Soon after we met, Isabelle showed me a picture of her and her children, taken on 1 January last year in better times. She is now 36, just 2 years older than me. She had her first child aged 16, and her fourth 6 years ago.

Struggling to stay well

When I met Isabelle last week for the first time, she told me how she was struggling to stay well in the conditions she’s living in. She has a huge smile and a warm spirit, and was very open with me about her HIV status. She knows how to look after her health and ensure that she lives positively.

But Isabelle is now living in an overcrowded camp in the town of Duekoué, a town located to the west of the country near the border of Liberia, with 27,000 others, who don’t have enough to eat or a proper roof over their heads.

Since she has been in Duekoué camp Isabelle’s health has deteriorated and she has lost a lot of weight. She is taking antiretroviral medicines (ARTs) to keep her HIV at bay and to enable her to live a healthy life. But in the camp that is not enough.

In order to maintain a healthy weight, Isabelle’s energy intake requirements are 20-30% more than people who are not on ART. The consequences of not having enough food were obvious when I met Isabelle. She is weak and very thin. She finds it hard to take her ARTs now as the drugs are strong and hard to stomach without enough food.

Unfortunately, Isabelle isn’t the only one who is now in this situation. People forced to flee their homes in the midst of violence do not often have the time to gather their things — including the medicines they need to keep their HIV under control.

One health worker I met with explained to me that she hadn’t heard from the vast majority of her regular patients — all of whom need a regular supply of ARTs in order to survive.

Fear that medicines will run out

Even for those who do have their medicines, like Isabelle, there is the fear that these will run out. So some people are skipping doses or sharing their drugs with others who are also in need.

Repeated trips to the health centre to pick up drugs is costly, time consuming and potentially dangerous for those who fear leaving their homes in the current instability. Even while the limited ARTs available last, many of those displaced and living with HIV don’t have access to the food they need to be able to stomach the medicine.

Without antiretroviral medicines, people who need them will die

To respond to this acute need and ensure that those displaced people living with HIV are able to take their medicines, Save the Children has now started distributing supplementary food to people displaced by the conflict who are living with HIV, including Isabelle.

The need is urgent. Already Isabelle was too weak to wait in line for her food distribution. Her health has deteriorated to the point where she can’t stand for long, so we made sure that there were people able to carry it to her shelter for her.

Nutritious food to those who need it

We are keen to massively increase our distributions of food to vulnerable people like Isabelle, but so far our funds are limited.We are appealing for US $30 million to support our humanitarian efforts in Ivory Coast and Liberia. We urgently need funds so that we can meet the immediate needs of children and their families affected by the crisis.

Preventing transmission from mother to child

Money raised will go towards providing nutritious food for people living with HIV, and will help us start activities to prevent the transmission of HIV from pregnant mothers to their children, keeping babies protected and healthy.

So far there are no such prevention activities running in the camps and newborns are at risk. The needs are enormous and we need all the help we can get.

We’ve already started our response and our teams are working around the clock to make sure that needs are met, but there’s so much more to do. Please support our Ivory Coast Appeal

Around 10% of the 9 million new TB cases each year are found in children. In parts of the world, studies show rates can be much higher: in South Africa, Uganda, Tanzania and Zimbabwe more than 16% of TB cases are in children. In Pakistan it’s more than 25%. Children can present with TB at any age, but the most common age is between 1 and 4 years.

Tuberculosis also affects children indirectly. Globally it kills around 1.7 million people each year, leaving millions of children orphaned and increasing poverty because sick adults can’t provide for their families. It’s also a major cause of infertility in women and can increase the likelihood of complications in pregnancy and low-weight births.

Correct diagnosis is the first challenge

The real scale of paediatric tuberculosis is unknown because it’s very difficult to detect in children. It’s most commonly diagnosed through examinations of saliva but children generally don’t produce enough for a conclusive analysis. Diagnosis in children therefore relies on even less reliable methods such as the tuberculin skin test or x-rays. Late detection is a particular challenge for children as they tend to develop the disease more rapidly than adults and may already be extremely ill before detection. In many cases, the child may die before the disease is ever diagnosed.

This problem is compounded by the growing challenge of multi-drug resistant TB (MDR-TB) – a virulent strain that doesn’t respond to standard treatment. A recent case from South Africa has shown just how swiftly the disease can take hold. In a 2007 outbreak in Johannesburg, an unusually high number of children were infected. More than a third of these children died within a few months of diagnosis even though they had been started on treatment.

