providing at least one health centre in every local government; and the
Guinea-worm Eradication Programme, launched in 1988 with assistance of donor
agencies including UNICEF, which supports health interventions to control
diarrhea diseases, eradicate guinea-worm, and promote changes in knowledge,
attitudes and practices relating to water use, excreta disposal and general hygiene.
The effectiveness of the PHC programme was hampered by inadequate funding
from the LGAs, and lack of equipment, essential drugs, and trained manpower.
The Guinea-worm Eradication Programme succeeded in reducing the number of
reported guinea-worm cases from 650,000 in 1988 to 222,000 by the end of 1992.
In the Education Sector, the Nomadic Education Programme developed
curricula for nomadic education, trained nomadic teachers, and provided
infrastructure for the nomadic schools; additional programmes were targeted
towards girls education, women and children in exceptionally difficult
circumstances, and adult literacy.
CBN ECONOMIC & FINANCIAL REVIEW, VOL. 39 N0. 4
BOX 1 CONTD.
In the Transport Sector, the Federal Urban Mass Transit Progam was
established in 1988 to rescue the public transport system from imminent collapse.
New buses were put into public service and loan schemes helped cooperatives and
private operators acquire transport vehicles. However, the demand for public
transportation in many urban areas continues to outstrip supply.
In the Housing Sector, a Sites and Services Scheme commenced in 1987 to
increase the supply of land for residential development by all income groups. The
programme consists of site clearance, construction of concrete drains and culverts,
etc. However, shortage of funds resulted in non-payment of compensation to
former owners of assets in the acquired areas, and non-development of essential
infrastructure such as access roads, water, power supply, etc.
Financial Sector Programmes include a few initiatives begun in 1989/90: the
National Economic Reconstruction Fund which provide long-term loans at
concessionary interest rates to promote small and medium scale industrial
projects; the People’s Bank of Nigeria which extends credit to the poor who could
not have access to the credit facilities available in the commercial and merchant
banks; and the Community Banking Scheme which provides credit to small scale
producers on their own personal recognition.
Nutrition-Related Programmes consist of programmes aimed at improving food
security, prevention of micro-nutrient deficiencies in children and women,
promotion of exclusive breast-feeding, deworming of school children and
promotion of food quality and safety.
Manufacturing Sector Programme includes a Small-Scale Enterprises
Programme. This is designed to promote the growth of small-scale enterprises in
Nigeria. The programme involves government promotion of small-scale
industries through easier access to bank credit, artisan technology and the
provision of appropriate infrastructural facilities.
Source: Nigeria: National Planning Commission (1994 and 1995); World Bank
(1996).
Not only has the failure to ensure the successful implementation of the
various programmes and policies made the incidence of poverty to loom large, the
phenomenon has continued to spread and deepen. And very many factors have
tended to compound the poverty situation, among which are: slow economic
growth, economic mismanagement, infratructural deficiencies, weak political
commitment to poverty alleviation programmes and measures, and a host of
macroeconomic and sectoral problems such as inf lation, rising unemployment,
exchange rate depreciation, external debt overhang, etc (CBN, 1999:68-73).
These problems are also acknowledged by the government as enunciated by Aliu
(2001:4 -5) as follows:
(i) Poor macroeconomic and monetary policies resulting in low
economic growth rate and continuous downwards slide in the value
of naira from 1986;
(ii) dwindling performance of the manufacturing sector which has the
capacity to employ about 20 million people but currently employs
CBN ECONOMIC & FINANCIAL REVIEW, VOL. 39 N0. 4
only about 1.5 million by all the 2,750 registered members of the
Manufacturers Association of Nigeria (MAN);
(iii) increasing foreign debt overhang of almost US $30 billion,
requiring US $3.5 billion annually for servicing from an economy
earning just US$10-15 billion;
(iv) poor management of the nation’s resources, coupled with largescale
fraud and corruption, most of which has been siphoned out of
the country in hard currency; and
(v) poor execution of Government Programmes and projects especially
those aimed at the provision of social welfare services and those
aimed at the provision of economic infrastructure.
III. CURRENT EFFORTS AT POVERTY REDUCTION
The Government of President Olusegun Obasanjo, since inception in May,
1999, has expressed deep concern about the rising incidence of poverty in
Nigeria. The Government realized that if the worsening poverty situation
is not checked, the future of the nation would be doomed. In light of this,
the Government has introduced a number of progammes and measures
aimed at making a dent on poverty. Among the early activities of the
Government were the launching of the Universal Basic Education (UBE)
Programme, the Poverty Alleviation Programme and the constitution of
the Ahmed Joda Panel in 1999 and the Ango Abdullahi Committee in
2000. The immediate concern of the Panel/Committee was the
streamlining and rationalization of existing poverty alleviation institutions,
and the coordinated implementation and monitoring of relevant schemes
CBN ECONOMIC & FINANCIAL REVIEW, VOL. 39 N0. 4
and programmes. These culminated in the introduction early in 2001 of
the National Poverty Eradication Programme (NAPEP) and the
establishment of the National Poverty Eradication Council (NAPEC).
3.1 The Poverty Alleviation Programme (PAP)
This was an interim measure introduced early in 2000 to address the
problems of rising unemployment and crime wave, particularly among youths. It
was ultimately aimed at increasing the welfare of Nigerians. Essentially, the
primary objectives of PAP are three-fold:
· reduce the problem of unemployment and hence raise effective
demand in the economy;
· increase the productiveness of the economy; and
· drastically reduce the embarrassing crime wave in the society.
One could glean from government pronouncements that the
targets/components of the PAP include the following, among others:
· provide jobs for -200,000 unemployed;
· create a credit delivery system from which farmers would have
access to credit facilities;
· increase the adult literacy rate from 51 percent to 70 percent by
year 2003;
· shoot up health-care delivery system from its present 40 percent to
70 percent by year 2003
· increase the immunization of children from 40 percent to 100
percent;
CBN ECONOMIC & FINANCIAL REVIEW, VOL. 39 N0. 4
· raise rural water supply from the present 30 percent to 60 percent
and same for rural electrification;
· embark on training and settlement of at least 60 percent of tertiary
institutions’ graduates; and
· development of simple processes and small-scale industries.
To actualize the objectives of PAP, several measures were put forward in
the 2000 Budget as well as other policy documents such as:
· increase in the salary of public sector workers that has been
decimated over the past two decades;
· improving the supervisory capacity within the nation’s institutions;
· rationalization of organizations and methods within the system,
particularly that of the existing 16 poverty alleviation institutions
in Nigeria;
· encouraging and rewarding all deserving Nigerians for industry
and enterprise;
· substantial reduction of avenues for easy and illegitimate
acquisition of wealth; and
· the launching of Universal Basic Education Programme.
The orientation of the PAP is holistic in nature, and if properly planned
and managed could tame the menace of poverty in Nigeria. But inspite of the
broad feature of the programme, emphasis seemed to have placed more on the
creation of jobs through public work system. To this end, avenues were to be
provided for the gainful employment of 200,000 idle hands. This aspect of the
programme was designed to provide jobs for at least 5000 unemployed in each
CBN ECONOMIC & FINANCIAL REVIEW, VOL. 39 N0. 4
State. To actualize the programme, the Federal Government earmarked N10.0
billion, which was later raised to N17.0 billion by the Senate. No doubt, this
pointed to the Government’s commitment to the programme.
However, in implementation, the programme appeared to be ad-hoc in
orientation with little attention paid to the policy framework. The emphasis on
massive construction and other public work projects made it look like a one-off
affair rather than making it a revolving one.
The programme also paid little attention to the framework of allocation of
funds, sustainability aspect of the PAP and the needed collaborative arrangements
its success. The political connotation of the PAP served as an important threat to
the success of the programme. The programme was portrayed as the ruling
party’s programme and hence had met with resistance from the chief executives
of the states controlled by other political parties. This was quite noticeable in the
launching of the programme at the state level in February 2000.
Besides, the PAP also emphasized provision of credit to micro-enterprises
and trading to the exclusion of income and employment generating projects. The
programme also lacked appropriate framework for beneficiary targeting. The
timing and phasing of the direct labour (200,000 jobs) were not explicitly stated.
Yet, this aspect was very crucial to the suc cess of programme.
3.2 The National Poverty Eradication Programme (NAPEP)
Introduced early in 2001, NAPEP is the current Programme which
focuses on the provision of “strategies for the eradication of absolute poverty in
Nigeria” (FRN,2001:3) NAPEP is complemented by the National Poverty
Eradication Council (NAPEC) which is to coordinate the poverty-reduction-
CBN ECONOMIC & FINANCIAL REVIEW, VOL. 39 N0. 4
related activities of all the relevant Ministries, Parastatals and Agencies. It has the
mandate to ensure that the wide range of activities are centrally planned,
coordinated and complement one another so that the objectives of policy
continuity and sustainability are achieved.
Upon consideration of the Joda Panel and Abdullahi Committee Reports,
fourteen
(14) core poverty alleviation Ministries were identified as follows:
(i) Agriculture and Rural Development
(ii) Education
(iii) Water Resources
(iv) Industry
(v) Power and Steel
(vi) Employment, Labour and Productivity
(vii) Women Affairs and Youth Development
(viii) Health
(ix) Works and Housing
(x) Environment
(xi) Solid Minerals Development
(xii) Science and Technology
(xiii) Finance, and
(xiv) National Planning Commission
Similarly, thirty-seven (37) core poverty alleviation institutions,
agencies and programmes were identified. The poverty reduction-related
CBN ECONOMIC & FINANCIAL REVIEW, VOL. 39 N0. 4
activities of the relevant institutions under NAPEP have been classified
into four, namely:
176 CBN ECONOMIC & FINANCIAL REVIEW, VOL. 39 N0. 4
(i) Youth Empowerment Scheme (YES) which deals with capacity
acquisition, mandatory attachment, productivity improvement, credit
delivery, technology development and enterprise promotion;
(ii) Rural Infrastructure Development Scheme (RIDS) which deals
with the provision of potable and irrigation water, transport (rural and
urban), rural energy and power support;
(iii) Social Welfare Service Scheme (SOWESS) which deals with
special education, primary healthcare services, establishment and
maintenance of recreational centres, public awareness facilities, youth and
student hostel development, environmental protection facilities, food
security provisions, micro and macro credits delivery, rural
telecommunications facilities, provision of mass transit, and maintenance
culture; and
(iv) Natural Resource Development and Conservation Scheme (NRDCS)
Which deals with the harnessing of the agricultural, water, solid mineral
resources, conservation of land and space (beaches, reclaimed land, etc)
particularly for the convenient and effective utilisation by small-scale
operators and the immediate community.
In effect, the current poverty eradication programme of the country is
centered on youth empowerment, rural infrastructure development, provision of
social welfare services and natural resource development and conservation.
CBN ECONOMIC & FINANCIAL REVIEW, VOL. 39 N0. 4
Details about these are provided in the Blueprint for the schemes under the
National Poverty Eradication programme (as revised in June 2001). In the
attempt to overcome the inadequacies of provious programmes, the NAPEP
Blueprint has the following features (Aliu, 2001:12-13):
· it adopts the participatory bottom-up approach in programme implementation
and monitoring;
· it provides for rational framework which lays emphasis on appropriate and
sustainable institutional arrangement;
· it provides for pro-active and affirmative actions deliberately targeted at
women, youths, farmers and the disabled;
· it provides for inter-ministerial and inter-agency cooperation;
· it provides for the participation of all registered political parties, traditional
rulers, and the communities;
· it provides for technology acquisition and development particularly for
agriculture and industry;
· it provides for capacity building for existing skills acquisition and traning
centres;
· it provides for the provision of agricultural and industrial extension services to
rural areas;
· it provides for institutional development for marketing of agricultural and
industrial products; and
· it provides for integrated schemes for youth empowerment, development of
infrastructure, provision of social welfare services and exploitation of
natural resources.
CBN ECONOMIC & FINANCIAL REVIEW, VOL. 39 N0. 4
What becomes obvious from a careful consideration of the foregoing and
their elaborations in the blueprint is that much of the problems that attended
previous efforts have been sharply focussed upon following their identification.
Nonetheless, the statement of good intentions and enunciation of measures
towards poverty eradication are only necessary but not sufficient conditions. The
way forward is to recognise the problems and look beyond to operational and
incidental matters that may arise at the level of implementation vis-à-vis some
pertinent issues that may not have been adequately covered in the blueprint.
3.3 Poverty Reduction Strategy Paper (PRSP)
The government is currently preparing a Poverty Reduction Strategy Paper
(PRSP) under the supervision of the Economic Policy Coordinating Committee in
the Office of the Vice President. The PRSP is a document that will show the
commitment of the government in addressing poverty reduction. It will contain a
comprehensive poverty reduction plan and strategies to address it over a time
horizon. A National Core Team which was inaugurated in February, 2001, is
responsible for the technical preparation of the PRSP in two stages. The first
stage involves the preparation of an Interim-Poverty Reduction Strategy Paper (IPRSP),
which would dovetail into the second stage of preparing the full PRSP.
The I-PRSP was introduced to avoid delays in receiving international assistance
which donors have predicated on the production of a PRSP. The I-PRSP includes
a stocktaking of the country’s current mechanism for poverty reduction and a road
CBN ECONOMIC & FINANCIAL REVIEW, VOL. 39 N0. 4
map of how the country will develop its full PRSP. The I-PRSP was completed in
August 2001, thus paving way for the preparation of the PRSP.
IV. SOME PERTINENT ISSUES ON THE WAY FORWARD
Inspite of the expressed concerns of past governments and the plethora of
programmes and policies that have a bearing on poverty, the incidence and
scourge of poverty have worsened over the years. The factors which have
constrained the effectiveness of the programmes and policies have been
outlined already. Now, with the NAPEP being the centrepiece of the
Government’s efforts at poverty reduction what are the prospects of
achieving the international development goal of halving the incidence of
poverty by 2015? This question is pertinent against the background of the
Nigerian economy which is characterised by low economic growth, rapid
population growth, mismanagement of available resources and large-scale
corruption. Therefore, for NAPEP to make a meaningful dent on poverty,
there is the need for poverty reduction programmes to be implemented
within the framework of rapid economic growth with equity, controlled
population growth, sound economic management, and good governance,
among others. Some of these and other pertinent issues relating to poverty
reduction programmes are discussed briefly as follows:
(i) Broad-based Economic Growth with Equity
Rapid growth is important for poverty reduction. Therefore attention must
be focused on those macro and microeconomic policies and programmes which
CBN ECONOMIC & FINANCIAL REVIEW, VOL. 39 N0. 4
would ensure the rapid growth of the economic. Economic growth is crucial in
efforts aimed at conquering poverty as it would:
· Generate income earning opportunities for the poor, make job
creation possible, and thereby make use of their most abundant assetlabour;
· Produce additional resources for the government to use for social
programmes aimed at overcoming poverty; and
· Increase the incomes poor people receive as remuneration for their
labour.
However, economic growth alone is not sufficient for poverty reduction.
Therefore, growth must be accompanied by a deliberate policy of redistribution
and equity, promoted by participation. In this direction, broad-based growth that
involves the poor and generates employment is recognised to have a tremendous
impact on pove rty. In Nigeria, targeted efforts are required to induce broad-based
growth and provide social services and infrastructure aimed at reducing the depth
and severity of poverty of poverty across the country. Given the high incidence of
poverty in the country, the pursuit of rapid economic growth cannot be
overemphasised in the current and future efforts at poverty reduction. Indeed, for
a considerable decline in poverty, indications are that an economic growth rate of
7-8 per cent is required. And policies to foster growth would need to be
complemented by those aimed specifically at reducing poverty.
(ii) Targeting of Interventions
Considering the magnitude and profile of the magnitude and dimensions
of poverty in Nigeria, it would be clear that a sizable number of poor and
CBN ECONOMIC & FINANCIAL REVIEW, VOL. 39 N0. 4
disenfranchised people cannot participate directly in broad growth process. And
given the level of impoverishment, they may also not be able to have access and
use of the social and economic infrastructure provided to improve human capital.
It is therefore essential to provide targeted resource transfers and support to such
groups of people in rural and urban areas. The government can target the delivery
of some services and resources to reach poor areas and to communities living in
poverty, building on existing community-based organisations, civil society groups
and their activities where possible. Some element of targeting should also be
introduced in public expenditure, especially for social sector spending (health and
education) which touch the lives of the poor people than most of other public
expenditure.
(iii) Nature of Involvement of Beneficiaries
Experience from the past poverty alleviation programmes has shown the
inability to involve the people in their planning and implementation. However,
one of the main features of NAPEP is the adoption of the bottom-up approach to
programme implementation and monitoring (Aliu, 2001:12). But then, this tends
to give the indication that the bottom-up precludes the involvement of
beneficiaries in the identification in the identification of projects and programmes.
This is more so as “NAPEC is mandated to ensure that the wide range of activities
are centrally planned, coordinated and compleme nt one another so that the
objectives of policy continuity and sustainability are achieved” (FRN, 2001:5). If
the above indication is accurate, them there is the need to extend the bottom-up
concept to include direct participation of the benefiting communities in project
identification. Experience has shown that the non-involvement of such
CBN ECONOMIC & FINANCIAL REVIEW, VOL. 39 N0. 4
communities is always a detraction from appropriateness of projects, as well as
their sustainability. This is because the top-down approach widely adopted in
project identification and selection has often led to beneficiaries not associating
themselves with such projects. Therefore, there should be sufficient participation
of the grassroot people in the identification and implementation of projects
affecting their lives. This will not only increase their commitment to such
programmes but will also de -emphasize the erstwhile perception of such
programmes as conduit pipes for national cake sharing, which they feel is
responsible for their poverty. It also promotes empowerment on project
management as well as its sustainability.
(iv)Political Allegiance and Continuity of Programmes, Projects and Services
The communiqué and syndicate reports of the first retreat for Executive
Governors and State Coordinators of the NAPEP, June 24-25, 2001, issued under
the aegis of the Presidency, raised some very crucial issues. Paragraph 7 of the
communiqué states the following:
Discussion at both the Plenary Sessions and Syndicate Groups were frank,
and devoid of political, tribal or religious colourations, in a free and relaxed
atmosphere where the sole goal of all participants was to evolve lasting strategies
to eradicate a problem which, participants argreed, respects no political, ethnic or
religious boundaries. Participants expressed full support and commitment for the
programme but urged that everything be done to avoid its derailment either
through partisan considerations, corruption or other malpractices which militated
against the success of previous programmes (emphasis ours).
CBN ECONOMIC & FINANCIAL REVIEW, VOL. 39 N0. 4
Similarly, the third resolution/recommendation of syndicate Group A at
the retreat read: That NAPEP should not be limited to the life span of any
particular Government or Administration in power but should be sustained to
elicit desired objective and impact.
These remarks bring to the fore the issues and problems associated with
political culture and the politicisation of programmes and projects. The foreging
paragraph 7 of the communiqué under reference accurately underlines the fact of
poverty not recognising political boundaries. However, the Nigerian reality point
to the fact that political differences could be a strong factor in the accentuation of
poverty in particular areas. This arises when relevant schemes and programmes
are resisted in some regions/zones or states simply because of the perceived
advantages the implementation could confer on some political parties. For
instance, there were reports of the Nigerian Peoples Party (NPP) government in
old Anambra State refusing the construction of Federal roads in the State because
the rival National Party of Nigeria (NPN) could make it a campaign issue.
Similarly, in year 2000, there were reports that the Alliance for Democracy (AD)
Governors of South-West Zone were apprehensive that the People’s Democratic
Party (PDP) at the Centre might have conceived of the PAP for strategic political
gains. Indeed, there were allegations of the AD Governors working against the
PAP in order to frustrate the PDP Federal Government.
The point to stress is that poverty is too critical an issue that everyone,
irrespective of party affiliation and leaning, should be deeply concerned about its
eradication. The idea of sabotaging a scheme simply because it was initiated by a
rival political party/group should not arise. It is only with such a spirit that a
scheme could live beyond its initiators-a factor that is pertinent to the
CBN ECONOMIC & FINANCIAL REVIEW, VOL. 39 N0. 4
sustainability and continuity of services. Perhaps, consideration could be given to
making poverty alleviation an explicit constitutional matter in view of the fact that
no one administration can meaningfully bind its successor to its programmes.
This also reinforces the need to give expression to poverty alleviation objectives
in national development plans with the strategies consolidated into the nation's
overall development/policy management framework.
(v) Good Governance, Transparency, Accountability and Social
Responsibility
Corruption is generally acknowledged as having adversely affected
previous poverty alleviation efforts in Nigeria. Corruption is one of the aspects of
bad governance. The anti-corruption crusade of the present administration is
expected to have favourable implications for poverty alleviation if successfully
carried through. The communiqué earlier referred to has as one of the imperatives
for success of the NAPEP “ensuring that corruption and other sharp practices at
any stage of the programme are not condoned but severely punished”.
The manifestations and problems associated with corruption have various
dimensions. Among these are project substitution, plan distortion,
misrepresentation of project finances, diversion of resources to uses to which they
were not meant, even conversion of public funds to private uses, etc. The effect
of corruption is both direct and indirect on poverty increase. On the hand, the
indirect effect follows from the reduction or misapplication of resources which
penalizes growth rate and growth potential. When growth rates are lowered, there
will be no outputs and incomes to redistribute. So poverty could escalate. One
the other hand, the direct effect is that the poor are denied resources and access to
CBN ECONOMIC & FINANCIAL REVIEW, VOL. 39 N0. 4
facilities that could have been provided through judicious application of the
siphoned/diverted resources.
A related problem is that lack of social responsibility manifest in the
vandalisation or wilful destruction of facilities that benefit the poor. It is expected
that the bottom-up approach to project identification with attendant association of
beneficiaries with the projects, will minimise vandalisation. But beyond that it is
crucially necessary that efforts and resources are committed to security of
provisions. Finally, in order to ensure transparency and accountability in the
management of poverty reduction programmes and projects, all the stakeholders
should be involved in the monitoring and evaluation of such projects.
v. CONCLUSION
The embarassing paradox of poverty in the midst of plenty in Nigeria
suggests the compelling need for a single -minded pursuit of the objective of
poverty reduction and its eventual elimination. To this end, there is the need for
an agreed poverty reduction agenda that can be used by all stakeholders – Federal
Government, State Government, Local Governments, NGOs and the International
Donor Community. There is also the need for strong political commitment to the
poverty reduction goal, as well as a depoliticisation of poverty alleviation
programmes and projects. Very importantly, in order to make a meaningful dent
on poverty it is crucial for poverty reduction programmes and measures to be
implemented within the framework of rapid broad-based economic growth with
equity, controlled population growth, sound economic management and good
governance, among others. Finally, it is important to give expression to poverty
alleviation objectives in national development plans with the strategies and
CBN ECONOMIC & FINANCIAL REVIEW, VOL. 39 N0. 4
measures integrated into the country’s overall development/policy management
framework.
REFERENCES
Abdullahi, M. Yahoo (1993) The Design and Management of poverty Alleviation
projects in Africa. Washington, D. C.: Economic Development Institute
of the World Bank.
Aliu, A. (2001), National Poverty Eradication Programme (NAPEP):
Completion, Implementation, Coordination and Monitoring, NAPEP
Secretariat, Abuja, April.
Besley, Timothy (1996), “Political Economy of Alleviating Poverty: Theory and
Institutions”, in M. Bruno and B. Pleskovic (eds), proceedings of the
Annual World Bank Conference on Development Economics, The World
Bank Washington, D.C.
Central Bank of Nigeria, Research Department (1999) Nigeria’s development
Prospects: Poverty Assessment and Alleviation Study (Abuja: CBN).
Fajingbesi, A.A. and E.O. Uga (2001a), “Plans, Programmes and Poverty
Alleviation Strategies in Nigeria”, in Integration of poverty Alleviation
Strategies into plans and programmes in Nigeria, NCEMA, Ibadan.
FRN (2001), National Poverty Eradication Programme (NAPEP): A Blueprint for
the Schemes, NAPEP Secretariat, Abuja, June.
NCEMA (1995), Integration of Poverty Alleviation Strategies into Plans and
Programmes of Nigeria, Report of a National Workshop, Kaduna and
Ibadan, November – December.
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Nigeria. National Planning Commission (1995), “Community Action Programme
for Poverty Alleviation (CAPPA)”, Lagos.
Nigeria. National Planning Commission (1994), Government Policies and
Programmes to Reach the Poor”, Background paper to poverty
Assessment Studies (January).
Nigeria. Federal Ministry of Finance (2000)./ “Nigeria: CG Poverty Reduction
Paper”. Background paper for Consultative Group Meeting.
Obadan, M.I. (1996) “Analytical Framework for poverty Reduction: Issue of
Economic Growth Versus Other Strategies”, Proceedings of the 1996
Annual Conference of the Niger ia Economic Society (Ibadan: NES).
Obadan, M. I. (1996) “Poverty in Nigeria: Characteristics, Alleviation Strategies
and Programmes”, NCEMA Analysis Series, Vol. 2, No. 2.
Okowa, W.J. (1987), “Urban Bias in Nigerian Development Planning”, The
Nigeria Jour nal of Economic and Social Studies, Vol. 29 (1), March.
Okumadewa, F. (1996) “Nigeria: Poverty Reducing Growth Strategies and
Options”. Proceedings of the CBN/World Bank Collaborative Study
Workshop on “Nigeria: Prospects for Development”. (Abuja: CBN).
Olayemi, J.K. (1995), “A Survey of Approaches to Poverty Alleviation”. A
Paper Presented at the NCEMA National Workshop on Integration of
Poverty Alleviation Strategies into Plans and Programmes in Nigeria,
Ibadan, Nov. 27 – Dec. I.
The Presidency (2001), “Communique and Syndicate Groups Reports of the first
Retreat for Executive Governors and State Coordinators of the National
Poverty Eradication Programme (NAPEP)”, Abuja, June 22 – 24.
CBN ECONOMIC & FINANCIAL REVIEW, VOL. 39 N0. 4
Ukpong, S.J. (1996), “Putting People First: New Directions for Eradicating
Poverty”, A Paper Presented at the National Dialogue/Workshop on
Agenda for Sustainable Human Development in Nigeria, Organized by the UNDP
in port-Harcourt, 3-5 May.
World Bank (1996), Nigeria, Poverty in the Midst of Plenty: The challenge of
Growth with Inclusion. Washington, D.C.: World Bank.
World Bank (1993), Poverty Reduction Handbook Washington, D.C.: The
International Bank for Reconstruction and Development.
World Bank (1995), Advancing Social Development. Washington, D.C.: The
International Bank for Reconstruction and Development.
World Bank (1995), “Distribution and Growth: Complements, Not
Compromises”. Policy Research Bulletin, vol. 6, No. 3 (May-July).

