By Peggy Edwards, Grandmothers Advocacy Network
On a rainy weekend in mid-September global leaders vowed to help "end HIV/AIDS for good" by pledging a total of US$12.9 billion to the Global Fund to Fight AIDS, Tuberculosis and Malaria during the Fifth Replenishment Conference, hosted by Canada's Prime Minister Justin Trudeau.
The Grandmothers Advocacy Network applauds this commitment and Canada's leadership in making this happen. However, we are far from "ending it for good." Indeed, this laudable goal will not be achieved without a deliberate effort to include people of all genders and ages -- including older women.
Older women/grandmothers in sub-Saharan Africa are rarely recognized or included in programs and policies addressing HIV/AIDS, health-care strengthening and development assistance. Yet they are at the centre of the pandemic -- both in terms of their own vulnerability to disease and poverty, and their amazing resilience as they raise millions of young people orphaned by AIDS, and care for their dying children and others in the community living with HIV and AIDS.
UNAIDS estimates that some two million people living with HIV in sub-Saharan Africa are aged 50 and older. There may be many more since most of the survey instruments used do not include people past the age of 49. Nor are the data disaggregated by sex and age.
Similarly, there is almost no collection of data related to violence against women over the age of 49, even though we know that older women are victims of rape, sexual violence and traditions such as wife inheritance, all of which increase their risk for HIV infection.
Older women are denied basic services and protection of their rights because they are absent from official records and are therefore invisible to policy-makers and organizations providing development assistance.
People over age 50 exhibit many of the same risk behaviours found among younger age groups. Yes -- older women have sex. However, HIV prevention and other services, including condom distribution and tuberculosis screening, rarely include older people or reflect their specific realities and needs. Excluding older women from prevention programs not only increases their own risk of exposure to HIV, but also prevents them from informing the young people in their care.
Invisibility and the misconception that women past reproductive age will not become HIV-positive mean that older women are the last in line to be tested for HIV status and to receive appropriate antiretroviral therapy (ART). This is particularly ironic since grandmothers often act as caregivers of community members with HIV and help them manage their medications.
Grandmothers also face the difficult tasks of telling a child of their HIV status and what this means, and then ensuring that the child gets and takes the medicines he or she needs. Paediatric ART, especially in formats that are easy to administer, is often unaffordable or impossible to access, especially for grandmother-headed families living in rural areas.
The Sustainable Development Goals and the UNAIDS fast track targets support the need to prioritize the most vulnerable populations. Grandmothers raising families of young people orphaned by AIDS are among the poorest of the poor and most vulnerable populations.
Most receive no pensions or grants and do not have access to free medicines and age-friendly health care. While social security measures are available in some countries in Africa, they are largely inadequate, come too late or are impossible to access due to bureaucratic requirements (such as identity papers) and a lack of transportation to government offices.
Despite these hardships, the grandmothers in Africa, with the support and help of grassroots granny groups and community organizations, carry on. They are tireless in their efforts to provide food and shelter, and to raise and nurture the next generation who will lead Africa out of the AIDS pandemic.
At a recent gathering in Durban prior to the 2016 International AIDS Conference (AIDS 2016), the courageous grandmothers of South Africa said: "As older women, we face challenges that are still ignored. The health system is failing us and HIV-positive grandmothers have special needs that are not met ... We will continue to struggle, and we will not give up on the fight against HIV and AIDS, We will never give up because this grandmothers movement is powered by love. But we should not have to do this alone."
It is time to include older women/grandmothers as a key population in national, international and global plans to fight and end HIV/AIDS. This includes:
- Making HIV/AIDS services (prevention, testing, treatment and care) for older women/grandmothers a priority
- Including people over the age of 50 in data collection relating to HIV/AIDS, violence and caregiving, and ensuring that all data is disaggregated by sex and age
- Supporting community-level organizations and programs that address the challenges older women face in the fight to end HIV/AIDS
- Ensuring that ART and other life-saving medicines (including vaccines) are provided free to older women/grandmothers and the children in their care
- Supporting grandmothers in their caregiving, parenting and head-of-household roles
- Supporting families and children orphaned or made vulnerable by HIV/AIDS in countries at high risk, with direct special assistance to sub-Saharan Africa.
It is time for Canada and other countries to take an intergenerational, lifecourse approach to development assistance that considers all stages of life, that recognizes the important roles that older women play in sustainable development and HIV/AIDS, and that leads the data revolution needed to ensure that no-one is left behind.
Older women deserve to be counted and counted in.
Peggy Edwards is an active volunteer with the Grandmothers Advocacy Network, which works to engage Canadian and international support for policies and programs that will address the needs of African grandmothers as they strive to sustain their families and communities in the wake of the HIV/AIDS pandemic. Peggy is a health promotion consultant, policy analyst, and author on health and aging. She is a grandmother of 11 and great grandmother of 5. In 2011, she received the Alan Thomas Fellowship from the Carold Foundation to study the role of older women as advocates for social justice. You can see her video from that work at www.grannyvoices.com.
This blog is part of the blog series: AIDS, TB and Malaria: It's High Time for Us to End It. For Good by the Interagency Coalition on AIDS and Development (ICAD) in recognition of The Global Fund's Fifth Replenishment. The blog series runs from August 29 to October 3, 2016 and features a selection of blogs written by our member and partner organizations. Contributors share their broad range of perspectives and insight on the work of The Global Fund and the opportunity that this moment presents us one year following the inauguration of the global Sustainable Development Goals (SDGs).
Disclaimer: The views and opinions expressed in this blog series are those of the authors and do not necessarily reflect those of ICAD.
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