Treatments are inadequate

There’s an urgent need for better ways to quickly and accurately detect TB in children. And we need new, more appropriate treatments for children. On Monday, the World Health Organization included paediatric TB formulas in its first ever list of medicines that don’t yet exist but are urgently needed to save the lives of mothers and children. Current treatments require a child to swallow many tablets each day for at least six months. There are no child-size tablets or liquid formulas, so swallowing the tablets can be a horrible experience.

Treatment for drug-resistant TB is even worse. It’s extremely toxic with terrible side-effects and has to be taken every day for around two years. It’s also so expensive that the poorest countries often can’t afford to provide them for everyone who needs them.

Address the root causes

One-third of the world’s population are believed to be infected with the TB bacteria but most of those people will never become sick or die from the disease because their immune system is strong enough to hold it at bay. The eventual elimination of TB will only happen when the social economics that make people more vulnerable are addressed as well. Malnutrition, poor housing and HIV are just three underlying factors that make both children and adults more susceptible to TB.

HIV is a particular challenge because people infected with HIV are more likely to develop TB and diagnosis and treatment are more complicated.

In children, TB may be rare compared to other childhood diseases such as pneumonia, but it’s crucial that pressure is maintained on governments to eradicate the disease once and for all. This means increasing funding for TB programmes through mechanisms like the Global Fund to Fight AIDS, TB and Malaria and investing in the research and development of tools to improve diagnosis, treatment and prevention. Governments also need to strengthen health systems so there are adequate facilities and sufficient numbers of trained health workers to spot symptoms and support children and their families through the long course of treatment.

TB is rarely thought of as a child health issue. I hope that the greater focus on paediatric TB this year will help bring those communities concerned with TB, HIV and child survival even closer together.

The article tied in with the 100^th annual celebration of International Women’s Day.  Originally called International Working Women’s Day, the 8th of March every year is a major day of global celebration of women and our history.

This got me thinking about my own inspirational female figures. We all have icons of our own, of course. Whether it’s your mum, school teacher, midwife, campaigner or political figure, but what about the women who still have no voice?

When Salmina became ill, a Save the Children volunteer in Mozambique convinced Salmina to get tested for HIV/AIDS. She tested positive and was given anti-retro-viral medication which has improved her health so she can take care of her daughters. "I'm very thankful for Virginia and everything she has done for my family. She saved my life."

Four years ago I was asked to arrange a youth delegation trip of young campaigners to South Africa. We visited student campaigners in Zambia, accompanied a ‘street intervention’ project around the Alexandra Township in Johannesburg, Soweto and district six – historic anti-apartheid hotbeds.

But the place that had the most impact on me was Swaziland, one of the world’s poorest countries. Despite its poverty, it receives very little international aid. The regions’ king has taken on the tradition passed down by his father and rules by decree over his people; most of whom live in the countryside and follow traditional ways of life. Around 70% of the people live below the poverty line of $1 per day.

On the day we visited it took us three plane journeys and several bumpy road trips to get there, but it was well worth it if only to meet Siphiwe Hlophe.

In 1999, as a married 40-year-old looking to continue her education in agricultural economics, Siphiwe Hiophe discovered she was HIV positive. As a result, her husband left her and she lost an academic scholarship.  But she reacted by co-founding an organization in 2001 called Swazis for Positive Living (Swapol), which aims to fight gender discrimination related to HIV and Aids and help other people who have tested positive.

Siphiwe was nominated for, and won, the Index on Censorship award by RT Hon David Blunkett in 2007. Having been an activist all of her life fighting for equality and justice she is an amazingly courageous woman who has made an incredible difference to the lives of women and people living with HIV.

Siphiwe Hiophe

Siphiwe led our visit. Everyone of us found those 4 days extremely powerful. We were taken in our embarrassingly indiscrete ‘hello the visitors are here’ style truck to a small village miles away from any other, where women who had been ousted from their communities for contracting HIV were sent to live. Ousted, of course, even though the king in Swaziland openly allows bigamy. He himself has 12 wives.

Siphiwe took us to one of the huts and advised that we would go in four at a time. Next it was our turn. As I walked in it felt really dark, cold and lifeless. One fragile lady was lying on the floor, not much older than me. The average life expectancy in Swaziland is 34. She was doing quite well.