October 23, 2008 | 7:31 AM Comments  0 comments
Tags:


HIV POSITIVE WOMEN AND GENDER INEQUALITY
Related to country: India



HIV Positive Women, Poverty
and Gender Inequality
THE INTERNATIONAL COMMUNITY OF WOMEN LIVING WITH HIV/AIDS (ICW)
• New infections among women are
increasing at a faster rate than new
infections among men.
• In sub-Saharan Africa HIV positive
women out number HIV positive men.
(UNAIDS 2003)
• Many women, especially in rural sub-
Saharan Africa, define poverty as
their prime concern above all others,
including the risk or reality of HIV.
(Wallace 2004)
Gender inequalities in personal
relationships, in the community, within the
workforce, and in political circles affect
women all over the world. Inequalities
increase women’s vulnerability to poverty
and vice-versa: both impact harshly on our
ability to enjoy full human rights. Gender
inequality and poverty not only increase the
risk of HIV but also leave women more
vulnerable than men to its impact. Shortterm
survival needs force women to develop
a range of coping strategies with varying
implications for our long-term health and
well being. With increasing HIV related ill
health and stigma we may be unable to
make choices to improve both the health and
happiness of ourselves and our families.
Moreover, even when women (HIV positive
and HIV negative) know the risks, we may
not be in a position to practise safer sex.
In my opinion, the problems of positive
women are much like those affecting women
in general. The main one is that more
women on the planet lack power.(ICW
European contact from Spain quoted in
O’Sullivan 2000)
Sex refers to the biological
characteristics that categorise someone
as either female or male; whereas
gender refers to the socially created
ideas and practices of what it is to be
female or male. (Baden and Reeves
2000)
Livelihoods
Clearly the need for financial support or a
livelihood is important for all women.
However, an HIV positive diagnosis
compounds the problems women face in
finding and keeping work. HIV positive
women who sell goods may find that people
avoid their stall or shop, women farmers
may lose access to land, and employers have
been known to fire people after an HIV
positive diagnosis, sometimes after
compulsory testing.
At the same time that I got AIDS, I had my
job and they wanted to drive me out. I knew
but I did not accept it because I did not want
to quit my job. They forced me to have blood
taken. Eventually, they drove me to live in
this house for AIDS people.(Participant of
Thailand Voices and Choices 2003).
I felt like I was falling into a huge abyss
because I knew what was going to happen at
work. And so it was – they sacked me as
soon as they found out and most of my so
called friends turned their back on me. […]
My dream, what I was – a nurse known by
all, with prestige, loved by everyone – had
gone. I fell into a depression and forgot
everyone in the world.(Participant from
Mexico in Voces Positivas, ICW 2004)
2
HIV Positive Women, Poverty
and Gender Inequality
3
Many women, including HIV positive women,
also work in the informal sector. The
informal sector may provide flexible
opportunities to earn a living. However,
when informal sector workers or family
members are ill they do not get paid for the
work they miss. Moreover, stigma and
gender inequality combine to make it
difficult to obtain resources and customers
for small businesses.
I tried to do a local business but it ended
because of stigma. I started selling food, but
because people knew my status they did not
buy them. […] because they were things to be
eaten people thought they would catch HIV.
(Participant of Kampala conference, 20031)
Personal relationships
Gender inequality and discrimination against
women living with HIV hits personal
relationships too. When HIV positive women
face abuse from partners and other relatives
we are often even less able than other
women to assert ourselves. For many of us
there may be no possibility of practising safe
sex – even if we are aware of the risks. This
is especially true for young women who lack
the protection of elders and the power and
confidence to negotiate safer sex.
Our culture makes it difficult to rescue
women. They do what the husband or
partner says. They are not autonomous. If he
says no, then it is no.(Mexican participant,
Voces Positivas)
Our unequal status within families and society
means that we are often blamed for ‘bringing
HIV into the family’. Poverty and inequality
means that we are unable to avoid the bad
treatment that comes with this blame.
Losing two babies also made my partner
worried. Up to this time he had been denying
that he might be infected. He started to
question how he could be HIV positive and
began to blame me for bringing HIV to his
life. It did not stop there. He went to his
family and told them about my HIV status
but neglected to tell them that he was HIV
positive too. He warned them that if anything
happened to him I would be responsible.
(Personal testimony, South African positive
young woman, 2003)
Many women fear violence, the loss of
access to assets, children and homes. This is
particularly the case if we are HIV positive
and after the death of our husbands.
I know women in Papua New Guinea who
husbands have died and whose in-laws have
broken into their homes. I know women who
have lost custody of their children, who have
lost the pots and pans they use to cook food
for their children.(ICW member from Asia
Pacific, ICW 2001)
In some societies we find that even though
we may be legally entitled to own property in
our own name, in practice we can only gain
rights to land and other assets through men
(usually husbands or fathers).
We suffer, especially us widows. When
our husband passes away, you can be
tortured by the husband’s relatives. They
can throw you out, they can remove
everything from you. (Participant of
Kampala Conference, 2003)
1 11th International Conference of HIV Positive People,
Kampala, Uganda, October 2003.
4
Even if we know our rights, we rarely have
access to independent legal support. Those
women who do get support, for instance
from a women’s law group or community
leader, can often face increased anger and
ostracism from relatives. A village head in
Birchenough Bridge, Zimbabwe, stopped the
in-laws of an HIV positive widow with six
children from driving her out. He said they
had no right to do so when there were so
many children. However, this left the in-laws
bitter and angry and so the woman felt that
there was no one to help her when she was
sick (ICW 2002).
After the loss of a breadwinner, HIV
positive women in certain social situations
are faced with having to find an income, or
secure financial and social security through
another relationship. Young women
especially face strong pressure to marry
older men to secure financial and social
security, leaving them with little power to
negotiate healthy sexual relationships. Such
pressure to seek new livelihoods or maintain
existing ones is intensified by their own ill
health and the ill health and care of other
relatives, including children.
My father was the first one to die […], my
mother gave birth to a healthy baby, but she
also got sick. […] As I was the eldest
daughter, I was the one who took over all the
duties of looking after the family including
my mother and the baby. The baby was like
mine and when my mother died I became the
breadwinner. As my father had left no
pension I had to find ways to look after the
family. I had three brothers and one sister.
[…] When my young sister was three years,
she also became sick and died. There was no
other way to find money. I started to have sex
with anyone who could give me money. It was
not easy for me but I had to do it because I
had to find food for my brothers. All the
relatives did not want to help us. (Participant
of Zimbabwe Voices and Choices, ICW 2002)
Coping strategies
Sex work may be the only possible economic
option available to many women.
Yes we can stop sex for money, but what are
we going to do to have our needs fulfilled,
such as clothes? The problem is lack of
employment. (Young woman Malawi,
Welbourn 2002)
There are some women whose family knows
what kind of work they do but people who
come from the country generally don’t tell.
But when they work for a long time and keep
giving money to the family – to build a house,
buy the land, pay off debts, when their
siblings don’t have to go to school in torn
clothing any more – then they’ll tell the family
about their work. They’ll tell them bit by bit,
so it doesn’t come as a huge shock. And they
might say, please try to be economical at
home because now you know the kind of
work we have to do to get this money.
(Thai interviewee, ICW 2001)
Women who are involved in
sex work generally face
greater discrimination.
Women who are involved in sex work
generally face greater discrimination than
other women because of social ideals about
what makes a ‘good’ woman. Such
discrimination can come from women and
men, both HIV positive and negative.
Women, young and older, HIV positive and HIV
negative, may have to use sex to ensure the
smooth running of other livelihood strategies,
such as having to offer sex to officials in
exchange for being allowed to trade goods.
Unfortunately, in some societies, women who
act independently and move around more
than their peers are labelled as immoral by
our communities, making our efforts to earn
a secure living even harder.
Border jumping is very risky because if the
police get hold of you, you probably have to
offer sex. These days when you tell someone
that you are a vendor who sells from one
country to another it’s almost the same as
saying you sleep with people. (Participant of
Zimbabwe Voices and Choices review workshop)
Investing in the future?
Poverty and gender inequality also limit our
access to health care and nutritious food
which is not only needed to maintain good
general health but also affects the possibility
of taking up anti-retrovirals (ARVs).
I wanted to tell young people that this
disease is very expensive. For sure the way
it is expensive is that I have many diseases;
tuberculosis, sexually transmitted
infections, coming on and off.
(Participant of Kampala conference)
Now we have ARVs in Kenya, but if people
don’t have anything to eat, it’s letting them
down and causes more problems.
(ICW interview, Kenya, June 2004)
Impacts of poverty on children include
having to withdraw them from school to help
in the home or with income generating
activities or because there is not enough
money to pay school costs. This is likely to
affect girls more than boys as often less
value is placed on their education.
The only problem as a single woman is that I
do not have a [waged] job, I rent a house, at
least I have my business because this
disease needs medicine, proper food as well
as school fees for my three year old son.
(Participant of Kampala conference)
Yet poverty makes claiming our rights to
equality, safe and secure livelihoods and
good health almost impossible. If we cannot
even afford to feed ourselves how can we
afford to travel to the places where decisions
are made about our lives?
5
Vision Paper 3 >>>
If we can not afford to feed
ourselves how can we afford
to travel to the places where
decisions are made about
our lives.
ICW Call for Action
ICW recognises that gender inequality and
poverty both need to be tackled for HIV
positive women and their families to thrive.
We call for the following:
Support for women’s groups:
• Support women’s organisations already
campaigning for better access to land,
property ownership and inheritance rights.
• Support self-help and support groups – as
they often help women discover livelihood
opportunities as well as providing space to
explore and challenge gender inequality.
Economic rights:
• Conduct research into the effectiveness of
income generating activities and what
specific factors support their success.
• Support strategies designed to increase
women’s financial independence, such as
micro-credit schemes; financial support
for carers unable to work and to keep
children in education.
• Support the resource, training and capacitybuilding
needs of income generating
groups, for instance, management training
and how to access resources to invest in
equipment and transport.
Workplace policies:
• Involve HIV positive people in workplace
policy development and implementation.
Policies that promote the retention and
employment of HIV positive staff, including
women, and ensure that benefits to staff
include a range of appropriate care and
support, which is not just drug specific.
• Develop a proactive awareness throughout
the whole management and staff body,
from top to bottom, of the way in which
HIV and gender affects all our lives.
Law Reform:
• Review ownership and inheritance laws and
promote advocacy work with both women
and men at the community level to take
note of the impact these laws have on HIV
positive women, men and their families.
Work with men:
• Challenge violent and abusive behaviour,
to encourage them to recognise that their
roles are also governed by gender
stereotypes and that gender inequities
harm them too.
• Create environments that enable men to
support their partners. This includes
media campaigns, one-on-one counselling,
male peer support groups, and
community-wide life-skills programmes.
Examples of work on gender equality
and poverty
Developing a shared understanding of
inequality
Creacion Positiva is an organisation based in
Barcelona, Spain, that works on HIV/AIDS
from a gender perspective. By considering
the different ways that women and men are
affected by gender in all areas of life
Creacion Positiva is able to address the
complexity of behaviours, ideas, emotions
and feelings related to HIV infection. This
organisation offers a space for reflection,
support and activism.
For more information contact: tel: +34 93431
4548, email: creacionpositiva@eresmas.net.
6
The Indian Railroad is the
world’s third largest employer,
with over 1.5 million staff.
Challenging negative stereotypes
The Gender AIDS Forum (GAF) and ICW
hosted a National Summit - Confronting
marginalisation in the context of HIV/AIDS in
Durban, South Africa, 7-8 August 2003.
The aim of the summit was to bring together
women and men from marginalised groups
such as sex workers, lesbian, gay, bisexual,
and transgendered women and men,
refugees, prisoners, and women and men
living with HIV to discuss the realities of
their lives. Participants created a national
advocacy agenda for action on gender and
HIV/AIDS in South Africa (Ewing 2003 -
report available on ICW website).
Raising awareness among community
members
The Stepping Stones training programme on
gendered, and inter-generational,
communication and relationship skills for all
community members, has enabled both
older and younger male and female
participants, in Africa, Asia and beyond, to
work together to reduce household quarrels,
increase male involvement in sharing of
household tasks and expenditure, write wills
to increase the chances of widows’
inheritance, reduce and outlaw gender
violence, increase respect and support for
HIV positive neighbours, reduce numbers of
sexual partners and increase condom use
within and outside marriage.
(www.steppingstonesfeedback.org)
Income generating activities
Yolanda Zaldivar, an ICW member, describes
an income generating project in Honduras:
The project proposal was approved. I only
asked for 2000 Lempira and for that amount
for 11 women. First we approached
cooperatives. Unfortunately, none of them
accepted us because we were HIV positive
but then one said, yes, come over. We all
went and explained who we were, and the
manager accepted us and explained how to
be a part of the cooperative. The women put
1000 Lempira in the co-op and took away
1000. Each then one decided what she was
going to do with her share. One decided to
sell vegetables, the other decided to set up a
mini pulperia. When they needed more
money we negotiated with the donors and
received 3000 lempira more. Once there
were 20 children in our group who were not
studying because of lack of resources. This
year, all are in schools.
Now we have developed a second project to
train women as machinists to make more
school uniforms for orphaned children. In
the factories they ask you for an HIV test and
if it is positive you don’t get the job. So, in
our group we said, ‘Let’s show them that if
they trust us PWAs, we can do good work.’
We wrote to UNICEF, who approved the
project and are now paying for the premises.
It is amazing. In our factory there will be
only positive women. We are going to show
the world that we can succeed. The people
of Puerto Cortes are impressed, and they
are supporting us.(ICW 2004)
Work place policies
As a result of an initiative by UNIFEM and
the Vijaywada division of the Indian Railways,
Gender and HIV/AIDS education has been
introduced into the curriculum of all the
Indian Railway schools. Building upon the
existing curriculum on sex education and
HIV/AIDS prevention, the introduction of a
section on gender and sexuality aims to
encourage young people to question existing
gender stereotypes, enable young women to
negotiate safer sex and promote male sexual
responsibility. The Indian Railroad is the
world’s third largest employer, with over 1.5
million staff and an extensive infrastructure
including schools, hospitals and training
colleges. (Source: www.unifem.org.au)
7
Vision Paper 3 >>>
design and print ds print I redesign 020 8805 9585
References
Ewing, 2003, Confronting Marginalisation in
the Context of HIV/AIDS, report of the National
Summit, Durban, South Africa 7-8 August
2003, GAF/ICW
ICW, 2004, ICW NewsIssue 25, London:
International Community of Women Living with
HIV/AIDS (ICW)
ICW, 2002, Positive Women: Voices and
Choices,London: International Community of
Women Living with HIV/AIDS (ICW)
ICW, 2001, ICW NewsIssue 19, London:
International Community of Women Living with
HIV/AIDS (ICW)
Reeves, H., Baden, S. 2000, Gender and
Development Concepts and Definitions,
BRIDGE, Institute of Development Studies (IDS)
O’Sullivan, Sue, 2000, ‘Uniting Across
Boundaries: HIV positive women in global
perspective’,Agenda No.44
UNAIDS, 2003, AIDS Epidemic Update 2003,
Geneva: UNAIDS
Wallace, Tina, 2004, Inform, Inspire,
Encourage: A guide to producing effective
HIV/AIDS materials,London: ActionAid
International
Welbourn, Alice, 2002, ‘Gender, sex and HIV:
how to address issues that no one wants to
hear about, in Cornwall, Andrea and Welbourn,
Alice, 2002, Realising Rights: Transforming
Approaches to Sexual and Reproductive Wellbeing,
London: Zed Press
ICW research programmes and workshops
mentioned in this Vision Paper
Voices & Choices Zimbabwe, 2002, and Voices
and Choices Thailand, 2003
A project led by positive women to explore the
impact of HIV on their sexual behaviour, well
being and reproductive rights, and to promote
improvements in policy and practise.
Voces Positivas – process of empowerment
and training for HIV positive women from
Central America and the Caribbean, 2003.
ICW Vision Papers (2004) have been written
for HIV positive members and our supporters
to use when advocating and organising around
ICW’s visions, aims, and objectives. In them
you will learn what ICW’s positions are and be
able to represent ICW well at any meetings or
in any groups you attend, or if you are asked in
any circumstances to explain what ICW stands
for. They are meant as an aid to your own work
and can be used creatively. ICW welcomes your
feedback and evaluation of its vision papers.
Please tell us how you have been able to use
them. We’d love to hear from you.
This Vision Paper on gender inequality and
poverty one of five ICW Vision Papers. This
series outlines ICW’s position on: access to
care and treatment; participation and policy
making, gender equity and poverty; human
rights; and HIV positive young women. They
are available in English, Spanish and French.
ICW is very grateful to The Joint United Nations
Programme on HIV/AIDS (UNAIDS) for funding
this series. We would also like to thank Novib,
Positive Action and Comic Relief for core
funding.
The International Community of Women
Living with HIV/AIDS (ICW), a registered UK
charity, is the only international network run
for and by HIV positive women. ICW 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.
All HIV positive women can join ICW for free.
Just contact us – details below.
International Community of Women
Living with HIV/AIDS (ICW)
Unit 6, Building 1
Canonbury Yard
190a New North Road
London N1 7BJ
UNITED KINGDOM
Tel +44 20 7704 0606
Fax +44 20 7704 8070
Email info@icw.org
URL www.icw.org
ICW is the convening agency for the treatment
and care arm of the Global Coalition on
Women and AIDS.
ICW is registered in the UK as a company
limited by guarantee with charitable status.
Company No 2987247
Registered charity No 1045331