Siphiwe advised that she was dying of HIV. She had no family and she only had the women around her in the village for comfort. Everyone just stood and stared. This was quite possibly Siphiwe’s way of introducing us to the stark reality of life there. As Siphiwe continued to tell us her story the fragile women lay lying on the floor, moaning out in pain and occasionally crying.

We all knelt down and held her hand. Siphiwe explained there was a health clinic about 8 miles away. Why isn’t she there? She couldn’t afford the cost to travel to the clinic.

The journey cost £4.

We all agreed to pay. The woman was clearly very grateful and Siphiwe arranged a car to take her to the clinic then and there. However to this day I’m not sure how much longer she survived.

This is a daily occurance for women in Africa and around the world.

Siphiwe continues to champion womens issues and survival tactics for every women living in these conditions. Find out about more of her work on the Positive Women website.

She’s my inspiration. Who’s yours?

In a world where budget constraints at home have made aid donors wary of new commitments, here is a development good news story. Last year, Sierra Leone lifted official charges for healthcare for mothers and children. Now, it is introducing its first vaccination programme for pneumonia, provided free through the public health system. Kenya, Guyana and Yemen are doing the same.

The Global Alliance for Vaccines and Immunisation (GAVI), the partnership between aid donors and the private sector which is financing this initiative, estimates that globally between 250,000 and 550,000 children’s lives could be saved annually through the pneumococcal vaccine. Even at the lower end of this scale, the vaccine could represent a major step forward towards the millennium development goal of a two-thirds reduction in child mortality by 2015.

GAVI’s track record in reducing the lag between life-saving vaccines being developed and reaching children in developing countries has been impressive. But GAVI also faces a funding shortfall of $3.7bn (£2.3bn) between now and 2015. A pledging meeting in London in June will require some hard decisions to be taken if universal coverage of life-saving vaccines in the poorest countries is to become a reality.

As Save the Children argues in a new report released today, No Child Born to Die: closing the gaps, there’s a compelling case for investing in vaccines as part of a wider strategy to cut the mortality of under-fives. Vaccines work: the success of immunisation against measles has been spectacular, with a fall in deaths from 750,000 a year at the start of this decade to 160,000 in 2008. The smallpox and polio eradication programmes are – justly – regarded as totemic development successes. At the right price, vaccines can make a hugely cost-effective contribution to tackling some of the major causes of death and disability in children, saving on costly healthcare further down the line.

There are two challenges ahead. One involves expanding access to the new pneumococcal and rotavirus vaccines. Yet this cannot happen unless a major unfinished agenda is implemented at the same time. Despite the push to expand vaccine coverage in the past decade, one in five children – 23 million a year – go without the DPT vaccine for diphtheria, tetanus and whooping cough, and almost one third of children in Africa are not immunised against measles. Overwhelmingly, these are children from the poorest families, who are most at risk of the diseases vaccines help to prevent. They are usually not being immunised because they are not being reached effectively by wider healthcare. So governments in developing countries need not just to boost overall vaccine coverage, but to focus on the poorest children and as part of a wider set of interventions, without which the impact of vaccines will be blunted.

Bridging the growing funding gap that is opening up for GAVI between now and 2015 will require substantial increases in donor funding, whether from bilateral aid or from innovative finance. At the moment, some major countries, including Germany, Australia, Spain and Italy, contribute very little.

Donors should increase their funding, but also use it judiciously to ensure vaccine coverage is expanded for the poorest children, and to leverage further movement on price by pharmaceutical companies. At the moment, the prices for pneumococcal and rotavirus remain many times those for more established vaccines, and explain a large part of the GAVI $3.7bn funding shortfall. Closing the gap cannot be achieved simply by donors giving more: the private sector needs to help place immunisation on a sustainable financial footing by bringing down costs. A new architecture for pricing needs to be agreed in London, which puts life-saving vaccines within the reach of every child.

Implementing this threefold strategy in 2011 – focusing on the poorest children as part of a drive to expand health care; increasing donor funding; and bringing down prices – could make decisive progress towards the international goal of a two-thirds reduction in child mortality.

This first appeared on the Guardian’s Poverty Matters blog

Please take action on vaccines today

Find out more about No Child Born to Die

Home-based carers get 90 days’ training; they visit and provide care for those who are chronically sick, often with HIV or tuberculosis in their homes. They visit eight or nine people a day and work five days a week. They encourage people who are sick to take their medication, ensure they have eaten and washed, they listen to their problems, advise them and their families on health issues, and encourage them to seek formal healthcare when they need it. When I asked one group to explain what they did for those they care for, one woman said quite simply “We love them”.