August 2, 2007 | 1:37 PM Comments  0 comments
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THE HISTORY OF HIV UP TO 1986

WELCOME TO MY WORLD OF HUMAN SUSTAINABILITY

THE HISTORY OF HIV UP TO 1986


Mid-1970's-1980 history

We do not know how many people developed AIDS in the 1970s, or indeed in the years before. Neither do we know, and we probably never will know, where the AIDS virus HIV originated (see our origins page for some theories). But what we do know is:

"The dominant feature of this first period was silence, for the human immunodeficiency virus (HIV) was unknown and transmission was not accompanied by signs or symptoms salient enough to be noticed. While rare, sporadic case reports of AIDS and sero-archaeological studies have documented human infections with HIV prior to 1970, available data suggest that the current pandemic started in the mid- to late 1970s. By 1980, HIV had spread to at least five continents (North America, South America, Europe, Africa and Australia). During this period of silence, spread was unchecked by awareness or any preventive action and approximately 100,000-300,000 persons may have been infected."

- Jonathan Mann -1
1981 History

Kaposi's Sarcoma (KS) was a rare form of relatively benign cancer that tended to occur in older people. But by March 1981 at least eight cases of a more aggressive form of KS had occurred amongst young gay men in New York.2

At about the same time there was an increase, in both California and New York, in the number of cases of a rare lung infection Pneumocystis carinii pneumonia (PCP)3. In April this increase in PCP was noticed at the Centers for Disease Control (CDC) in Atlanta. A drug technician, Sandra Ford, noticed a high number of requests for the drug pentamine, used in the treatment of PCP:

"A doctor was treating a gay man in his 20s who had pneumonia. Two weeks later, he called to ask for a refill of a rare drug that I handled. This was unusual - nobody ever asked for a refill. Patients usually were cured in one 10-day treatment or they died"

- Sandra Ford for Newsweek -4

In June, the CDC published a report about the occurrence, without identifiable cause, of PCP in five men in Los Angeles5. This report is sometimes referred to as the "beginning" of AIDS, but it might be more accurate to describe it as the beginning of the general awareness of AIDS in the USA.

A few days later, following these reports of PCP and other rare life-threatening opportunistic infections, the CDC formed a Task Force on Kaposi's Sarcoma and Opportunistic Infections (KSOI).6


Dr. Conant and Dr Volverg discussing

Kaposi's Sarcoma. Circa 1981

Around this time a number of theories were developed about the possible cause of these opportunistic infections and cancers. Early theories included infection with cytomegalovirus, the use of amyl nitrite or butyl nitrate "poppers", and "immune overload".7 8 9

Because there was so little known about the transmission of what seemed to be a new disease, there was concern about contagion, and whether the disease could by passed on by people who had no apparent signs or symptoms.10 Knowledge about the disease was changing so quickly that certain assumptions made at this time were shown to be unfounded just a few months later. For example, in July 1981 Dr Curran of the CDC was reported as follows:

"Dr. Curran said there was no apparent danger to non homosexuals from contagion. 'The best evidence against contagion', he said, 'is that no cases have been reported to date outside the homosexual community or in women'"

- The New York Times -11

Just five months later, in December 1981, it was clear that the disease affected other population groups, when the first cases of PCP were reported in injecting drug users.12 At the same time the first case of AIDS was documented in the UK.13
1982 History

The disease still did not have a name, with different groups referring to it in different ways. The CDC generally referred to it by reference to the diseases that were occurring, for example lymphadenopathy (swollen glands), although on some occasions they referred to it as KSOI, the name already given to the CDC task force.14 15

In contrast some still linked the disease to its initial occurrence in gay men, with a letter in The Lancet calling it "gay compromise syndrome".16 Others called it GRID (gay-related immune deficiency), AID (acquired immunodeficiency disease), "gay cancer" or "community-acquired immune dysfunction".17 18

In June a report of a group of cases amongst gay men in Southern California suggested that the disease might be caused by an infectious agent that was sexually transmitted.19

By the beginning of July a total of 452 cases, from 23 states, had been reported to the CDC.20

Later that month the first reports appeared that the disease was occurring in Haitians, as well as haemophiliacs.21 22 This news soon led to speculation that the epidemic might have orignated in Haiti, and caused some parents to withdraw their children from haemophiliac camps.23


The occurence of the disease in non-homosexuals meant that names such as GRID were redundant. The acronym AIDS was suggested at a meeting in Washington, D.C., in July.24 By August this name was being used in newspapers and scientific journals.25 26 27 AIDS (Acquired Immune Deficiency Syndrome) was first properly defined by the CDC in September.28

An anagram of AIDS, SIDA, was created for use in French and Spanish.29 Doctors thought AIDS was an appropriate name because people acquired the condition rather than inherited it; because it resulted in a deficiency within the immune system; and because it was a syndrome, with a number of manifestations, rather than a single disease.30

Still very little was known about transmission and public anxiety continued to grow.

"It is frightening because no one knows what's causing it, said a 28-year old law student who went to the St. Mark's Clinic in Greenwich Village last week complaining of swollen glands, thought to be one early symptom of the disease. Every week a new theory comes out about how you're going to spread it."

- The New York Times -31

By 1982 a number of AIDS specific voluntary organisations had been set up in the USA. They included the San Francisco AIDS Foundation (SFAF), AIDS Project Los Angeles (APLA), and Gay Men's health Crisis (GMHC).32 In November 1982 the first AIDS organisation, the "Terry Higgins Trust" (later known as the Terrence Higgins Trust), was formally established in the UK, and by this time a number of AIDS organisations were already producing safer sex advice for gay men.33 34

In December a 20-month old child who had received multiple transfusions of blood and blood products died from infections related to AIDS.35 This case provided clearer evidence that AIDS was caused by an infectious agent, and it also caused additional concerns about the safety of the blood supply. Also in December, the CDC reported the first cases of possible mother to child transmission of AIDS.36

By the end of 1982 many more people were taking notice of this new disease, as it was clearer that a much wider group of people was going to be affected.

"When it began turning up in children and transfusion recipients, that was a turning point in terms of public perception. Up until then it was entirely a gay epidemic, and it was easy for the average person to say 'So what?' Now everyone could relate."

- Harold Jaffe of the CDC for newsweek -37

It was also becoming clear that AIDS was not a disease that just occurred in the USA. Throughout 1982 there were separate reports of the disease occurring in a number of European countries.38

Meanwhile in Uganda, doctors were seeing the first cases of a new, fatal wasting disease. This illness soon became known locally as 'slim'.39
1983 History

In January, reports of AIDS among women with no other risk factors suggested the disease might be passed on through heterosexual sex.40

At about the same time the CDC convened a meeting to consider how the transmission of AIDS could be prevented, and in particular to consider the newly emerged evidence that AIDS might be spread through blood clotting factor and through blood transfusions. As James Curran, the head of the CDC task force, said:

"The sense of urgency is greatest for haemophiliacs. The risk for others [who receive blood products] now appears small, but is unknown."41

The risk for haemophiliacs was so great because the blood concentrate that some haemophiliacs used exposed them to the blood of up to 5,000 individual blood donors.

In March, the CDC stated that,

"persons who may be considered at increased risk of AIDS include those with symptoms and signs suggestive of AIDS; sexual partners of AIDS patients; sexually active homosexual or bisexual men with multiple partners; Haitian entrants to the United States; present or past abusers of IV drugs; patients with hemophilia; and sexual partners of individuals at increased risk for AIDS."

The same report also said,

"each group contains many persons who probably have little risk of acquiring AIDS... Very little is known about risk factors for Haitians with AIDS."42

Nevertheless, the inclusion of Hatians as a risk group caused much controversy. Haitian Americans complained of stigmatisation, officials accused the CDC of racism, and Haiti suffered a serious blow to its tourism industry.43 44 Before long people were talking colloquially of a "4-H Club" at risk of AIDS: homosexuals, haemophiliacs, heroin addicts and Haitians.45 46 Some people substituted hookers for haemophiliacs.47

In the UK there were public concerns about the blood supply with references in newspapers to "killer blood".48 The media more generally started to take notice of AIDS, with the screening of a TV Horizon programme, "The Killer in the Village", and a number of newspaper articles on the subject of the "gay plague".49 50

In May 1983, doctors at the Institute Pasteur in France reported that they had isolated a new virus, which they suggested might be the cause of AIDS.51 Little notice was taken of this announcement at the time, but a sample of the virus was sent to the CDC.52 A few months later the virus was named lymphadenopathy-associated virus or LAV, patents were applied for, and a sample of LAV was sent to the National Cancer Institute.53

But whilst progress was being made by scientists there was at the same time increasing concern about transmission, and not just in relation to the blood supply. A report of AIDS occurring in children suggested quite incorrectly the possibility of casual household transmission.54

AIDS transmission became a major issue in San Francisco, where the Police Department equipped patrol officers with special masks and gloves for use when dealing with what the police called "a suspected AIDS patient".

"The officers were concerned that they could bring the bug home and their whole family could get AIDS."

- The New York Times -55

And in New York:

"landlords have evicted individuals with AIDS" and "the Social Security Administration is interviewing patients by phone rather than face to face."

- Dr David Spencer, Commisioner of Health, New York City -56

There was considerable fear about AIDS in many other countries as well:

"In many parts of the world there is anxiety, bafflement, a sense that something has to be done - although no one knows what."

- The New York Times -57

As anxiety continued, the CDC tried to provide reassurance that children with AIDS had probably acquired it from their mothers and that casual transmission did not occur:

"The cause of AIDS is unknown, but it seems most likely to be caused by an agent transmitted by intimate sexual contact, through contaminated needles, or, less commonly, by percutaneous inoculation of infectious blood or blood products. No evidence suggests transmission of AIDS by airborne spread. The failure to identify cases among friends relatives, and co-workers of AIDS patients provides further evidence that casual contact offers little or no risk... the occurrence in young infants suggests transmission from an affected mother to a susceptible infant before, during, or shortly after birth."58

Reports from Europe suggested that two rather separate AIDS epidemics were occurring. In the UK, West Germany and Denmark, the majority of people with AIDS were homosexual, and many had a history of sex with American nationals. However in France and Belgium AIDS was occurring mainly in people from Central Africa or those with links to the area.59

Examples of this second epidemic included a number of previously healthy African patients who were hospitalised in Belgium with opportunistic infections (such as PCP and cryptosporidosis), Kaposi's sarcoma, or other AIDS-like illnesses. All of these Africans had immune deficiency similar to that of American AIDS patients. However they had no history of blood transfusion, homosexuality, or intravenous drug abuse.60 In light of such reports, European and American scientists set out to discover more about the occurrence of AIDS in Central Africa.

By this time, doctors working in parts of Zambia and Zaire had already noticed the emergence of a very aggressive form of Kaposi's sarcoma. This cancer was endemic in Central Africa, but previously it had progressed very slowly and responded well to treatment, whereas the new cases looked very different and were often fatal.61 62

In September the CDC published their first set of recommended precautions for health-care workers and allied professionals designed to prevent "AIDS transmission".63 In the UK, people who might be particularly susceptible to AIDS were asked not to donate blood.64

In October, the first European World Health Organisation (WHO) meeting was held in Denmark. At the meeting it was reported that there had been 2,803 AIDS cases in the USA.65

That meeting was followed in November by the first meeting to assess the global AIDS situation. This was the start of global surveillance by the WHO and it was reported that AIDS was present in the U.S.A., Canada, fifteen European countries, Haiti and Zaire as well as in seven Latin American countries. There were also cases reported from Australia and two suspected cases in Japan.66

By the end of the year the number of AIDS cases in the USA had risen to 3,064 and of these 1,292 had died.67
1984 History

At the CDC researchers had been continuing to investigate the cause of AIDS through a study of the sexual contacts of homosexual men in Los Angeles and New York. They identified a man as the link between a number of different cases and they named him "patient O" for "Out of California".68 The research appeared to confirm that AIDS was a transmittable disease, and the co-operation of "patient O" contributed to the study.69

However a problem arose when other people read the scientific paper.

"I called this guy Patient O... But my colleagues read it as Patient Zero."

- Darrow for Newsweek -70

And so in March 1984 the myth of Patient Zero began.71 See 1987 for more information about Patient Zero.

Just one month later, on April 22nd, Dr Mason of the CDC was reported as saying:

"I believe we have the cause of AIDS."

He was referring to the French virus, LAV, and he was basing his opinion on the findings made in the preceding weeks by the researchers at the Pasteur Institute who had discovered the virus the previous year.72


Margaret Heckler

Just one day later, on April 23rd, the United States Health and Human Services Secretary Margaret Heckler announced that Dr. Robert Gallo of the National Cancer Institute had isolated the virus which caused AIDS, that it was named HTLV-III, and that there would soon be a commercially available test able to detect the virus with "essentially 100 percent certainty". It was a dramatic and optimistic announcement that also included:

"We hope to have a vaccine [against AIDS] ready for testing in about two years."

And it concluded with:

"yet another terrible disease is about to yield to patience, persistence and outright genius".73 74

The same day patent applications were filed covering Gallo's work, but there was clearly a possibility that LAV and HTLV-III were the same virus.75 76 The scientific papers regarding Gallo's discovery of HTLV-III were published on 4th May.77 By 17th May, private companies were already applying to the Department of Health & Human Services for licences to develop a commercial test, which would detect evidence of the virus in blood, a test which it had already been said would be used to screen the entire supply of donated blood in the USA.78 79

Meanwhile there continued to be concern about the public health aspects of AIDS. This was particularly the case in San Francisco where all the gay bath houses and private sex clubs were closed. Some gay men regarded the closures as an attack on their civil rights. But Mervyn Silverman, Director of the San Francisco Department of Public Health stated the public health view as follows:


Dr Robert Gallo

"There are certain places where things are allowed and certain places where they are not. You can't have sex at the McDonald's. You generally cannot have sex in the pews of a church or in a synagogue. People don't feel their civil liberties are being in any way abrogated because of that."80

Researchers who had visited Central Africa in late 1983 reported they had identified 26 patients with AIDS in Kigali, Rwanda, and 38 in Kinshasa, Zaire. The Rwandan study concluded that, "an association of an urban environment, a relatively high income, and heterosexual promiscuity could be a risk factor for AIDS in Africa".81 The Zairian study found there to be a "strong indication of heterosexual transmission".82

In light of these findings the Zairian Department of Public Health, in collaboration with American and European scientists, launched a national AIDS research programme called Projet SIDA.83

By the end of 1984, there had been 7,699 AIDS cases and 3,665 AIDS deaths in the USA, and 762 cases had been reported in Europe.84 85 In the UK there had been 108 cases and 46 deaths.86
1985 History

In January 1985 a number of more detailed reports were published concerning LAV and HTLV-III, and by March it was clear that the viruses were the same.87 The same month the U.S Food and Drug Administration (FDA) licensed, for commercial production, the first blood test for AIDS. The test would reveal the presence of antibodies to HTLV-III/LAV, and it was announced that anyone who had antibodies in their blood would not in future be allowed to donate blood.88

There were a number of social and ethical issues, as well as certain medical matters, that had to be considered before the new test could be used even to ensure the safety of the blood supply. And even more aspects needed to be considered before the test could be more widely used. Concern particularly centred on issues of confidentiality and the meaning of a positive test result.89 90

"Richard Dunne, director of the Gay Men's Health Crisis, said that the group would not object to the wider availability of the procedure provided that certain safeguards were assured: informed consent, good counselling and confidentiality, 'which means anonymity,' he said. He stressed that the city must prevent insurance companies, employers, schools and others from gaining access to test results."

- The New York Times -91

The first small-scale needle and syringe exchange project had been started in 1984 in Amsterdam, the Netherlands, but more projects were started in 1985 as a result of growing concerns about HTLV-III/LAV.92

In April more than 2000 people attended the first international Conference on AIDS held in Atlanta. Three major topics of discussion were the new HTLV-III/LAV test, the situation with regard to AIDS internationally, and the extent of heterosexual transmission.93


"Some experts are sceptical that AIDS will spread as rapidly among heterosexuals as it has among homosexuals. Yet other experts, taking their cues from data emerging from preliminary studies from Africa showing equal sex distribution among males and females, are less sure."

- The New York Times -94

Immediately after the conference, the World Health Organization (WHO) organized an international meeting to consider the AIDS pandemic and to initiate concerted worldwide action.95

Meanwhile in many countries there was a separate "epidemic of fear" and prejudice.96

In the UK tabloid press, AIDS gained many headlines and caused alarm among the public. In some newspapers, the prejudice was obvious. The haemophiliacs were seen as the "innocent victims" of AIDS whereas gays and drug-users were seen as having brought the disease upon themselves.97 The fear of AIDS caused firemen to ban the kiss of life, and caused holidaymakers to cut their holiday short for fear of contracting AIDS from an HTLV-III positive passenger on the Queen Elizabeth 2.98 99 A 9-year old HTLV-III positive haemophiliac was allowed to attend the local school, but some of the pupils where kept home by anxious parents.100


In the US, it was feared that drinking communion wine from a common cup could transmit AIDS, and Ryan White, a 13-year old haemophiliac with AIDS, was barred from school.101 102

"In 1985, at 13, Ryan White became a symbol of the intolerance that is inflicted on AIDS victims. Once it became known that White, a haemophiliac, had contracted the disease from a tainted blood transfusion, school officials banned him from classes."

- Time Magazine -103

The CDC removed Haitians from their list of AIDS risk groups, in light of information that suggested both heterosexual contact and exposure to contaminated needles played a role in transmission.104

On September 17th, President Reagan publicly mentioned AIDS for the first time, when he was asked about AIDS funding at a press conference. At the same press conference he was also asked a question whether he would send his children if they were younger to school with a child who has AIDS.

"It is true that some medical sources had said that this cannot be communicated in any way other than the ones we already know and which would not involve a child being in the school. And yet medicine has not come forth unequivocally and said, 'This we know for a fact, that it is safe.' And until they do, I think we just have to do the best we can with this problem. I can understand both sides of it."

- Ronald W. Reagan -105

Drugs such as ribavirin, thought to be active against HTLV-III/LAV, were being smuggled from Mexico into the USA.106

The actor Rock Hudson died of AIDS on October 3rd 1985. He was the first major public figure known to have died of AIDS.107

All UK blood transfusion centres began routine testing of all blood donations for HTLV-III/LAV in October.108

For the Global Surveillance of AIDS, the WHO had initially used the definition of AIDS as developed in the USA in 1982. But this definition was difficult to use in developing countries where there was a lack of sophisticated laboratory tests. So in order to help with the surveillance of AIDS, particularly in Africa, a new WHO definition was adopted in October. This definition of AIDS became known as the Bangui definition.109

Towards the end of the year, Western scientists became much more aware of the "slim disease" that had become increasingly common in South West Uganda since 1982. Studies found that most cases were among promiscuous heterosexuals, the majority of whom tested positive for antibodies to HTLV-III/LAV. The site and timing of the first reported cases suggested that the disease arose in neighbouring Tanzania. Some scientists who studied slim concluded:

"Although slim disease resembles AIDS in many ways, it seems to be a new entity."110

However, others thought differently:

"[Evidence] suggests that slim disease cannot be distinguished from AIDS and ARC [AIDS related complex] by extreme weight loss and diarrhoea. Thus slim disease may not be a new syndrome but simply identical with AIDS as seen in Africa."111

In December 1985, the Pasteur Institute filed a lawsuit against the National Cancer Institute to claim a share of the royalties from the NCI's patented AIDS test.112

During the year, knowledge of transmission routes was to change again, when the first report appeared of the transmission of the virus from mother to child through breast feeding.113 The first case of AIDS was also reported in China, and AIDS had as a result been reported in every region in the world.114

By the end of 1985, 20,303 cases of AIDS had been reported to the World Health Organisation.115 In the USA 15,948 cases of AIDS had been reported,116 and in the UK 275 cases.117
1986 History

The first UK needle exchange scheme started in Dundee in February.118

In the UK, the government launched, in March, the first public information campaign on AIDS, with the slogan "Don't Aid AIDS". There were a series of advertisements in national newspapers.119

There was still at this time disagreement about the name of the virus.

"The name of the virus had itself become a political football as the French insisted on LAV (lymphadenopathy-associated virus), while Gallo's group used HTLV-3 (human T-cell lymphotropic virus, type 3)."

- Time Magazine -120

In May 1986, the International Committee on the Taxonomy of Viruses ruled that both names should be dropped and the dispute solved by a new name, HIV (Human Immunodeficiency Virus).121

At the opening speech of the International Conference in Paris, held from 23rd to 25th June 1986, Dr H Mahler, the Director of WHO, announced that as many as 10 million people worldwide could already be infected with HIV.122

In August, the USA Federal Government accused an employer of illegal discrimination against a person with AIDS for the first time. A hospital had dismissed a nurse and refused to offer him an alternative job. This was seen as a violation of his civil rights.123

In September there was dramatic progress in the provision of medical treatment for AIDS, when early results of clinical tests showed that a drug called azidothymidine (AZT) slowed down the attack of HIV. AZT was first synthesised in 1964 as a possible anticancer drug but it proved ineffective.

The AZT clinical trial divided patients into two groups: one received AZT and the other received placebo, or dummy drugs. At the end of six months, only one patient in the AZT group was dead, whilst there were 19 deaths among the placebo group. The clinical trial was stopped early, because it was thought to be unethical to deny the patients of the placebo groups a better chance of survival.124


"The announcement set off a flurry of excitement and controversy. AIDS hotlines and doctors' offices were flooded with calls, community leaders warned about undue optimism, and doctors debated the ethical and medical issues raised by the early cancellation of the AZT study."

- Time Magazine -125

In the United States, the Surgeon General's Report on AIDS was published. The report was the Government's first major statement on what the nation should do to prevent the spread of AIDS. The "unusually explicit" report urged parents and schools to start "frank, open discussions" about AIDS.126

By this time, scientists had accumulated enough evidence to form an overview of AIDS in Africa. Studies of medical records showed there had been marked increases in a number of AIDS-related conditions during the late 1970s and early 1980s. In particular:
Slim disease in Kinshasa, Zaire (late 1970s)
Slim disease in Uganda and Tanzania (early 1980s)
Esophagel candidiasis in Rwanda (from 1983)
Aggressive Kaposi's sarcoma in Kinshasa, Zaire (early 1980s)
Aggressive Kaposi's sarcoma in Zambia and Uganda (from 1982 and 1983)
Crypotococcal meningitis in Kinshasa, Zaire (late 1970s to early 1980s).

In conclusion:

"These studies suggested that while isolated cases of AIDS may have occurred in Africa earlier, it was probably rare until the late 1970's and early 1980's, a pattern similar to that in the United States and Haiti."127

As in developed countries, AIDS in Africa was found to primarily affect young and middle-aged people, especially those who were unmarried. The sex and age distributions were seen to reflect other sexually transmitted diseases, and the major transmission routes had been identified:

"Available data suggest that heterosexual activity, blood transfusions, vertical transmission from mother to infant, and probably frequent exposure to unsterilized needles account for the spread of HIV infection and AIDS in Africa."128

HIV and AIDS had also been detected in India, among sex workers in the southern state of Tamil Nadu, igniting fears that the disease would soon spread across the subcontinent. In response, the Indian government decided to increase the number of HIV testing centres and improve the screening of blood donations.129

By the end of the year, 85 countries had reported 38,401 cases of AIDS to the World Health Organisation. By region these were: Africa 2,323, Americas 31,741, Asia 84, Europe 3,858, and Oceania 395.130
Further reading


There are four other history of AIDS pages:
History of AIDS from 1987 to 1992
History of AIDS from 1993 to 1997
History of AIDS from 1998 to 2002
History of AIDS from 2003 - onwards

This page was written by Annabel Kanabus and Jenni Fredriksson.
References
Mann J. M (1989) 'AIDS: A worldwide pandemic', in Current topics in AIDS, volume 2, edited by Gottlieb M.S., Jeffries D.J., Mildvan D., Pinching, A.J., Quinn T.C., John Wiley & Sons
Hymes, K.B., Greene, J. B., Marcus, A., et al. (1981) 'Kaposi's sarcoma in homosexual men: A report of eight cases', Lancet 2:598-600
MMWR Weekly (1981) ' Kaposi's Sarcoma and Pneumocystis Pneumonia among Homosexual Men- New York City and California', July 4,30 (4); 305-308
Daniel McGinn, 'MSNBC: AIDS at 20: Anatomy of a Plague; an Oral History', Newsweek Web Exclusive
MMWR Weekly (1981) 'Pneumocystis Pneumonia- Los Angeles', June 5, 30 (21); 1-3
'The AIDS epidemic in San Francisco: The medical response, 1981-1984', Volume I, an oral history conducted in 1992-1993, Regional Oral History Office, The Bancroft Library, University of California, Berkeley, 1995
Gottlieb M.S., Schroff R., Schanker H.M., et al. (1981) 'Pneumocystis carinii pneumonia and mucosal candidiasis in previously healthy homosexual men: evidence of a new acquired cellular immunodeficiency', The New England Journal of Medicine 305:1425-31.
Goedert J.J., Neuland C.Y., Wallen W.C., (1982) 'Amyl Nitrite may alter T lymphocytes in homosexual men',the Lancet 1:412-6
Shearer G.M., Hurtenbach U. (1982) 'Is sperm immunosuppressive in homosexuals and vasectomized men?' Immunology Today 3 153-154
Darrow, W.W (1991) 'AIDS: Socioepidemiologic responses to an epidemic', in 'AIDS and the social sciences, common threads', edited by Ulack, R. and Skinner, W.F., 1991,The University Press of Kentucky
Altman, L.K, (1981) 'Rare cancer seen in 41 Homosexuals', the New York Times, July 3
Masur H., Michelis M.A., Greene J.B., Onorato I., Stouwe R.A., Holzman R.S., Wormser G., Brettman L., Lange M., Murray H.W. and Cunnigham-Rundles S. (1981) 'An Outbreak of community acquired Pneumocystis carinii pneumonia: initial manifestation of cellular immune dysfunction' (1981), The New England Journal Of Medicine, vol 305:1431-1438, December 10, Number 24,
Dubois, R.M., Braitwaite, M.A., Mikhail, J.R. et al., (1981) 'Primary Pneumocystis Carinii and Cytomegalovirus Infections', the Lancet, ii, 1339
MMWR Weekly (1982) 'Epidemiologic Notes and Reports Persistent, Generalized Lymphadenopathy among Homosexual Males', May 21, 31(19); 249-51
MMWR Weekly (1982) 'Diffuse, Undifferentiated Non-Hodgkins Lymphoma among Homosexual Males- United States', June 4,31(21); 277-9
Brennan, R.O. and Durack, D.T., (1981) 'Gay compromise syndrome', the Lancet, 2 1338-1339:
Altman, L.K. (1982) 'New homosexual disorder worries officials', the New York Times, May 11
The Washington Blade (1982) 'Gay cancer focus of hearing', April 16
MMWR weekly (1882) 'A Cluster of Kaposi's sarcoma and Pneumocystis carinii Pneumonia among homosexual male residents of Los Angles and Orange counties, California', June 18/31 (23); 305-7
CDC (1982) ' Kaposi's Sarcoma (KS), Pneumocystis Carinii Pneumonia (PCP), and Other Opportunistic Infections (01): Cases Reported to CDC as of July 8'
MMWR Weekly (1982) 'Opportunistic infections and Kaposi's Sarcoma among Haitians in the United States', July 9,31 (26); 353-4,360-1
MMWR Weekly (1982) 'Epidemiologic notes and Reports Pneumocystis carinii Pneumonia among persons with hemophilia A', July 16, 31(27); 365-7,).
McKeown P. (1982) ''Gay Plague' Baffling Medical Detectives', Philadelphia Daily News, August 9
Time (2003) 'A Name for the Plague', March 30
Marx J.L. (1982) 'New disease baffles medical community', Science, August 13
Herman R. (1982) 'A Disease's spread provokes anxiety', the New York Times, August 8
McKeown P. (1982) ''Gay Plague' Baffling Medical Detectives', Philadelphia Daily News, August 9
MMWR Weekly (1982) 'Current Trends Update on Acquired Immune Deficiency Syndrome (AIDS)- United States', September 24, 31(37); 507-508, 513-514,
Direction Generale De La Sante (1982) 'Syndrome d'immuno-depression acquise', Bull. Epid. Hebd., no. 50 (1982b)
Connor S. and Kingman S. (1988) 'The search for the virus, the scientific discovery of AIDS and the quest for a cure', Penguin Books, p.14
Herman R. (1982) 'A Disease's spread provokes anxiety', the New York Times, August 8
About SFAF, www.sfaf.org/aboutsfaf; About APLA, www.apla.org/apla/about/about.html; About GMHC, www.gmhc.org/aboutus/gmhc.html
Berridge V., (1996), 'AIDS in the UK, the making of policy' 1981-1994, Oxford University Press
For example: Bay Area physicians for human rights leaflet on Kaposi's Sarcoma, GMHC health recommendation brochure.
MMWR Weekly (1982) 'Epidemiologic Notes and Reports Possible Transfusion-Associated Acquired Immune Deficiency Syndrome, AIDS- California', December 10, 31 (48); 652-4
MMWR Weekly (1982) 'Unexplained Immunodeficiency and Opportunistic Infections in Infants- New York, New Jersey, California', December 17,31 (49); 665-667
McGinn D. 'MSNBC: AIDS at 20: Anatomy of a Plague; an Oral History', Newsweek Web Exclusive,
For example: Vilaseca , J. et al. (1982) 'Kaposi's sarcoma and Toxoplasma gondi brain abscess in a Spanish homosexual', The Lancet 1, 572; Rozenbaum, W., et al. (1982) 'Multiple opportunistic infection in a male homosexual in France', The Lancet 1,572-573; Francioli, P., et al. 'Syndrome de deficience immunitaire acquise, infections opportunists et homosexualite. Presentation de trios cas observes en Suisse', (1982) Schweiz. Med. Wschr. 112, 1682-1687
Serwadda D, Mugerwa RD, Sewankambo NK, et al (1985) 'Slim disease: a new disease in Uganda and its association with HTLV-III infection', the Lancet, 2:849-52
MMWR Weekly (1983) 'Epidemiologic notes and reports immunodeficiency among female sexual partners of males with Acquired Immune Deficiency Syndrome (AIDS) - New York' (1983), January 7, 31(52);697-8
Marx J.L. (1983) 'Health officials seek ways to halt AIDS', Science, 21 January
MMWR Weekly (1983) 'Current trends prevention of Acquired Immune Deficiency Syndrome (AIDS): Report of Inter-Agency Recommendations', March 4, 32(8);101-3
Altman L. K. (1983) 'Debate Grows on U.S. Listing Of Haitians in AIDS Category', New York Times, July 31
Simons M. (1983) 'For Haiti's Tourism, the Stigma of AIDS is Fatal', New York Times, November 29
Callen M. (1983) 'Remarks to the New York Congressional Delegation', May 28
Goldstein A. (1983) 'AIDS Fear Hits Gay Populace Doctors: More Deaths Likely', Miami Herald, June 12
Black D. (1986) 'The Plague Years', Chapter 3 Part 12
Mail on Sunday (1983) May 1
Vass. A. (1986) 'AIDS: A Plague in Us', Venus Academica, p.25
For Example Daily Telegraph (1983) "Gay Plague" May Lead to Blood Ban on Homosexuals', May 2, and Daily Mirror (1983) 'Alert over "Gay Plague"', May 2
Barre-Sinoussi F. , Chermann J-C., Rey F., Nugeyre M.T., Chamaret S., Gruest J., Dauguet C., Axler-Blin C., Brun-Vezinet F., Rouzioux C., Rozenbaum W., and Montagnier L. (1983), 'Isolation of a T-Lymphotropic retrovirus from a patient at risk for Acquired Immune Deficiency Syndrome (AIDS)', Science, May 20
Office of Technology Assessment (1985) 'Review of the Public Health Service's Response to AIDS', U.S. Congress, Washington DC., February, p.28
Connor S. and Kingman S. (1988), 'The search for the virus, the scientific discovery of AIDS and the quest for a cure' Penguin Books, p.35
Oleske J., et al. (1983), 'Immune Deficiency Syndrome in children', Journal of American Medicine Association, 249 (17), 2345-2349
New York Times (1983)'San Francisco Seeks to Combat Fear of AIDS', May 22
Enlow, R.(1984), 'Special session', in Acquired Immune Deficiency Syndrome, Annals of the New York Academy of Science, Volume 437, edited by Selikoff I.J, Teirstein A.S. and Hirschman S.Z., The New York Academy of Sciences, p.291
Altman L.K. (1983) 'Concern over AIDS grows internationally', the New York Times, May 24
MMWR Weekly (1983) 'Current Trends Acquired Immunodeficiency Syndrome (AIDS) Update - United States', June 24, 32 (24); 309-11
Weller I., Crawford D.H., Iliescu V., MacLennan K., Sutherland S., Tedder R.S., and Adler M.W. (1984) 'Homosexual men in London: Lymphadenopathy, immune status, and Epstein-Barr virus infection ', Annals of the New York Academy of Science, Volume 437, edited by Selikoff I.J, Teirstein A.S. and Hirschman S.Z., The New York Academy of Sciences, p.248-249
Clumeck N, Sonnet J, et al (1984) 'Acquired immunodeficiency syndrome in African patients', New England Journal of Medicine, 23;310(8):492-7
Bayley A.C. (1984) 'Aggressive Kaposi's sarcoma in Zambia, 1983', the Lancet 1:1318-20
Coker R, Wood PB (1986) 'Changing patterns of Kaposi's sarcoma in N.E. Zaire', Trans R Soc Trop Med Hyg., 1986;80(6):965-6
MMWR Weekly (1983) 'Acquired Immunodeficiency Syndrome (AIDS): Precautions for Health-Care Workers and Allied Professionals', September 2, 32 (34); 450-1
Gunson H H, (1986) 'The blood transfusion service in the UK', in Proceedings of the AIDS Conference 1986, edited by Jones P., Intercept, p.91-100
MMWR Weekly (1983) 'International Notes Acquired Immunodeficiency Syndrome (AIDS) - Europe', November 25, 32 (46); 610-1
WHO (1983) 'Acquired Immune Deficiency Syndrome Emergencies', Report of a WHO Meeting, Geneva, 22-25, November
AIDS Activity Center For Infectious Diseases Centers For Disease Control (1983) 'Acquired Immunodeficiency Syndrome (AIDS) weekly surveillance report- United States', December 22
Darrow, W.W (1991) 'AIDS: socioepidemiologic responses to an epidemic', in 'AIDS and the social sciences, common threads', edited by Ulack, R. and Skinner, W.F., 1991,The University Press of Kentucky
Auerbach D.M., Darrow, W.W., Jaffe, H.W, and J.W Curran (1984)'Cluster of cases of the acquired Immune Deficiency Syndrome-patients linked by sexual contact' ,American Journal of Medicine, 76, 487-492
McGinn D. 'MSNBC: AIDS at 20: Anatomy of a Plague; an Oral History', Newsweek Web Exclusive,
The Associated Press (1984), 'U.S. Medical study singles out a man who carried AIDS', the New York Times, March 27
Altman L.K. (1984) 'Federal official says he believes cause of AIDS has been found', the New York Times, April 22
Heckler, M. M. Secretary, U.S. Department of Health and Human services, Washington DC, Statement regarding AIDS, April 23, 1984
Office of Technology Assessment (1985) 'Review of the Public Health Service's Response to AIDS', U.S. Congress, Washington DC., February, p.29
Culliton B.J. (1984), 'Crash development of AIDS test nears goal', Science, September 14
Altman L.K. (1984), 'New U.S. report names virus that may cause AIDS', the New York Times, April 24
Marx J.L. (1984), 'Strong new candidate for AIDS agent', Science, May 4
Culliton B.J. (1984), 'Five firms with the right stuff', Science, September 14
Office of Technology Assessment (1985) 'Review of the Public Health Service's Response to AIDS', U.S. Congress, Washington DC., February, p.29
'The AIDS Epidemic in San Francisco: the medical response, 1981-1984', Volume I, an oral history conducted in 1992-1993, Regional Oral History Office, The Bancroft Library, University of California, Berkeley, 1995
Van de Perre, P, Rouvroy D., Lepage, P et. al. (1984) 'Acquired Immunodeficiency Syndrome in Rwanda', the Lancet 2:62-5
Piot P, Quinn T.C., Taelman H. et al. (1984), 'Acquired Immunodeficiency Syndrome in a heterosexual population in Zaire', the Lancet 2:65-69
Mann J., Kapita B., Colebunders R. et al. (1986), 'Natural history of Human Immunodeficiency Virus Infection in Zaire', the Lancet, 2, 707-709
AIDS Activity, Center For Infectious Diseases, Centers For Disease Control (1984)'Acquired Immunodeficiency Syndrome (AIDS), Weekly Surveillance Report- United States', December 31
MMWR Weekly (1985) 'International Notes Update: Acquired Immunodeficiency Syndrome Europe', 34(11);147-150 March 22,
Department of Health & Social Security (1985) 'Acquired Immune Deficiency Syndrome, general information for doctors', May
Marx J.L. (1985), 'A virus by any other name�', Science, March 22
'Pear R. (1985), 'AIDS blood test to be available in 2 to 6 weeks', the New York Times, March 3
Krieger N. and Appleman R (1986), 'The politics of AIDS', Frontline Pamphlets, the Institute for Social and Economic Studies, p.25
Gunson H. H. (1986) 'The blood transfusion service in the UK', in Proceedings of the AIDS Conference 1986, edited by Jones P., Intercept, p.91-100
Eckholm E. (1985) 'City, in shift, to make blood test for AIDS virus more widely available', the New York Times, December 23
National Institute on Drug Abuse (1988) 'Needle sharing among intravenous drug abusers: national and international perspectives', Research Monograph Series 80
Patton C. (1985) 'Sex and germs, the politics of AIDS', South End Press, Boston, p.37
Altman L.K. (1985) 'The Doctor's world: AIDS data pour in as studies proliferate', the New York Times, April 23
Mann , J. M (1989) 'AIDS: A worldwide pandemic', in Current topics in AIDS, Volume 2, edited by Gottlieb M.S., Jeffries D.F., Mildvan D., Pinching A.J., Quinn T.C., R.A. John Wiley & Sons
Boffey P.M. (1985) 'U.S. counters public fears AIDS', the New York Times, September 20
Wellings K. (1988) 'Perceptions of risk, media treatment of AIDS, in 'Social Aspects of AIDS' edited by Aggleton P. and Homans H. (1988), Falmer Press, p.87
Brunt M. (1985) 'Ban on deadly kiss of life', Sunday Mirror, February 17
Sunday People (1985) 'Scandal of AIDS cover-up on QE2', February 17
Pinching A. (1990) 'Children with HIV infection: Dealing with the problem' in 'AIDS: A challenge in education', edited by D.R., Morgan, (1990), Institute of Biology
Berger J. (1985) 'Communion-Cup fear addressed' , the New York Times, September 13
Levine J. (1986) 'AIDS: prejudice and progress', Time Magazine, September 8,
Time Magazine (1990) 'American notes voices, the 'miracle' of Ryan White', April 23
MMWR Weekly (1985) 'Current Trends Update: Acquired Immunodeficiency Syndrome -- United States', May 10
Reagan R. (1985) 'The President's News Conference', September 17, www.reagan.utexas.resource/speeches/1985/91785c.htm
Arno P.S. and Feiden K.L. (1992) 'Against the odds: the story of AIDS development, politics and profits', HarperCollins Publishers and Palazzolo J. and Baker R. (1988) 'Antivirals for HIV infection', Bulletin of experimental treatments for AIDS (BETA), No.2, November
Berger J. (1985), 'Rock Hudson, screen idol, dies at 59', the New York Times, October 3
Gunson H. (1986) 'The blood transfusion service n the UK', in 'Proceedings of the AIDS conference 1986, Newcastle upon Tyne, UK', Edited by Jones P.
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Serwadda D, Mugerwa RD, Sewankambo NK, et al (1985) 'Slim disease: a new disease in Uganda and its association with HTLV-III infection', the Lancet, 2:849-52
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Krieger N. and Appleman R. (1986), 'The politics of AIDS', Frontline Pamphlets, the Institute for Social and Economic Studies
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Fischl M. A., Richman D. D., Grieco M. H., Gottlieb M. S., Volberding P. A., Laskin O. L., Leedom J. M., Groopman J. E., Mildvan D., Schooley R. T., et al. (1987)''The Efficacy of azidothymidine (AZT) in the treatment of patients with AIDS and AIDS-related complex, a double-blind, placebo-controlled trial', The New England Journal Of Medicine, Vol. 317: 185-191, Number 4
Levine J. (1986) 'A ray of hope in the fight against AIDS', Time Magazine, September 29
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Bureau of Hygiene & Tropical Diseases (1986) 'AIDS newsletter' Issue Volume 2 Issue 1 January 15