With every home-based carer I met I was struck by their dedication and devotion to the work they do. This is even more amazing when you consider that many of them aren’t paid. Some receive a stipend, some receive soap and some receive nothing. One woman explained that she had been a home-based carer for nine years and the last time she received a stipend was nine months ago, when she received 200 rand (about £20).

The current system of Home-Based Care appears in some cases to be expecting volunteers to do work that should be the responsibility of the state – for no remuneration. However, where the responsibility for these carers lies is not at all clear. Some are provided with stipends from the government, some from NGOs and some from the government through NGOS. One carer explained that it all depends on if you are registered or not, but she had no idea about how an unregistered carer became registered. In general the carers weren’t sure what the difference was between those who received stipends and those who didn’t. It’s all very confusing and does need to be clarified.

So for now, I promised the home-based carers of the drop-in centre in Messina (pictured above) that I would tell as many people as I could about them. So please, if you’re reading this, tell someone else about the wonderful home-based carers of South Africa, because they really do deserve a whole heap of recognition.

On first reading, the Strategy is a very positive document and addresses many of the concerns that we had expressed. One of our biggest worries is that the new UK government, with its emphasis on “measureable results”, would be losing many of the principles which has made DFID one of the most respected donor agencies. The government is to be congratulated for ensuring that its approach is still rooted in building nationally-led health systems. While there are many other organisations that have a role in health (Save the Children being one ourselves), the only long-term sustainable solution is to build accessible health sytems that serve the whole population. Many of the actions under this document are in line with this approach and the fact that almost every indicator is ambitious and national-level should ensure that small-scale projects should take a back seat to building national systems.

We very much welcome the recognition that women’s rights must be central to improving women’s health, and that empowerment and rights are essential if women are able to control their fertility. No amount of services or “contraception education” will make a difference unless women’s legal and social status is changed. The UK is also to be congratulated for its strong stand on safe abortion, a controversial topic which needs powerful champions. We are pleased that girls’ education status is seen as vital to improving rights.

The strategy gives strong emphasis to the need to remove barriers to access and rightly emphasises health user fees as a priority. The UK has an proud record in this area and recently the UK has confirmed that it will support more countries that want to move from regressive to equitable ways of financing their health services.

The Strategy also has very welcome sections on the importance of health workers to deliver services, the need for pro-equity approaches that looks at the poorest communities, improved health information systems and birth and death registration, a focus on fragile and conflict-affected states and the role of civil society.

We have a few ongoing concerns, of course. We believe, as DFID says it does, that it makes sense to plan action as part of continuum of care from reproductive health through to child health. Since many women with young children are likely to be pregnant or avoiding pregnancy, since family planning needs do not stop after birth, since young children accompany their mothers to health services, failing to planning integrated action and services is a mistake.

The document acknowledges that there is a lack of evidence for use of vouchers for healthcare or for equitable outcomes from using private providers but it continues to explore these options when it would be better to be unequivocal that free-at-the-point of use government-led services are the best system.

Finally, the push for measureable results and accountability is important but, as many others are starting to point out, can mean the opposite of the transformative action that is needed to make permanent changes in poor societies. Donors should not be holding developing country governments to account, their citizens should. There is a real danger that trying to attribute specific changes to UK money will undermine this democratic accountability and national leadership, although the strategy, as written, skilfully avoids this.

Save the Children warmly welcomes this Framework for Results and, as one of the recipients of DFID’s Programme Partnership Agreements, we are ready to play our part in ensuring communities are able to demand their right to reproductive, maternal, newborn and child health.

I met this nine-year-old fan of the Brazilian football team a few weeks ago. At that meeting he educated me on all the cool cartoons on TV like Dragon Ball, Pokemon and Ben 10.  He also told me that he had loads of friends at school. He likes riding his bike, never goes to sleep without completing his homework and likes mathematics the best.

Picture Bikash drew of his bike

He is Bikash. His father was an intravenous drug user who contracted HIV. He passed away five years ago leaving behind his wife Neeru and son, both HIV positive.

Neeru was 22 when she got married and had no idea that her husband was a drug user. It was only after her husband started becoming very ill and was hospitalised that she found out that he had HIV. He passed away soon after. By that time she already had a child. The doctor who was treating her husband immediately sent both Neeru and her son to get tested for HIV and they found out that the news was not good.

“When I found out, I was in shock. I couldn’t say anything to my husband who was lying in the hospital,” Neeru says, ”I worried about my son.”

She found out more about the disease from an organisation working for women and children affected by HIV and AIDS.  She met many women and their families like her there, and she’s slowly started to believe that she will be able to live with HIV and make a good life for Bikash.
She doesn’t regret that she told her family about her condition. She feels fortunate that her family hasn’t subjected her to any discrimination. She’s seen many women who have had to move away from their home to avoid the stigma that comes with it. She lives with her husband’s parents now and Bikash gets a lot of care from his grandmother.

Her biggest fear is for her son. She says that it gives her immense joy everyday to see her son go to school. But she has not told the school about her son’s condition. She has heard about children being denied admission to schools for being HIV positive and suspended from school after finding out that their parents had HIV.

Bikash started taking ARVs (antiretroviral drugs) last year after a blood test showed that he had a low CD4 count (the count is used to asses the immune system of patients). Neeru is also taking ARVs now, which are distributed for free from the government.

Bikash doesn’t know why he’s taking the medicine. Neeru has to mix the medicine with sugar everyday in order to get Bikash to take it. Every time he asks, Neeru tells him: “the medicine will make him strong.”

“He doesn’t like meat, or vegetables so I make chicken soup for him to mix with rice,” Neeru says. “He loves drinking tea and instant noodles.”

Bikash is busy being a normal nine-year-old, going to school, playing with his friends, doing homework, watching cartoons and refusing to eat his vegetables.

As he draws a blue bicycle on his sketch book, I tell him, “If you want to become a football player, you will have to start drinking milk and eat lots of vegetables.” He looked up from his drawing and told his mom, “I will drink milk if you boil some tea with it.”

Neeru and I laughed.

Read about how we’re helping other children in Brazil with HIV/AIDS

To protect the identity of the children, some names and details may have been changed.

It was very enriching for everyone to have them with us, and to help us to understand much more about the realities of living with HIV, and the implications that that has on day to day life.

Jean Claude is 17; he is a tall, softly spoken young man who was very open with us about his story. He told us that his parents both died from AIDS-related illnesses when he was a very small child.

However, he was not told the truth about how they died until he was 15, when he became very ill, had to stay in hospital and was tested for HIV himself.

Once he tested HIV positive, even after he started on antiretroviral medicine (ARVs) and became well again, his relatives who he lived with rejected him and considered him good for nothing.

They thought he was not worth investing in; for example it would be a waste of money to pay his school fees, as they perceived that he was going to die.

Jean Claude also faced stigma and discrimination in the community and at school. He tried to hide his HIV status from his school friends but one of them went through his bag and found a box of ARVs one day.

The supply of ARVs in DRC is very unreliable, but it is imperative that people on ARVs take them every day without fail, otherwise they develop resistance and the drugs stop working.

So when the clinic receive a new batch of ARVs they phone Jean Claude on his mobile and he has to go straight there to collect them. This can be in the middle of a school day, and it has been very hard for him to suddenly have to leave classes without giving an explanation.

The stigma is such that he doesn’t feel able to tell his teachers.

It has not been easy for Jean Claude to accept his HIV status, and the fact that he has contracted a sexually transmitted infection without having had sex.

He has had a lot of counselling and support from other people living with HIV, and he is now an open and active advocate for others living with HIV.

There are 33.3 million people globally living with HIV, but  no official estimates of the number of people living with HIV in DRC. What we do know is that the majority of people with HIV in DRC are unaware of it, and those who do know their HIV status face problems similar to Jean Claude’s experiences of accessing medication, stigma, and discrimination.

Save the Children has just started a new programme to support communities to respond to some of these problems – supporting vulnerable children who can’t get to school or to the health centre, and working with communities to help them understand about HIV and to support people living with HIV, rather than discriminate against them.

There are things we can celebrate this World AIDS Day — for example the number of new HIV infections globally is falling and more people have access to ARVs.

But let’s not get complacent, and reflect on the stories behind the statistics.

Jean Claude has access to ARVs, but the unreliable supply, the stigma and discrimination mean that he is still in need of a lot of support and care.