August 2, 2007 | 1:30 PM Comments  0 comments
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IMPROVING MATERNAL HEALTH
Related to country: Sierra Leone

Improving Maternal Health


08/18/2005


UN Millennium Development Goal #5

Childbirth remains an unnecessarily dangerous and life-threatening risk for women throughout the developing world. Every year, twelve million women are permanently disabled and between 500,000 and 600,000 die from treatable complications during childbirth because of lack of access to proper pre-and post-natal care – accounting for nearly 1,600 maternal deaths per day. Ninety-nine percent of all maternal deaths occur in developing countries – specifically in Asia and sub-Saharan Africa where poverty is most prevalent. One in every sixteen women in sub-Saharan Africa dies of pregnancy-related causes; in the developed world, only one woman in every 2,800 is at risk of maternal death. Almost all of the women who die in developing countries during childbirth would still be alive if they had pre- and post-natal care, access to a skilled midwife or doctor in childbirth and effective emergency care for obstetric emergencies. Additionally, improved access to contraceptives could further help in reducing maternal mortality by allowing women to plan their families

As contraceptives are often difficult to get reliably in developing countries, many women are unable to time or space their births leading to large families and children born close together, which can weaken women’s health. Lack of contraceptives and sexual education also leads to unwanted pregnancies which can further deter women from spending scare resources on pre-natal care. Delaying marriage and the birth of a first child, preventing unwanted pregnancies and eliminating unsafe abortions would cut the number of maternal deaths by up to a third. Abortion is illegal in most developing countries and for the thousands of pregnant women every year without access to legal and safe abortion, abortion can result in death. Globally every year, 80 million women face an unwanted or unplanned pregnancy and 20 million women risk having an unsafe abortion rather than carry their pregnancy to term.

Many women in developing countries have very little access to pre- or post-natal care which puts them further at risk for complications during their pregnancy. Women in developing countries often lack the economic resources and education to make informed decisions about their health and nutrition. Some women are denied or lack access to services because of logistical, social or cultural barriers. Combined with excessive physical labor and poor nutrition, this lack of prenatal care increases the risk of maternal mortality. Additional factors that prevent women in developing countries from receiving the life-saving health care they need include distance from health services, costs, poor quality of available services and substandard treatment by health providers.

Gender-based violence also greatly contributes to maternal mortality. Women who suffer from domestic violence in pregnancy are more likely to miscarry which can cause complications. Female genital circumcision which is prevalent in some developing countries can also complicate childbirth. The disparity in women’s health among rich and poor countries is becoming increasingly pronounced. Recognizing the poor condition of women’s health globally and the devastating reality of maternal morbidity and mortality, UNICEF has characterized it as “in scale and severity the most neglected tragedy of our times.”


The Fifth Goal

The fifth goal of the UN Millennium Challenge is thus to improve maternal health.

To Improve Maternal Health


Target: Reduce by Three-Quarters, Between 1990 and 2015, the Maternal Mortality Ratio


The repercussions from high maternal mortality rates echo throughout the developing world. Each year, three million babies die within their first week of life. Improved maternal health could prevent up to 70% of these neonatal deaths. Up to two million children every year are orphaned because their mother has died as a result of complications in pregnancy or childbirth. Only Latin America and the Caribbean are on track to meet the international target of having 90% of births attended by a skilled health worker by 2015. Asia has only made limited progress and in Sub-Saharan Africa, the rate has remained the same since 1990. Without more action at the national and international level, the target won’t be met. To achieve the targeted measure of improving women's health and reducing the maternal mortality ratio by three-quarters, the UN Taskforce on Child and Maternal Health has outlined a broad range of reforms and interventions.

In order to allow couples to plan their families, sexual and reproductive health education and communication skills must be made available to all men and women. Quality contraceptives must also be readily available alongside this education. Having a strong primary healthcare system which can be accessed and used by everyone, particularly poor and under-served women, is a prerequisite for many of the actions needed to improve maternal health. Healthcare facilities staffed with trained birth attendants can ensure easier access to basic pre- and post-natal care for all women. Beyond treating complications and attending the birth, trained birth attendants are often the only source of comprehensive reproductive and physical health information – a vital lifeline inaccessible to millions of women throughout the world. Alongside improved access to health care facilities, access to skilled birth attendants or health workers trained in midwifery greatly improve a woman’s chances of surviving childbirth. Many women’s lives are lost because of delays during the childbirth. Without improvements in gender equity within domestic healthcare systems, reductions in maternal mortality and the general improvement of women's health will not be possible.

The Displaced and Stateless Populations

Displaced and stateless mothers are disproportionately impacted by maternal morbidity and mortality. Lack of access to basic health care has caused displaced people to have some of the highest rates of infant and maternal mortality in the world. For displaced women, lack of quality reproductive health services can also lead to increase in the spread of sexually transmitted infections, including HIV/AIDS, an increase in unsafe abortions and increased morbidity related to high fertility rates and poor birth spacing.

In addition to receiving inadequate reproductive health care, displaced women are more vulnerable to sexual violence by armed forces and others and face exploitation in the absence of traditional socio-cultural constraints. Without access to emergency contraception, displaced women who have been raped often find themselves pregnant with an unwanted child. Displaced women fleeing conflict also lack access to safe childbirth and emergency obstetric care.

Displaced women are often unable to access humanitarian assistance and healthcare due to the extremely dangerous security conditions that caused the displacement in the first place. Displaced camps are often inaccessible because of infrastructure problems as well as insecurity and this can prevent humanitarian workers from delivering needed healthcare. Reproductive and maternal health is often seen as “non-essential” humanitarian assistance and under-funded. When displaced people live outside camps, they are often unable to access healthcare from international humanitarian assistance efforts. Displaced women cannot rely on host communities where they seek refuge to provide assistance as these communities often reside in under-developed areas and are rarely able to provide adequate health services to their own people. A sudden influx of refugees or an internally displaced population can overburden even the most basic services of the local health system. Although refugee camps provide a measure of assistance to displaced populations, internally displaced women often lack even the modicum of protection and assistance provided refugee mothers.

Stateless women, lacking citizenship and nationality, are often unable to access even basic services of the state such as government health clinics, putting them further at risk. As many stateless live in poverty and lack the economic opportunities offered to others, they are unlikely to be able to use many private clinics that charge user fees, making them more likely to resort to unattended births. Stateless women are also less protected by any government laws regarding age of marriage because they are unlikely to have documents for birth registration.

Therefore, Refugees International recommends that


Beyond expanding and improving the quality and coverage of primary health systems in areas where internally displaced and stateless populations reside, governments of developing countries and international donors increase investments in public health in general to provide basic pre-and post-natal healthcare for women;
In order to increase the access to state-run health facilities, governments remove or lower user fees for primary healthcare to increase access for displaced or stateless women;
Donors and governments work to increase the number and quality of skilled birth attendants and health workers trained in midwifery in developing countries;
Donors support governments in incorporating family planning and comprehensive sexual and reproductive health education, including information on contraception and abortion, into education curriculums to delay early marriage and childbearing and prevent and manage unwanted pregnancies;
The U.S. Congress remove restrictions for funding the United Nations Population Fund, the world’s leading provider of family planning and maternal health in developing countries;
The U.S. government immediately repeal the “Mexico City Policy,” an executive order imposing restrictions on U. S. funding for international family planning and prohibiting nongovernmental organizations outside the United States from receiving funding if, with their own funds and in accordance with the laws of their countries, they “performed” or “actively promote[d] abortion as a method of family planning.” This policy has the effect of limiting the ability of international and local health care providers in developing countries from providing full reproductive health care services to their patients.
Donors, international humanitarian organizations and local NGOs increase maternal health, nutrition and reproductive programming in refugee and displacement camps, communities hosting displaced populations, as well as within vulnerable and under-served stateless populations;
Governments and international agencies augment security and protection services and humanitarian assistance to refugee, displaced and stateless women in order to minimize deaths associated with conflict, rape and gender-based violence, and HIV/AIDS.

August 2, 2007 | 12:36 PM Comments  0 comments
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ENVIRONMENTAL SUSTAINABILITY
Related to country: Sierra Leone

PROTECTING OUR ENVIRONMENT

Water Factsheet (234 kb) | Environmental Sustainability Factsheet(151 kb) | Slumdwellers Factsheet(215 kb) | DFID's approach to the Environment(858 kb) | Water and sanitation


Poor people often have limited access to clean water and fresh air, fertile land and fertile crops, and the healthy livestock and other animals that are essential for livelihoods and health. Also, it is the poor who usually bear the brunt of environmental hazards and degradation. In addition, poor people and poor countries are dependent on natural resources such as timber, agricultural crops, fuel and minerals for their livelihoods and for economic growth. So, sound environmental management and the sustainable use of natural resources are essential to economic growth in developing countries.

DFID is helping to tackle environmental problems by:
committing to double our assistance to water and sanitation in Africa to £95 million a year by 2007/08, and more than double funding again to £200 million by 2010/11.
supporting a programme with civil society organisations in Kenya to better represent the needs of poor communities to government and make improvements in legislation to benefit poor people.
significantly increased research funding to improve the capacity of African countries to adapt to climate change.
working to improve climate science in Africa through the Global Climate Observing System (GCOS).
helping to develop guidance on how to screen all development investments for the effects of climate change.
support UN Habitat, the UN agency leading on urban development and shelter, to improve the lives of slum-dwellers.
fund a number of regional and country programmes, such as the large urban services programmes in Kolkata Andhra Pradesh and Madhya Pradesh in India, which total £266 million.

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There are however, a number of environmental problems to tackle:
assessments of national development plans by the World Bank have shown limited integration of the environment;
environmental assets (such as clean water, clean air, fertile crops) provide roughly two-thirds of household income for the rural poor, but the loss of environmental resources continues. Forest cover, for example, has declined by 7.3 million hectares per year over the past five years – an area about the size of Sierra Leone.
climate change is a major threat to development – natural disasters such as hurricanes and floods are expected to increase in intensity and severity. Higher temperatures will cause diseases like malaria to spread. Shorter and more changeable rainy seasons will cause crops to fail. Greater competition over resources could lead to conflict.
1.1 billion people still lack access to safe drinking water; 2.6 billion lack access to basic sanitation.
according to UN Habitat, there are currently 989 million slum-dwellers worldwide, and this is expected to increase to 1.4 billion by 2020 if current trends do not change.

August 2, 2007 | 12:27 PM Comments  0 comments
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GENDER INEQUALITY
About this event: National Youth Empowerment Summit
Related to country: Ghana

3. The Geography of Gender Inequality
Document(s) 6 of 13


A great deal of human behaviour is not the result of individual preferences. Rather, it is governed by institutional rules, norms and conventions that have powerful material effects on people’s lives. Institutions have been defined as the ‘rules of the game’ in a society. These rules may be written or unwritten, explicit or implicit, codified in law, mandated by policy, sanctified by religion, upheld by convention or embodied in the standards of family, community and society. They play a powerful role in shaping human behaviour, in terms of both what is permitted and what is prohibited. In the economy, they:
influence the gender division of labour between production and reproduction in different parts of the world; and
give rise to distinctive regional patterns in labour force participation and economic activity by women and men.