At a conference organised by EuroNGOs on gender, sexual and reproductive health and rights, held in London, this issue was discussed. The International Planned Parenthood Federation explained that the reluctance to discuss girls’ and young women’s sexuality with them means they’re denied the information and resources they need to make informed decisions to protect themselves from unplanned pregnancy, HIV and sexually transmitted diseases. It also adds to feelings of shame about their bodies and the view that sex is something to feel guilty about.

Girls and boys in this situation learn about sex from unreliable sources, sometimes from friends, sometimes from the internet and sometimes from experience. There are reputable internet sites with good information, however others contain myths and untruths and some are pornographic. These sites contain information that can lead teenagers to make risky decisions.

Much of this applies to Vietnam. Today’s adolescents in Vietnam have experienced much change in their lives. They grew up with a system of rote learning where authority figures were to be respected. Where families and teachers didn’t and still don’t discuss sexual and reproductive health with adolescents.

The country’s economic growth, increasing free time, easy access to the internet and lifestyle changes mean adolescents have more freedom to meet who they want and do what they want. This combination of cultural change, lack of information, freedom and exposure to unreliable internet sites has contributed to greater sexual risk-taking by Vietnamese adolescents.

This is evidenced by the fact that up to one-third of abortions (Vietnam has one of the highest abortion rates in the world) are sought out by adolescent girls.

In order to help tackle this situation, Save the Children is aiming to pilot a reproductive health education programme in Vietnam, to help teenagers make informed decisions, feel proud of who they are and protect themselves from sexually transmitted infections and unplanned pregnancies.

Find out more about our work in Vietnam

A landmark study on women’s health and domestic violence carried out by the World Health Organisation (WHO) in 2008 confirmed what many individuals and organisations working on the issue for many years already knew – that it is widespread and can have far-reaching health consequences on the lives of women and their children.

The 10-country (Bangladesh, Brazil, Ethiopia, Japan, Peru, Namibia, Samoa, Serbia and Montenegro, Thailand and Tanzania) multi-country study on Women’s Health and Domestic Violence Against Women, showed that up to 71% of women reported physical or sexual violence by a husband or partner.

While physical, sexual and emotional abuse by an intimate partner or family member remains the most common manifestation of gender-based violence (GBV), sexual harassment and abuse by authority figures (such as teachers, police officers or employers); trafficking for forced labour or sex; dowry-related violence and honour killings (when women are murdered in the name of family honour) are all acts of violence against women. They all constitute a violation of the fundamental human rights of women and girls.

Similarly, trafficking in women and girls is on the rise and many traditional practices that are harmful to women – such as child marriage and female genital mutilation/cutting – to women and girls persist, causing psychological damage, physical injury and death.

Working with the military in the Congo

The systematic use of rape as a weapon of war has become increasingly widespread in conflict situations over the last few decades. The war in the Democratic Republic of Congo (DRC) has been called “a war against women”, with rape being the “war within the war”. 160 reported rape attacks take place every week in eastern DRC (and those are only the cases that are reported).

Save the Children, with support from the Positive Action for Children Fund, is delivering a new, sustainable model of community care in the DRC for families affected by HIV in conflict-affected states where, according to the WHO and UN estimates, the total number of people living with HIV is estimated to be between 450,000 – 2,600,000 people, and the incidence rate between 1.7% and 9.9%.

With 19% of all pregnancies in the DRC occurring amongst teenagers, the initiative will work closely with adolescent girls who, with little or no skills, training, family or community support, run the risk of being forced into transactional sex to support themselves and their children, putting them at further risk of HIV.

The project adopts a family-centred approach where children and adolescents living with HIV and their communities are supported to challenge traditional gender roles and relationships. Through improved communication skills and greater mutual respect between women and men and girls and boys, families are able to support each other to prevent future transmissions of HIV and reduce stigma and discrimination against families already affected by HIV.

The initiative is particularly innovative in engaging the military as stakeholder groups, as HIV rates among uniformed men are among the highest in the country. As one of the key perpetrators of sexual violence, working with the military will be critical to bringing about a sustainable reduction in violence against women and the spread of HIV.

Violence against women has to be seen as inextricably linked to gender-based inequalities. Gender-based violence also serves — by intention or effect — to perpetuate male power and control.

Programmes to address violence against women need to adopt an approach that meets both the practical and strategic needs of women. They need to end the violence, but also work with women, men and communities to address gender inequalities through strengthening women’s agency and the community’s capacity to protect and uphold the rights of women and girls by challenging gender disparities and opposing violence against them.