A great deal of human behaviour is not the result of individual preferences. Rather, it is governed by institutional rules, norms and conventions . . .

While institutions themselves are abstract concepts, they take concrete form in organisations – the ‘teams’ that play the game. There are four key categories of institutions, each with a particular domain (or area of influence) in society and each associated with a different set of organisations and groups. These are states, markets, civil society/community, and kinship/family (see box 3.1).

These institutions govern the processes of production, reproduction and distribution in a society. The way they are set up varies by level of economic development, structure of economy and extent of commodification (i.e. the extent to which a market value has been given to previously non-commercial goods and services). In terms of the productive pyramid shown in Fig. 2.1, there are likely to be differences across the world in the extent both of formal markets and state regulation and of subsistence production.
Box 3.1 Key Categories of Institutions in Society

States: The state is responsible for the overall governance of society. It enforces the rules and procedures that regulate how the different institutional domains interact. Access to state resources, including employment, is through its legislation, policies and regulations. Examples of state organisations include those associated with the bureaucracy, the police, the legislature, the judiciary and local government.
Markets: Markets are organised around a commercial logic – the maximisation of profit – and resources are exchanged on the basis of contract-based entitlements. Market-based organisations include firms, commercial farms, micro-enterprises, trade networks and multinational corporations.
Civil society/community: Civil society refers to a range of associations whose members pursue a variety of interests. The membership and goals are usually ‘chosen’, and members determine how resources and responsibilities will be distributed on the basis of some agreed set of principles. Such organisations include trade unions, non-governmental organisations (NGOs) and professional associations. Community is used here to refer to associations and groups based on what sociologists call ‘primordial’ ties. Membership of these groups is ascribed rather than chosen. Individuals’ access to their resources depends on how they are positioned in the group by these ascribed identities. Examples of community include caste, tribe and patron-client relationships.
Kinship/family: Kinship and family refer to forms of social organisation, including lineages and clans, that are based on descent, marriage and various forms of adoption or fostering. One of the key organisations associated with kinship and family is ‘the household’, usually based on shared residence and/or shared budgets. Elson calls households the site par excellence of ‘provisioning’, that is, “the activity of supplying people with what they need to thrive, including care and concern as well as material goods”.

Four key categories of institutions in society are: states, markets, civil society/community and kinship/family.

Institutions provide a structure, and hence a degree of stability, to everyday life. They reduce uncertainty, make certain forms of behaviour more predictable and allow individuals to co-operate with others to produce results that they would not be able to achieve on their own. At the same time, however – and whatever their official ideologies – institutions rarely operate in egalitarian ways. Rather, they tend to support hierarchical relationships organised around:
inequalities of ownership or access to the means of production (land, capital, finance, equipment);
achieved or acquired attributes (education, skills, contacts); and
various socially-ascribed attributes (gender, age, caste, etc.).

A variety of explanations and justifications are given for these hierarchies, including merit, capacity, aptitude, biology, nature or divine will. Institutions’ rules of access – and exclusion – also intersect and overlap (see box 3.2).

Society’s institutional framework – its rules, norms, beliefs and practices – means that individuals and social groups not only start from different places, but also have different opportunities to improve their situation in the course of their lives.
Box 3.2 Intersecting Inequalities and the State

Institutional inequalities in one area can be offset or worsened by access or exclusion in another. For example, inequalities in a community on the basis of caste, race or gender can be countered by anti-discrimination laws in employment or by the ability of subordinate groups to take advantage of new opportunities in the market place. On the other hand, prejudice by employers or exclusionary practices by trade unions and professional associations can make these inequalities worse. Society’s institutional framework – its rules, norms, beliefs and practices – means that individuals and social groups not only start from different places, but also have different opportunities to improve their situation in the course of their lives. Given its importance in the overall governance of society, the state can play a critical role in maintaining, reinforcing or countering inequalities in other domains.
Institutions and Gender Inequality

Gender inequality, the main focus of this book, is one of the most pervasive forms of inequality. This is not just because it is present in most societies, but also because it cuts across other forms of inequality (see introduction to Chapter 1). It is constructed through both:
the formal laws and statutes that make up the official ideologies of a society and its institutions; and
the unwritten norms and shared understandings that help shape everyday behaviour in the real world.

Gender inequality . . . is one of the most pervasive forms of inequality . . . not just because it is present in most societies, but also because it cuts across other forms of inequality.

Although gender inequality is thus found throughout society, institutional analyses of it generally start by looking at kinship and family. This is because these are the primary forms of organisation that are inherently gendered. Women’s and men’s roles and responsibilities in the domestic domain also reveal how the wider society views their natures and capabilities and hence constructs gender difference and inequality. In addition, a great deal of productive, as well as reproductive, activity is organised through kinship and family. This is particularly the case among the poor in poorer parts of the world. Consequently, even when women and men participate in the wider economy, their participation is partly structured by relations in the household.

Families and kinship are different from other institutions because of the nature of the relationships within them. These are usually based on intimate ties of blood, marriage and adoption (in contrast to the more impersonal relationships of contract and statute found in the market and state). They are also generally ‘gender-ascriptive’. In other words, to be a husband, wife, brother or daughter is to be a male or a female. In most societies, women are associated with the functions of care and maintenance. These include bearing and rearing children and the wider range of activities necessary to the survival and well-being of family members on a daily basis. While men may participate in some of these activities, particularly in training boys ‘how to be men’ or sharing in certain household chores, they tend to have far less involvement than women.

Women thus play a key role in unpaid processes of social

reproduction (i.e. reproducing society’s human resources on a daily and intergenerational basis). They may also predominate when these activities are shifted into the market, for example, nursing, teaching and social work. However, the part they play in production and accumulation – and the form that their involvement takes – varies considerably across cultures. Different rules, norms and values govern the gender division of labour and the gender distribution of resources, responsibilities, agency and power. These are critical elements for understanding the nature of gender inequality in different societies. Ideas and beliefs about gender in the domestic sphere often get reproduced in other social relations, either consciously as gender discrimination or unconsciously as gender bias. Rather than being impersonal, state or market institutions thus become ‘bearers of gender’. They position women and men unequally in access to resources and assign them unequal value in the public domain.
Regional Perspectives on Gender Inequality

Gender inequality varies at the regional level, suggesting a ‘geography’ of gender. This geography reflects systematic regional differences in:
the institutions of kinship and family;
the household patterns they have given rise to; and
the associated gender division of resources and responsibilities.

These have in turn given rise to regional differences in the gender division of labour between production and reproduction, paid and unpaid work, and the domestic and public domains.

[The] different rules, norms and values [that] govern the gender division of labour and the gender distribution of resources, responsibilities, agency and power . . . are critical elements for understanding the nature of gender inequality in different societies.

Regional differences mean not only that women and men participate in their national economies differently from each other, but also that these differences are not uniform across the world. Two factors are particularly important for the extent to which women play a role in the wider economy, the scope of their agency and their access to socially valued resources:

1. how corporate the unit is around which the household economy is organised (i.e. the extent to which resources and efforts are managed and allocated on a joint basis); and

2. how rigid the ‘public-private’ divide is, and hence women’s degree of public mobility and opportunities for direct economic participation.

Research from a variety of social science disciplines suggests that there are a range of household types associated with distinct ‘regional patriarchies’. These have particular patterns of land inheritance, marital practices, economic activity and welfare outcomes.

There are a range of household types associated with distinct ‘regional patriarchies’. These have particular patterns of land inheritance, marital practices, economic activity and welfare outcomes.
Asia

Despite variations in women’s public mobility and labour force participation across the region, ‘Asian’ households are generally organised along corporate lines, usually centred on the conjugal relationship.
Western Asia, South Asia and East Asia

The most marked forms of gender inequality in the region are associated with regimes of extreme forms of patriarchy. These include the belt stretching from North Africa and western Asia across the northern plains of South Asia, including Bangladesh and Pakistan. They also take in the countries of East Asia – China, Japan, Republic of Korea and Taiwan. These countries clearly have widely differing economies, histories, cultures and religions. However, they have certain historical similarities in how family, kinship and gender relations are organised and in patterns of female economic activity.

Kinship structures in these regions are predominantly patrilineal: descent is traced and property transmitted through the male members. Marriage tends to be exogamous and patrilocal: women marry outside their kin and often outside their village community, leaving their own homes at marriage to join their husband’s family. Households are organised along highly corporate lines, with strong conjugal bonds and cultural rules that emphasise male responsibility for protecting and provisioning women and children. Household resources and income are pooled under the management and control of the male patriarch. The payment of dowry by the bride’s family to the groom is the norm in the northern plains of India, though not necessarily elsewhere in East or western Asia.

Female chastity is emphasised (with severe penalties for any transgression). This is considered essential to ensure that property is transmitted based on biological fatherhood. Female sexuality is controlled through a strong public-private divide, with women secluded in the private domain. While the practice of ‘purdah’ is usually associated with Muslim societies, female seclusion based on norms of honour and shame is also practiced by Hindus, particularly the upper castes. Restrictions on female mobility, patrilineal inheritance and patrilocal marital practices have meant the economic devaluation of women and their overall dependence on men in much of this region. ‘Son preference’ is also marked.

Boserup pointed to the extremely low percentages of women in agriculture and trade in western Asia, North Africa and Pakistan, which she called ‘male farming systems’. Female family labour did not exceed 15 per cent of the total agricultural labour force (with the exception of Algeria, Tunisia and Turkey). Women made up less than 10 per cent of the labour force in trade in South and western Asia, and less than one-



Women in agriculture, Jordan
INTERNATIONAL LABOUR ORGANIZATION

third in East Asia and areas of Chinese influence (Hong Kong, Singapore, Republic of Korea and Taiwan). In China, too, prior to the revolution, only 7 per cent of the Chinese labour force in trade were women. However, Boserup also noted variations to the pattern within the region. In South Asia, for example, women’s participation in trade varied from 2–6 per cent in Bangladesh, the northern plains of India and Pakistan to around 17 per cent in the southern states of India.

Somewhat less rigid gender relations are found in the way kinship and family are organised in South-East Asia . . . and, to some extent, the southern states of India and Sri Lanka.
South-East Asia

Somewhat less rigid gender relations are found in the way kinship and family are organised in South-East Asia (Burma, Cambodia, Indonesia, Lao PDR, Malaysia, the Philippines, Thailand and Vietnam) and, to some extent, the southern states of India and Sri Lanka. The structure of households is still along corporate lines, but with important differences. For example, a child is considered equally related to both its parents and a person’s most important social grouping comprises relatives from both sides. Son preference is moderate or non-existent.

There are more cases of women as well as men being able to inherit property, and a greater incidence of matrilineal kinship, where property and descent are traced through women. While income is likely to be pooled in these households, women are often responsible for managing the household budget. A greater number of newly married couples set up their own households and more wives retain links with their natal families. The exchange of wealth at marriage tends to be reciprocal between the families of bride and groom, or else greater on the part of the latter in the form of ‘bride-wealth’. Most South-East Asian countries have traditionally been more tolerant of sexual freedom for both women and men, although colonialism brought in more restrictions, particularly for women.

Boserup noted that female family labour made up around 50 per cent of the total agricultural force in Thailand and 75 per cent in Cambodia, both areas of female farming. Women also made up around half of the labour force engaged in trade and commerce in Burma, Cambodia, Lao PDR, the Philippines, Thailand and Vietnam (see box 3.3).
Box 3.3 Gender Relations in Vietnam

Despite the strong influence of Confucianism among the ruling elite in pre-revolutionary Vietnam, most rural women worked daily in the fields and were largely responsible for trade. Vietnamese women were not only involved in managing the household budget, but also in direct production such as transplanting rice and, importantly, in marketing the produce. Husbands could not dispose of harvested rice without their wives’ consent. Although there was patrilocal-patrilineal marriage and some evidence of son preference, women were not regarded as ‘helpers to men’ but as their equals.

However, the absence of any marked restrictions on women’s mobility, and some degree of symmetry in the division of labour in the household, should not be taken to imply an absence of gender inequality in general in these societies. For example, even though Filipino women may have high status relative to women in some other countries, this needs to be assessed in relation to Filipino men to be meaningful. It should also be noted that it is in the relatively more egalitarian regimes of South-East Asia – Thailand and the Philippines – that sex tourism has emerged as a key source of income for women. Clearly, labour markets continue to reproduce gender disadvantage. Bearing this in mind, it is still clear that gender regimes in this part of the world do not result in the very marked gender inequalities in survival and well-being which, as shown in the next chapter, continue to characterise regions marked by ‘extreme’ patriarchy.
Sub-Saharan Africa

Research on household arrangements in sub-Saharan Africa point to the wide prevalence of highly complex, lineage-based homesteads with considerable gender segmentation. Women and men from the same homestead may work in separate groups, in different economic crops or on separate fields, and spouses may maintain individual accounting units. This presents a different challenge to mainstream economic portrayals

of the household (as a unified entity whose members pool and share their resources in order to maximise their joint welfare) to that posed elsewhere. Where households are organised on a corporate basis, as described earlier, the challenge has consisted of noting the existence of gender and other inequalities in the distribution of household welfare. There, certain members are systematically discriminated against in the distribution of the gains to household production. Here, however, household goods and incomes are generally not even meant to be held in common. Instead, cultural ideas and practices require that male and female income and resources belong to different spheres and are intended for different uses. Hence the need for a complex set of transactions in the household through which labour and incomes are used and needs met.

Along with [some] similarities there are important differences in the social organisation of kinship and gender relations across the African sub-continent, and even in the same country.

Much of sub-Saharan Africa is patrilineal. Women’s access to land is usually through usufructuary rights (i.e. rights to farm the land and profit from the produce but not to ownership) through their husband’s lineage group. Since women’s obligations to the family include food provisioning and caring for their children, they are granted this access to enable them to carry out these responsibilities. Female seclusion is uncommon, although it does occur among some communities such as the Muslim Hausa in Nigeria. However, such seclusion occurs in segmented households and Hausa women retain considerable economic autonomy. They manage their own enterprises and engage in ‘internal market’ transactions with their husbands. Marriage in the region usually involves the contractual payment of bride-wealth to the lineage of the woman by the husband’s family.

As might be expected, along with these similarities there are important differences in the social organisation of kinship and gender relations across the African sub-continent, and even in the same country. The organisation of gender relations in Uganda varies from region to region, but is generally strongly patrilineal and patriarchal structures predominate, with women’s economic autonomy and independent access to land being relatively more constrained than elsewhere in East Africa. Under customary law and practice in Uganda, women were minors without adult legal status or rights. In general, in much of eastern and southern Africa, women’s labour contribution tends to be subsumed in the cultivation of ‘household

fields’ over which men have ultimate control. However, studies from Zambia report evidence of jointly managed fields as well as fields individually managed by both sexes.

In parts of West Africa on the other hand (e.g. Burkina Faso, the Gambia, Ghana and Nigeria), women generally have usufruct rights to separate holdings through their husband’s lineage. Both women and junior men also provide labour on household fields that are controlled by the compound head. These domestic groups are characterised by strong lineage ties and weak conjugal ties. Moreover, women enjoy direct access to land in matrilineal areas, many of which are also in West Africa (including Côte d’Ivoire, southern Ghana, Malawi and Zambia), as well as in areas of Muslim influence. Matrilineality means married women are able to retain links with their families of origin and gain access to land as members of their own lineage groups. As a result, their obligations are not limited to the conjugal unit but extend to natal family networks.

Women enjoy direct access to land in matrilineal areas, many of which are also in West Africa . . . , as well as in areas of Muslim influence.

In addition, there are more polygamous marriages in West and central Africa (with over 40 per cent of currently married women in such unions). The equivalent figures are 20–30 per cent in East Africa and 20 per cent or less in southern Africa. Polygamy contributes to a pattern of separate (rather than pooled) spousal budgets, assets and income flows and may include separate living arrangements. Women exercise considerable economic agency in the family structure and are not dependent on their husbands in the way that they are in much of South Asia.
Latin America and the Caribbean

Countries in Latin America and the Caribbean have experienced very different histories and patterns of economic development within three broad cultural traditions: indigenous, Hispanic and Afro-Caribbean. This has led to considerable diversity in their household arrangements. Nevertheless, many of the countries share certain features in common, including the intersection of colonialism and slavery, and large urban populations (around 70 per cent).

The region belongs to the weaker corporate end of the spectrum. The Spanish and Portuguese colonisers introduced their own version of the public-private divide into Latin America,

associating men with the calle (street) and women with the casa (home). However, this division is far stronger among the upper classes in areas with Hispanic, and hence Roman Catholic, influence. It is far less often found among the black and indigenous populations. While legal marriage may be the social ideal, as well as the norm in many parts of the region, there is a high incidence of consensual or visiting unions. In some areas of Latin America, this appears to reflect partly indigenous antecedents and partly the precariousness of marriage when male mobility is an integral part of economic strategies. In the Caribbean, it reflects the impact of slavery, which weakened ties between children and their fathers as slave children became the property of their mother’s owner. One result of this is a high number of female-headed households, as well as complex extended households made up of children from different unions.

Boserup noted that women’s economic activity in the public domain varied across the [Latin American and Caribbean] region. There were higher rates in populations with a strong African or Asian presence than in countries on the Atlantic coast where the Spanish influence is stronger.

Boserup noted that women’s economic activity in the public domain varied across the region. There were higher rates in populations with a strong African or Asian presence than in countries on the Atlantic coast where the Spanish influence is stronger. The region as a whole is characterised by low levels of female economic activity in rural areas and higher levels in urban areas. Women tend to be more active in agriculture in the Caribbean region, where there are more smallholder farms, than in Latin America. Large-scale plantation agriculture, and the fact that commoditisation and mechanisation have gone further in Latin American agriculture than elsewhere in the Third World, explain why it is less significant as a source of overall as well as of female employment. However, women are active in trade throughout the region and also dominate in the flows of migration into urban areas. This is an indication of the lack of strict restrictions on women’s mobility.
Updating the Geography of Gender

There have been significant changes since the period that informed Boserup’s analysis, including:
the oil shocks of the 1970s and subsequent debt crisis and recession;
the structural adjustment programmes (SAPs) of the 1980s;
the collapse of some socialist societies and the managed transition to the market economy of others; and
the acceleration of the forces of economic deregulation, liberalisation and globalisation.

Most economies today are far more oriented to the market, far more open to international competition and far more integrated on a global basis than they were in the 1960s. The rest of this chapter looks at the extent to which changes in the wider economic environment have influenced the gender division of labour in different regions and modified the geography of gender described above.

Most economies today are far more oriented to the market, far more open to international competition and far more integrated on a global basis than they were in the 1960s.
Globalisation and the rise of flexible labour markets

Two factors have been particularly significant in driving the pace of globalisation:
the changing technology of transport and telecommunications, which served to compress time and space across the world; and
the dismantling of the regulatory frameworks that had provided some degree of national stability in markets for labour and capital in the post-war decades.

There has been a massive increase in world trade flows. Trade now accounts for 45 per cent of world Gross National Product (GNP) compared to 25 per cent in 1970. Much of this increase is in manufacturing, which accounts for 74 per cent of world merchandise exports (compared to 59 per cent in 1984). Developing countries have performed well in this sector. The share of manufactured goods in developing country exports tripled between 1970 and 1990 from 20 to 60 per cent. Exports in labour-intensive manufacturing have grown particularly rapidly, the most important and fastest growing being electronic components and garments. These accounted respectively for 10 and 6 per cent of total developing country exports in 1990–91.

There has also been a dramatic increase in the inter-

national mobility of capital. Capital flows in the industrial countries rose from around 5 per cent of Gross Domestic Product (GDP) in the early 1970s to around 10 per cent in the early 1990s. The equivalent figures for transitional and developing countries were 7 and 9 per cent. Previously, transactions between countries occurred mainly in the form of trade in goods. Today, however, it is possible for individuals and firms to invest freely in foreign exchange and financial markets. This increased movement of capital between countries is often motivated by short-term opportunities to gain from more favourable interest or exchange rates. As recent crises in East Asia and Latin America have demonstrated, economies are extremely vulnerable to the ups and downs of this global market.

Different forms of labour, such as outworking, contract work, casual labour, part-time work and home-based work have been replacing regular, full-time wage labour.

However, the movement of labour has not been deregulated to the same degree. On the contrary, there have been increasing restrictions on the mobility of unskilled labour, particularly by the developed countries. Migration per 1,000 of population declined during this period from around 6.5 to 4.5 in the industrialised countries and remained static at around one elsewhere (though this does not take account of illegal labour movements, particularly increasing trafficking in women).

At the same time, within national economies, labour markets have become increasingly ‘informalised’ and social protection has been eroded. Different forms of labour, such as outworking, contract work, casual labour, part-time work and home-based work have been replacing regular, full-time wage labour. These changes have largely affected the organised labour force in industrialised countries and the small minority in formal labour in poorer countries. The overwhelming majority of the working population in these poorer countries is still engaged in livelihood strategies outside the formal, protected economy. These strategies include a diverse set of activities, contractual arrangements and working conditions. There is consequently a social hierarchy to the labour market, depicted in Fig. 3.1, that loosely overlaps with the economic pyramid depicted in Fig. 2.1.

The occupational hierarchy in the formal labour market consists of:
An elite group of wealthy industrialists, financiers, entrepreneurs, etc. at the pinnacle. They make the ‘rules of the

Figure 3.1: Social Hierarchy of Livelihoods



game’ in their society, are wealthy enough to ensure their own security and often take advantage of the growing global market in savings, pensions and insurance.
Salaried and professional classes. They generally enjoy a considerable degree of job security and social status in the labour market.
‘Core workers’. They are in full-time employment, often unionised and protected by state provision. Some may be unemployed but they may still have some security in the form of state unemployment assistance.

The elite is likely to be smaller and much less wealthy in the poorer countries than in the richer countries. The second and third groups also represent a far smaller proportion of the total

work force in developing countries than in Organisation for Economic Cooperation and Development (OECD) countries. They are likely to have shrunk even further with the downsizing of the public sector in the wake of SAPs.

Comparing women’s labour force participation around the globe is problematic, and the difficulty of capturing often irregular, casual forms of work in the informal economy is compounded by the different definitions used in measurement.

Meanwhile, the informalised workforce – which has little stability of work, social security provision or state regulation – has expanded. It makes up more than 80 per cent in low-income countries and around 40 per cent in middle-income countries. The informal economy has its own hierarchy, distinguishing those with some degree of security in their lives from those without any:
Owners of some land or capital. They are in a position to hire labour on their farms or in their enterprises.
Waged workers in some form of regular employment. They often work in medium-sized enterprises, or on plantations or commercial farms.
Own-account workers, with little or no capital. They rely on their own or family labour.
Casual labourers and home-based workers. They are either unpaid family workers or disguised wage workers who earn a fraction of their directly employed counterparts.
A category of ‘detached’ labour. They eke out a living from various stigmatised occupations: prostitution, pimping, recycling trash, picking pockets, begging and so on. They not only lack any formal ties to the state, pension and insurance markets, but may also have lost their place in kin or community structures.
Gender and labour force participation in the 1980s and 1990s

Comparing women’s labour force participation around the globe is problematic, and the difficulty of capturing often irregular, casual forms of work in the informal economy is compounded by the different definitions used in measurement. The discussion here uses the conventional definition (i.e. activities done for pay or profit). While this does not fully capture women’s contribution to the economy, nor show what is happening in the unpaid economy, it reveals the restrictions

Table 3.1: Estimated Economic Activity Rate of Women and Female Percentage of the Labour Force



Table 3.1: Estimated Economic Activity Rate of Women and Female Percentage of the Labour Force (continued)



Source: The World’s Women 1970–1990: Trends and Statistics


Source: 2001 World Development Indicators

that women face in terms of paid work relative to men and how these vary across the world. It also has something important to say about the pattern of women’s work in recent decades and the extent to which the geography of gender difference in labour market participation has changed from that observed by Boserup.

The most striking features of labour force participation patterns in the last few decades are: (a) the rise in the percentage of women in the labour force; and (b) the accompanying increase in their share of overall employment. In almost every region, there are now many more women involved in the visible sectors of the economy (see Table 3.1). In addition, women’s participation has increased faster than men’s in almost every region except Africa, where it was already high. With a stagnating or, in some cases, decreasing male labour force, gender differences in labour force participation have shrunk in many regions.

[W]omen’s [labour force] participation has increased faster than men’s in almost every region except Africa, where it was already high.

These changes reflect a number of factors:
Demographic transition (i.e. the change from high to low rates of births and deaths) in most regions and a decline in fertility rates have allowed many more women to go out to work.
The increasing enrolment of young men in secondary and tertiary education, as well as the growing availability of pensions for older men, partly explain diminishing male participation.
The changing nature of labour markets has resulted in what can be described as a ‘double feminisation’ of the labour force internationally. Women have increased their share of employment while employment itself has started to take on some of the ‘informalised’ characteristics of work conventionally associated with women.

Another major change in patterns of work in recent decades has been in the distribution of the labour force between different sectors of the economy. Only in South Asia and sub-Saharan Africa has female labour remained largely concentrated in the agricultural sector. East and South-East Asian countries, by contrast, are characterised by high levels of female labour force participation and by a more even distribution of female labour across agriculture, industry and services (see Table 3.2). Women made up over a third of the labour in each sector during 1970–1990, with their representation increasing in ‘services’ over this period. There is of course variation across the region (see box 3.4).

Table 3.2: Employment by Economic Activity



Table 3.2: Employment by Economic Activity (continued)



Table 3.2: Employment by Economic Activity (continued)


Box 3.4 Variations in Women’s Labour Force Participation in Asia

In Indonesia, there was an overall decline in national labour force participation, partly due to a restrictive time period for measuring economic activity and partly because the working age population was increasing over this period. However, female rural labour force participation continued to increase, outweighing these two factors. In rural areas, women’s labour force participation declined slightly in agriculture but increased in manufacturing and trade. In Vietnam, too, rural households rely heavily on off-farm and self-employment to supplement earnings from farming. In the Philippines, female employment is high, with women making up 37 per cent of the total labour force.

According to the UN, industrialisation as part of globalisation is currently as much female-led as it is export-led.

There have not only been changes in the distribution of women’s labour between different sectors of the economy. There has also been a change in their participation in the ‘traded’ sector of the visible economy. In some parts of the world, this has taken the form of higher participation in export manufacturing employment as economies moved from a capital-intensive, import-substituting industrialisation to a labour-intensive export-oriented one. According to the UN, industrialisation as part of globalisation is currently as much female-led as it is export-led.

Women’s high rates of participation in export-oriented manufacturing started in the East Asian ‘miracle’ economies and Mexico and spread to other parts of Asia and Latin America. However, the spread has not been universal. In South Asia, it has mainly taken off in Bangladesh where there has been an astonishing rise in the female labour force in the manufacturing sector since the early 1980s due to the emergence of an export-oriented garment industry. Other countries in Asia that have seen a dramatic increase in both labour-intensive export manufacturing and the share of women in the manufacturing labour force include Indonesia, Malaysia, Mauritius, the Philippines, Sri Lanka and Thailand. On the other hand, as export-production has become more skill- and

capital-intensive in a number of middle-income countries, the demand for female labour in manufacturing appears to have weakened (for example, in Puerto Rico, Republic of Korea, Singapore and Taiwan).



A textile factory in the Philippines
INTERNATIONAL LABOUR ORGANIZATION

Women form at least as high a percentage of the workforce in the ‘internationalised’ service sector, including data entry and processing, as they do in export-manufacturing. Indeed they make up the entire labour force in this sector in the Caribbean. In a number of countries, such as the Philippines and Thailand, where tourism had become the largest provider of foreign exchange by 1982, a considerable percentage of this income is generated by the sex industry, which largely employs women.

Globalisation and economic liberalisation, often with the imposition of SAPs, have also caused changes in agriculture. There has been a shift from subsistence to cash crops and from

weak-performing traditional agricultural products (coffee, tobacco, cotton and cocoa) to higher value non-traditional agricultural exports (NTAEs) such as fresh fruit and nursery products. These require little or no additional processing, and most are produced as part of global supply networks (see box 3.5). The need to remain competitive means that production involves flexible and informal work arrangements similar to those seen in manufacturing. These include piecework; temporary, seasonal and casual work; and unregulated labour contracts. Studies suggest that women make up a disproportionate share of the workforce in this sector.

[W]omen make up a disproportionate share of the workforce in the [non-traditional agricultural exports (NTAEs)] sector.
Box 3.5 Women and Non-traditional Agricultural Exports (NTAEs)

In Latin America, particularly Colombia and Mexico where the sector is well established, NTAEs have generated seasonal employment for women. In Mexico in 1990, women made up around 15 per cent of the agricultural labour force but their participation went up to 50 per cent if only the production of fruit and flowers was considered. Women have also found employment in this sector in the Caribbean (leading to a decrease in the availability of the food for the local market that they traditionally produced and sold). In Africa, women make up around 90 per cent of the workforce in the NTAEs produced in large-scale enterprises organised along quasi-industrial lines. They are paid cash in direct exchange for their labour, in contrast to the unpaid labour they provide on family farms. However, many of these products are grown on smallholdings, often on a contract basis. While women provide much of the labour, they do not necessarily receive an equivalent proportion of the proceeds.

Along with these changes, there are still signs of the earlier regional pattern in female activity. Rates of female labour force participation were lowest in the belt of ‘extreme’ patriarchy, both in 1970 and in 1990, with the smallest increases recorded for the Arab countries of the Middle East.
Gender and hierarchies in the labour market

The increasing presence of women in paid work, and their greater share of employment, does not mean that gender inequalities have disappeared. It is also important to know where women and men are located in the social hierarchy of the market place. In other words, information on where women are relative to men in the pyramid of production depicted in Fig. 2.1 has to be supplemented by information on where they are in the social pyramid depicted in Fig. 3.2.

In countries where there are large numbers of women in the formal economy, they tend to be under-represented at the higher levels and over-represented in those lower down.

The percentages of both women and men in waged and salaried work – those most likely to work outside the home – are high in the industrialised countries of the OECD, in Eastern Europe, in Latin America and the Caribbean and in East Asia. Involvement in unpaid family work is low for both women and men in these regions. The picture is more uneven in South-East Asia, with high involvement in the waged economy in Malaysia, but lower involvement in Indonesia, the Philippines and Thailand. It is generally low in sub-Saharan Africa and South Asia, but with important differences in women’s economic activity. Women in South Asia (and in other regions of extreme patriarchy) continue to be concentrated in unpaid family work (over 60 per cent of the female work force) while in sub-Saharan Africa, percentages of women in unpaid family work are generally below 60 per cent. The rest are distributed between self-employment and, in a few countries, in waged employment (see box 3.6).

Measuring economic activity in the informal economy is particularly difficult and it varies considerably across the world. In India, for example, formal, protected employment accounts for around 10 per cent of overall employment, but only 4 per cent of female employment. Women’s share of formal employment, however, increased from 12 per cent in 1981 to 15 per cent in 1995.

Both formal and informal markets continue to be segmented by gender. In countries where there are large numbers of women in the formal economy, they tend to be under-represented at the higher levels and over-represented in those lower down. In Morocco, for example, 38 per cent of the total labour force is in ‘professional and technical’ and ‘administrative’ work, but only 10 per cent of the female labour force is in

these categories. In East Asia, South-East Asia and the English-speaking Caribbean, women’s participation in clerical, sales and services; production and transport; and agriculture, hunting and forestry is fairly high. However, they are generally under-represented in management and administration. In South Asia, women are concentrated in agriculture/forestry but less well represented in other sectors. There is a generally low representation of women in the labour force in the Middle East and North Africa, with Morocco reporting higher rates than the rest of the region.
Box 3.6 Female Employment in Sub-Saharan Africa and Latin America

In sub-Saharan Africa, women’s share of employment in the formal economy between 1970 and 1985 rose from 6 per cent to 25 per cent in Botswana, from 1.5 per cent to 6 per cent in Malawi, from 9 per cent to 20 per cent in Swaziland and from 0.6 per cent to 2 per cent in Tanzania. In Zambia, only 7 per cent of formal wage employment was female. In Guinea-Bissau, women accounted for 3.6 per cent of formal sector employment.

In Latin America, the percentage of the female labour force in formal sector employment was generally high in the 1980s, varying between 32 per cent in Paraguay, 41 per cent in Ecuador, 52 per cent in Chile, 53 per cent in Brazil, 59 per cent in Argentina and 61 per cent in Panama. However, these rates, and the apparent increase they represent over those prevailing in the 1970s, may be somewhat misleading. This is because they are inflated by the inclusion of women working in micro-enterprises, most of which operate in the informal economy.

From 1950 onwards, there has been a systematic rise in female labour force participation in Latin America. One of the most striking features of this has been the increasing share of ‘white collar’ (professional and technical) employment in almost every major city in the region. In Chile, women made up half this workforce. However, for the majority of poorer women, oppor-

tunities are more limited. In Mexico, women’s workforce participation since the early 1990s has increased steadily while that of men has decreased. Gender differences in participation rates have thus declined in both urban and rural areas (particularly in non-agricultural self-employment). Between 1991 and 1995, women made up 68 per cent of the increase in this sector, and 90 per cent in rural areas. However, only women with secondary or higher levels of education were in salaried employment.

Working hours are on average shorter in industrialised than in developing countries, and shorter in urban areas of developing countries than in rural. Yet women work longer hours than men in every case.

Finally, data on gender differences in time allocation show what is occurring in the non-market economy alongside changes in the market economy. They highlight a different, and persisting, dimension of gender inequality. Working hours are on average shorter in industrialised than in developing countries, and shorter in urban areas of developing countries than in rural. Yet women work longer hours than men in every case. The extent of the difference varies considerably. Women work just 10 per cent longer than men in rural Bangladesh, where they spend 35 per cent of their total work time in System of National Accounts (SNA) activities. In Kenya, on the other hand, they work 35 per cent longer and spend 42 per cent of their work time in SNA activities. Women’s longer working day – and the extent to which it exceeds that of men – may reflect the difference between situations where seclusion restricts their economic activities and those where they are expected to participate in production. In any case, women continue to put in long hours of unpaid work into the reproductive economy regardless of their role in the productive economy.
Classifying Gender Constraints

This chapter has provided an institutional explanation of gender inequality. It has focused on the organisation of family and kinship, but has also pointed to the relevance of the wider institutions of markets, states and civil society as ‘bearers of gender’. This section looks at different categories of gender constraint – those reflecting kinship and family systems and those reflecting the wider institutional environment. These are gender-specific constraints, gender-intensified constraints and imposed forms of gender disadvantage. They provide a background to the analysis of the relationship between gender inequality and poverty that occupies the rest of this book.
Gender-specific constraints

These reflect the rules, norms and values that are part of the social construction of gender. They vary among particular social groups in particular contexts and the way these groups define masculinity and femininity. Ideas about, for example, male and female sexuality, purity and pollution, female seclusion and the ‘natural’ aptitudes and predisposition of men and women all help to explain differences in what is permitted to men and to women in different cultures.

Gender-intensified constraints . . . reflect the uneven distribution of resources and opportunities between women and men in the household.
Gender-intensified constraints

These reflect gender inequalities in resources and opportunities. Class, poverty, ethnicity and physical location may also create inequalities but gender tends to make them more severe. Gender-intensified constraints are found in, for example, workloads, returns to labour efforts, health and education and access to productive assets (see box 3.7). They reflect the uneven distribution of resources and opportunities between women and men in the household. Where resources are scarce, women find themselves at a greater disadvantage than male members of the family. Some inequalities may be the result of community norms, such as customary laws governing inheritance. Others arise from decisions in the household, often because females are seen as having less value than males.
Box 3.7 An Example of Gender-intensified Constraints from Uganda

In Uganda, women produce 80 per cent of the food and provide about 70 per cent of total agricultural labour. An assessment of poverty in the country showed how women’s gender-specific domestic responsibilities interact with household poverty to increase their disadvantages in farming. Women are mainly found in the unpaid subsistence sector and perform their agricultural tasks without the use of technological innovations, inputs or finance. While it is true that many of these problems also apply to poor male farmers, men are not constrained by competing claims on their labour time.
Imposed forms of gender disadvantage

These reflect the biases, preconceptions and misinformation of those outside the household and community with the power to allocate resources. These institutional actors may actively reproduce and reinforce custom-based gender discrimination. Examples include:
employers who refuse to recruit women or only recruit them in stereotypically ‘female’ – and hence usually the most poorly paid – activities;
trade unions and professional associations that define their membership rules in ways that discourage the membership of women workers and professionals;
non-governmental organisations (NGOs) that treat women as dependent clients rather than active agents;
religious associations that define women as somehow lesser than men, refusing to let them become priests or to read the holy texts;
banks that refuse to lend to women entrepreneurs because they pre-judge them to be credit risks;
judges who think women get raped through their own fault; and
states that define women as minors under the guardianship of men or as second-class citizens with fewer rights than men.

Gender is a key organising principle in the distribution of labour, property and other valued resources in society.

These forms of gender disadvantage show how cultural norms and beliefs are also found in the supposedly impersonal domains of markets, states and civil society.
Conclusion

Gender is a key organising principle in the distribution of labour, property and other valued resources in society. Unequal gender relationships are sustained and legitimised through ideas of difference and inequality that express widely held beliefs and values about the ‘nature’ of masculinity and femininity. Such forms of power do not have to be actively exercised to be effective. They also operate silently and implicitly through compliance with male authority both in the home and

outside it. For example, if the senior male in the household or lineage has the main responsibility for members’ welfare, he usually also has privileged access to its resources. Women, and junior men, accept his authority partly in recognition of his greater responsibilities and partly because they have less bargaining power.

While institutionalised norms, beliefs, customs and practices help to explain the distribution of gender resources and responsibilities in different social groups, they are clearly not unalterable. This is shown by the significant changes in work patterns that have occurred in the last quarter of the twentieth century. Female labour force participation rates have risen in most countries, while male rates have often stagnated or even declined. Various factors have played a role in different regions, including:
greater impoverishment in some places and rapid growth in others;
demographic transition and falling birth rates;
rising rates of education;
public policy;
socialist egalitarianism;
economic liberalisation; and
greater integration into the global economy.

While institutionalised norms, beliefs, customs and practices help to explain the distribution of gender resources and responsibilities in different social groups, they are clearly not unalterable.

Nevertheless, gender inequalities persist. They help explain why regions with extreme forms of patriarchy continue to have lower rates of female labour force participation than can be explained by their levels of per capita income. They may also help to explain some of the regional variations in the relationship between gender equality and economic growth noted in the previous chapter. Indeed, the use of religion as a variable noted in Dollar and Gatti’s analysis may simply be picking up regionally clustered institutions of ‘extreme patriarchy’, of which religion is only one aspect.

These more resilient aspects of patriarchy may also help to explain the positive relationship found by Seguino between gender inequality in wages and rates of economic growth. She suggests that institutions in patriarchal societies reinforce the

internalisation of social norms that favour men. Thus political resistance and therefore the costliness of gender inequality are reduced. For example, the state in the Republic of Korea condoned the marriage ban – the widespread practice by employers to make women quit work on marriage – that limited women’s job tenure, organisational ability and potential for wage gains. This explanation is also supported by a study of women’s labour market experiences in seven Asian countries (see box 3.7).

Gender inequality in areas such as education, wages and legal infrastructure is . . . related to broad regional variations in patriarchal regimes . . .
Box 3.7 The Importance of Enforcing Rights to Gender Equality

A study of women in the labour market in India, Indonesia, Japan, Malaysia, the Philippines, the Republic of Korea and Thailand notes that differences in patriarchal organisation helped explain why Japan and the Republic of Korea, despite their high rates of economic growth, have lower rates of female labour force participation than the Philippines and Thailand. Women had higher relative pay and made greater inroads into higher paying occupations in the latter two countries. Of the five countries where women had lower relative pay, India, Japan and the Republic of Korea had equal pay laws while the latter two had also recently enacted strong equal-opportunity legislation. The institution of formal rights in support of gender equality is an important message about social values. However, legislation is clearly not sufficient on its own to bring this about and makes little difference if not enforced. Public action in the form of strong civil society organisations, including an active women’s movement, is necessary to ensure such laws are translated into practice.

The empirical findings show that gender inequality in areas such as education, wages and legal infrastructure is only partly related to per capita GNP. It is also related to broad regional variations in patriarchal regimes, particularly among the poorer countries of the world. The next chapter examines the relationship between gender inequality and poverty revealed by different approaches to poverty analysis.





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HIV & AIDS IN NIGERIA
About this event: National Youth Empowerment Summit
Related to country: Nigeria

Why is Nigeria important?
Nigeria has the biggest population in Africa with 1 in 6 Africans being Nigerian. Although the HIV prevalence is much lower in Nigeria than in other African countries such as South Africa and Zambia, the size of Nigeria's population meant that by the end of 2005, there were an estimated 2,900,000 people living with HIV/AIDS. This is the largest number in the world after India and South Africa.1

Nigeria has a great deal of influence in West Africa. It is an important member of ECOWAS (the Economic Community of West African States) and plays a central role in ECOMOG's (the Economic Community of West African States Monitoring Group) peacekeeping operation. HIV/AIDS has already badly affected Nigeria society and its economy. If the epidemic continues at its current rate, or worsens, there could be knock on effects across the whole region.2

Background
Nigeria gained independence from Britain in 1960 and from 1966 to 1999 was controlled for the most part by various military governments. In May 1999, the democratically elected government of Olusegun Obasanjo, a former military dictator, assumed power. He was re-elected to a second term in 2003.

Nigeria has a population of around 140 million and life expectancy is around 50 years. It is an ethnically and religiously complex country with over 250 ethnic groups. More than 50% of the population belong to the Hausa-Fulani, Yoruba and Ibo ethnic groups.

Around 50% of the population are Muslim, 40% Christian and 10% hold indigenous beliefs. The official language is English, but over 250 other languages are spoken.

Nigeria is the 5th largest oil producer in the world and oil dominates the economy. The military governments in power between 1966 and 1999 failed to develop the economy in other areas. This, along with economic mismanagement and corruption, has contributed to Nigeria's poor economic performance and rising poverty. There is a highly unequal distribution of wealth in Nigeria with 66% of the population falling below the poverty line of $1 a day. This puts it among the 20 poorest countries in the world.3

HIV and AIDS in Nigeria

Celebrations for World AIDS Day 2001
The first case of AIDS was identified in Nigeria in 1986 and HIV prevalence rose from 1.8% in 1988 to 5.8% in 2001. Since 1991, the Federal Ministry of Health has carried out a National HIV/syphilis sentinel seroprevalence survey every 2 years. The 2003 survey estimated that there were 3,300,000 adults living with HIV/AIDS in Nigeria, and 1,900,000 (57%) of these were women.

In the 2003 survey, the national HIV prevalence had dropped to 5% from 5.8% in 2001. However, it found that state prevalence rates varied from as low as 1.2% in Osun state to as high as 12% in Cross River state. Overall, 13 of Nigeria's 36 states had an HIV prevalence over 5%. These figures give support to the claim that there are explosive, localized epidemics in some states.

At 5.6%, HIV/AIDS prevalence is highest among young people between the ages of 20 and 24 compared with other age groups. Nigeria's STD/HIV Control estimates that over 60% of new HIV infections are in the 15-25 year old age group.4

In 2005 it was estimated there were 220,000 deaths from AIDS, and 930,000 AIDS orphans living in Nigeria. There has been an alarming increase in the number of HIV positive children in recent years, 90% of whom contract the virus from their mothers.

Currently very few Nigerians have access to basic HIV/AIDS prevention, care, support or treatment services.

How is HIV transmitted in Nigeria?
Some 80% of HIV infections in Nigeria are transmitted by heterosexual sex. Factors contributing to this include a lack of information about sexual health and HIV, low levels of condom use and high levels of sexually transmitted infections (STIs) such as chlamydia and gonorrhoea, which make it easier for the virus to be transmitted.

Blood transfusions are responsible for about 10% of all HIV infections. There is a high demand for blood because of road traffic accidents, blood loss from surgery and childbirth, and anaemia from malaria. As there is no coordinated national blood supply system, blood isn't routinely tested for HIV, and a recent study found that 4% of blood donors in Lagos were HIV positive.

The remaining 10% of HIV infections are acquired through other routes such as mother-to-child transmission, homosexual sex and injecting drug use. The rate of mother-to-child transmission in Nigeria has gone up in recent years as the number of HIV positive women has increased.5

Factors contributing to the spread of HIV in Nigeria
Lack of sexual health information and education
Sex is traditionally a very private subject in Nigeria for cultural and religious reasons. The discussion of sex with teenagers, especially girls, is seen as indecent. Up until recently there was little or no sexual health education for young people and this has been a major barrier to reducing rates of HIV and other STIs. Lack of accurate information about sexual health has meant there are many myths and misconceptions about sex and HIV, contributing to increasing transmission rates as well as stigma and discrimination towards people living with HIV/AIDS.

Stigma and discrimination
Stigma and discrimination against people living with HIV/AIDS are commonplace in Nigeria. Both Christians and Muslims see immoral behaviour as being the cause of the HIV/AIDS epidemic. This affects attitudes towards people living with HIV/AIDS (PLWHA) and HIV prevention. PLWHA often lose their jobs or are denied healthcare services because of the ignorance and fear about HIV and AIDS. There is so much ignorance that 60% of healthcare workers think HIV positive patients should be isolated from other patients.6

Poor healthcare services
Over the last two decades, Nigeria's healthcare care system has deteriorated because of political instability, corruption and a mismanaged economy. Large parts of the country lack even basic healthcare provision, making it difficult to establish HIV testing and prevention services such as those for the prevention of mother-to-child transmission. Sexual health clinics providing contraception and testing and treatment for other STIs are also few and far between.7

Why are so many women being infected with HIV in Nigeria?
Nigeria is a male dominated society and women are seen as inferior to men. Women's traditional role is to have children and be responsible for the home. Their low status and lack of access to education increases their vulnerability to HIV infection. Certain social and cultural practices also make them vulnerable to HIV.

Marriage practices
Harmful marriage practices violate women's human rights and contribute to increasing HIV rates in women and girls. In Nigeria there is no legal minimum age for marriage and early marriage is still the norm in some areas. Parents see it as a way of protecting young girls from the outside world and maintaining their chastity.

Many girls get married between the ages of 12 and 13 and there is usually a large age gap between husband and wife. Young married girls are at risk of contracting HIV from their husbands as it is acceptable for men to have sexual partners outside marriage and some men have more than one wife (polygamy). Because of their age, lack of education and low status, young married girls are not able to negotiate condom use to protect themselves against HIV and STIs.8

Female circumcision
Female circumcision/female genital mutilation (FGM) is a cultural practice whereby all or part of the external female genitalia is removed by cutting. Around 60% of all Nigerian women experience FGM and it is most common in the south, where up to 85% of women undergo it at some point in their lives. FGM puts women and girls at risk of contracting HIV from unsterilized instruments, such as knives and broken glass that are used during the procedure.9

Sex work
Although prostitution is illegal in Nigeria there are more than a million female sex workers. HIV infection rates among sex workers have been estimated to be as high as 30% in some areas. There are low levels of condom use among sex workers because of a lack of knowledge about HIV transmission and poor acceptance by male clients.10

The Government response
It wasn't until the restoration of democracy in 1999 that a serious national effort was made in Nigeria to tackle HIV/AIDS. Since then, the Olesegun administration has placed high priority on prevention, treatment, care and support activities. It has established two key institutions - the Presidential Committee on AIDS and the National AIDS Action Committee on AIDS (NACA) to coordinate the various HIV/AIDS prevention, treatment and care activities in Nigeria.

NACA's main responsibility is the execution and implementation of activities under the HIV/AIDS Emergency Action Plan (HEAP), introduced in 1996 as a bridge to long-term strategic plan. HEAP had two main components: firstly to break down barriers to HIV prevention and support community based responses, and secondly to provide prevention, care and support interventions directly. HEAP has now been replaced with the National HIV/AIDS Strategic Framework, which will run until 2009.

So far there has been some progress towards the goals of HEAP but there are still huge gaps in HIV prevention, treatment and care services, particularly at community level.11

Prevention
Education
Nigeria's STD/HIV control estimates that 60% of all new HIV infection occurs in young people between the ages of 15 and 25. Last year a new curriculum was introduced for comprehensive sex education for 10-18 year olds. It focuses on improving young people's knowledge and attitudes to sexual health and reducing sexual risk taking behaviours. In the past attempts at providing sex education for young people were hampered by religious and cultural objections. The new curriculum was developed with consultation from religious and community leaders and hopefully will remain in place in the future.12

Condoms
Condoms have become nearly universally available in Nigeria because of efforts to increase coverage and subsidise prices. Uptake and use is affected by people's perceptions of how effective condoms are, perceived effects on sexual satisfaction and people not wanting to be seen as promiscuous as a result of buying them. These are all factors that are being overcome. More serious barriers are opposition from religious organisations and traditional societies, which are more difficult to break down, but with careful negotiation and consultation progress is being made.13

Media campaigns

Femi Kuti billboard poster
As Nigeria is such a large and diverse country, media campaigns to raise awareness of HIV are a practical way of reaching many people in different regions. Radio campaigns like the one created by the Society for Family Health have been extremely successful at increasing knowledge and changing behaviour. "Future Dreams", was a radio serial broadcast in 2001 in nine languages on 42 radio channels. It focused on encouraging consistent condom use, increasing knowledge and increasing skills for condom negotiation in single men and women between 18 and 34 and was very successful.14

Another high profile media campaign is fronted by Femi Kuti, the son of Fela Kuti, the famous Afro beat musician who died of AIDS in 1997. He appears on billboards alongside roads throughout Nigeria with the slogan 'AIDS: No dey show for face' which translates as you can't tell someone has AIDS by looking at them.15

Treatment
National antiretroviral programme
In 2002 the Nigerian government started an ambitious antiretroviral (ARV) treatment programme to get 10,000 adults and 5,000 children onto ARVs within one year. An initial $3.5 million worth of ARVs were imported from India and delivered at a subsidized monthly cost of $7 per person.

In 2004 the programme suffered a major setback when it was hit by a shortage of drugs. This meant that some people didn't receive treatment for up to three months. Eventually, another $3.8 million worth of drugs were then ordered and the programme resumed. However, it took a long time to achieve the 2002 goal because of poor infrastructure and management.16

At the end of 2006, around 550,000 people were estimated to require antiretroviral therapy, of whom 81,000 (15%) were receiving the drugs.17 Although this is twice as many as were on treatment at the end of 2005, Nigeria's coverage rate is still only half of the average for sub-Saharan Africa.18

ARV production in Nigeria
In 2001, Ranbaxy Nigeria, a subsidiary of Ranbaxy India, India's largest pharmaceutical company, signed an agreement with the Nigerian Government to supply ARVs manufactured at its plant in Lagos. In 2004 Archy Pharmaceuticals, a Nigerian owned pharmaceutical company, also set up a new plant manufacturing ARVs in Lagos. This should increase the availability of ARVs to people in Nigeria and other West African countries.19

Funding
Government spending on HIV/AIDS
Government spending on HIV/AIDS has been very low. The WHO recently estimated that only 4 Naira ($0.03) is spent per person on HIV/AIDS prevention, treatment and care by the Nigerian government. To be effective, the UN estimates that 260-390 Naira ($2-3) needs to be spent per person.20

Sources of funding
Many NGOs and international organisations provide funding for HIV/AIDS in Nigeria. The main donors are PEPFAR, the Global Fund and the World Bank.

PEPFAR
In the past few years, Nigeria has received large amounts of money to target HIV/AIDS from the US as part of PEPFAR (the President's Emergency Plan for AIDS Relief). Some have suggested that part of the reason for this is US interest in Nigeria's oil and natural gas reserves. The US hopes to double the amount of oil imported from Nigeria in the next five years and is pressing Nigeria to withdraw from OPEC (the Organisation of Petroleum Exporting Countries) to give the US control over the oil market there.21

PEPFAR is expected to allocate $84 million to Nigeria in 2005 for HIV/AIDS prevention, treatment and care. It aims to provide antiretrovirals to HIV positive people, prevent over one million new infections and provide care and give support to people affected by HIV/AIDS, including AIDS orphans.

PEPFAR funds will focus on abstinence and fidelity education, mother-to-child transmission (MTCT) and blood safety. Existing sites will be scaled up and new ones created. Access to home-based care and voluntary counselling and testing services will be expanded too. Condom marketing will be improved, but only for those for those thought to be at high risk of being infected, such as prostitutes and truck drivers. Condoms will not be marketed to young people or married couples; this may or may not affect the general availability of condoms in Nigeria.22

An example of a PEPFAR funded project is the Global HIV/AIDS Initiative Nigeria (GHAIN). This is a five-year project aiming to provide ART and care to HIV positive people and to prevent 800,000 new infections by 2009.23

The Global Fund
The Global Fund is providing $28 million over two years to expand government ART, prevention and MTCT programmes to reach 20,000 people. Nearly $9 million of this will be given to the Nigerian government to fund the expansion of ART.24

The World Bank
A World Bank Multi-country HIV/AIDS Program (MAP) loan of $90.3 million was allocated to Nigeria in 2002. This was to support national programmes already in place. The Nigerian government was allocated the money as they agreed to channel it quickly to community programmes and NGOs. However, by 2004, only $9.62 million had been accessed, due to delays at national and state level. Because of this, it was reported last year that the Nigerian Government could lose the unspent World Bank money.25

WHERE NEXT ? AVERT.org has more about:
HIV & AIDS in Africa
HIV prevention
providing AIDS treatment in poor countries
women, HIV & AIDS
HIV & AIDS elsewhere in the world
Author Jane Pennington

References
UNAIDS/WHO 2006 Report on the global AIDS epidemic
Institute for Security Studies, Profile: Economic Community of West African States (ECOWAS) www.iss.co.za/AF/RegOrg/unity_to_union/ecowasprof.htm/
The World Factbook: Nigeria Country Information, www.cia.gov/cia/publications/factbook/geos/ni.html
Nigeria Country Profile (HIV/AIDS), USAID, July 2003, www.usaid.gov/locations/sub-saharan_africa/countries/nigeria
'Hospitals to pay N.5 fine for transfusing HIV-infected blood, Sola Ogundipe, The Vanguard, 22 April 2005, www.vanguardngr.com
Reducing stigma and discrimination surrounding HIV and AIDS in Nigeria, EngenderHealth, www.engenderhealth.org/itf/nigeria-2.html
Social development and poverty in Nigeria, Chapter 3 in Measuring poverty in Nigeria', Sofo, C.A. Ali-Akpajiak and Toni Pyke 2003, Oxfam Working Paper www.oxfam.org.uk/what_we_do/where_we_work/nigeria/resources.htm
Child Marriage Briefing Nigeria, Population Council. September 2004 www.phishare.org/documents/PopCouncil/2478?
Nigeria: Report on Female Genital Mutilation (FGM) or Female Genital Cutting (FGC), US Department of State, www.state.gov/g/wi/rls/rep/crfgm/
'A job to die for', www.news24.com/News24/Africa/Features/0,,2-11-37_1456450,00.html
Nigeria: Rapid Assessment of HIV/AIDS Care in the Public and Private Sectors, August 2004, Partners for Health Reformplus (PHRplus), www.phishare.org/documents/PHRplus/2708/
'Proposed sex education for schools: Who will accept it?, Farooq Adamu Kperogi, The Weekly Trust.
Access to Condoms and HIV/AIDS Information: A Global Health and Human Rights Concern, Human Rights Watch, December 2004 hrw.org/backgrounder/hivaids/condoms1204/
'Nigerian Radio Campaign Generates Safer Behaviour', March 2003, Population Services International, www.psi.org/resources/profiles.html
www.firstuniversal.clara.net/femi-kuti.htm
ARV Treatment in Africa, A. Odutola, Centre for Health Policy and Strategic Studies, Lagos, Nigeria, 2004, http:/academic.udayton.edu/health/06world/africa04.htm
WHO, Towards Universal Access: Scaling up priority HIV/AIDS interventions in the health sector, 17th April 2007
WHO, Progress in scaling up access to HIV treatment in low and middle-income countries, June 2006, 16th August 2006
'Nigeria to begin making HIV/AIDS generic drugs', Reuters NewMedia, Tuesday, July 27, 2004 www.aegis.com
APIN Summary Report of Presidential Forum, www.hsph.harvard.edu/apin/report-forum.html
The New Gulf Oil States, Servant,J.-C., Le Monde Diplomatique, January 2003, MondeDiplo.com/2003/01/08oil?var_recherche=jean-christophe+servant
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'FHI 'GHAINS' new funds for HIV/AIDS, TB services in Nigeria', Family Health International, 2004, www.fhi.org/en/HIVAIDS/country/Nigeria/nigernews.htm
The Global Fund, Portfolio of Grants in Nigeria, www.theglobalfund.org/search/portfolio.aspx?lang=en&countryID=NGA
'Nigeria may lose N11.2956 World Bank Grant' ThisDay, June 28, 2004 www.naijapost.com/news/publish/article_980.shtml

May 11, 2007 | 10:13 PM Comments  0 comments
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