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close this bookYoung Women: Silence, Suspectibility and the HIV Epidemic (UNDP, 10 p.)
View the document(introduction...)
View the documentGender as an independent variable for hiv infection
View the documentSilence
View the documentAge as an independent variable for hiv infection
View the documentAnatomy as destiny?
View the documentSituational factors
View the documentThe unheard scream
View the documentThe prophetic voice
View the documentAn action agenda
View the documentBreaking the silence
View the documentChanging the operational research agenda
View the documentSanctuaries
View the documentSanctions
View the documentSafety
View the documentRestructuring gender
View the documentThe circle of the dance
View the documentReferences


1. Chin, James L. "The increasing impact of the HIV/AIDS Pandemic on Women and Children." Paper presented at the American Public Health Association meeting. Atlanta. November 1991.

2. Quinn, Thomas C., Jonathan M. Mann, James Curran, Peter Piot. "AIDS in Africa, an Epidemiologic Paradigm." Science. Vol. 234, No. 957. 1986.

3. Reid, Elizabeth. "Gender, Knowledge and Responsibility." AIDS in the World 1992. Harvard University Press. 1992.

4. Jacob, May. "STDs among seropositive patients of a referral hospital in India and their role in the transmission of HIV." VIII International Conference on AIDS/III STD World Congress. Amsterdam. July 1992. [Poster Abstract PoC 4334].

5. Hunter, D., S. Kapiga, G. Lwihula et al. "Risk factors for HIV-1 infection among family planning clinic clients in Dar-es-Salaam, Tanzania." VIII International Conference on AIDS/III STD World Congress. Amsterdam. July 1992. [Poster Abstract PoC 4158].

6. Allen, Susan et al. "Human Immunodeficiency Virus Infection in Rwanda." Journal of the American Medical Association. Vol. 266. No. 12:1657-1663. 1991.

7. Sources are respectively: Figure 2, Thailand National AIDS Control Programme. 1991. Figure 3, Myanmar AIDS Control Programme. 1991. Figure 4, Uganda National AIDS Control Programme. 1991. Figure 5, European AIDS surveillance. 1991.

8. Wawer, Maria J. et al. "Dynamics of spread of HIV-1 Infection in a Rural District of Uganda". British Medical Journal Vol. 303:1303-1306. 1991.

9. Holt, Elizabeth. "HIV seroconversion in Haitian Women." Poster No. MC3010 presented at VII International Conference on AIDS. Florence. 1991.

10. Chao, Anne et al. "Risk factors for HIV-1 Among Pregnant Women in Rwanda." Poster No. MC3097 presented at VII International Conference on AIDS. Florence. 1991.

11. Wasserheit, J. "Epidemiological Synergy: Interrelationships between Human Immunodeficiency Virus Infection and Other Sexually Transmitted Diseases." Sexually Transmitted Diseases. 19 (No. 2): 61-77. 1992.

12. Van de Perre, Phillipe et al. "Risk factors for HIV seropositivity in selected urban-based Rwandese adults." AIDS Vol. 1:207-211. 1987.

13. Melbye, Mads, et al. "Evidence for Heterosexual Transmission and Clinical Manifestations of Human Immunodeficiency Virus Infection and Related Conditions in Lusaka, Zambia." Lancet: 1113-1115. November 15, 1986.

14. Padian, Nancy et al. "Male-to-Female Transmission of Human Immunodeficiency Virus." Journal of the American Medical Association. Vol. 258, No. 6:788-790. 1987.

15. Decosas, Josef and Violette Pedenault. "The Demographic AIDS Trap for Women in Africa." Paper presented at the VII International Conference on AIDS. Florence. 1991.

16. de Bruyn, Maria. "Women and AIDS in Developing Countries". Social Science and Medicine. Vol. 34 No. 3:249-262. 1992.

17. Bailey, Mike. Report for Save the Children Fund of Vth International Conference on AIDS in Africa, Kinshasa, 1990.

18. McNamara, Regina. Female Genital Health and the Risk of HIV Transmission. UNDP HIV and Development Issues Paper No. 4. 1992.

19. Bouvet, E. "Defloration as risk factor for heterosexual HIV transmission." Lancet: 615. March 18, 1992.

20. O'Farrell, Nigel and Isobel Windsor. "Sexual Behaviour in HIV-1 Spositive Zulu Men and Women in Durban, South Africa." Letter to the Editor, Journal of Acquired Immune Deficiency Syndromes. 4:1258-59. 1991.

21. Nyirenda, Meya. Oral presentation at VIII International Conference on AIDS/III STD World Congress. Amsterdam. 1992.

22. Forrest, Bruce. Women, HIV and Mucosal Immunity. Lancet. Vol. 337:835-836. 1991.

23. Duncan, M. Elizabeth et al. First coitus before menarche and the risk of sexually transmitted disease. Lancet. Vol. 335:338-340. 1990.

24. Forrest, Bruce. Personal Communication. 1991.

25. Alexander, Nancy J. "Sexual Transmission of Human Immunodeficiency Virus: Virus Entry into the Male and Female Genital Tract." Fertility and sterility. Vol. 54, No. 1:1-18. 1990.

26. Mandelblatt, Jeanne S. et al. "Association Between HIV Infection and Cervical Neoplasia; Implications for Clinical Care of Women at Risk for Both Conditions." AIDS. Vol. 6:173-178. 1992.

27. Terris, Milton and Margaret C. Oalmann. "Carcinoma of the Cervix: an Epidemiologic Study." Journal of the American Medical Association. Vol. 174. No. 4:1847-1851. 1960.

28. Dwyer, John. Personal Communication. 1992.

29. Miller, Christopher and Murray Gardner. "AIDS and Mucosal Immunity: Usefulness of the SIV Macaque Model of Genital Mucosal Transmission." Journal of Acquired Immune Deficiency Syndromes. Vol. 4:1169-1192, 1991.

30. Chandra, R.K. Nutrition, Immunity and Infection: Present Knowledge and Future Directions. Lancet. Vol.: 688-691. March 26, 1983.

31. Diallo, A. Boubacar. "A Tora Mousso Kele La: A call beyond duty"; often omitted root causes of maternal mortality in West Africa. UNDP HIV and Development Issues Paper No. 5. 1992.

32. UNDP. "Safe Motherhood Priorities and Next Steps: A Forward-Looking Assessment on the Reduction of Maternal Mortality and Morbidity Within the Framework of the Safe Motherhood Initiatives" (SMI). April 1991.

33. Cixous, Hel. From "Vivre l'Orange". Excerpted in Love Poems By Women, Wendy Mulford (ed). Fawcett Columbine. NY. 1991.

34. Stein, Zena. "HIV Prevention: The Need for Methods Women Can Use". American Journal of Public Health. Vol. 80:460-462. 1990.

35. Hamblin, Julie and Elizabeth Reid. "Women, the HIV Epidemic and Human Rights: A Tragic Imperative". Paper prepared for International Workshop on AIDS: A Question of Rights and Humanity. International Court of Justice. The Hague. May 1991.

36. Reid, Elizabeth. "Women and HIV." Editorial in AIDS Health Promotion Exchange. 1992.

37. Baker, G., Felicia Knaul and Ana Vasconcelos. "Development as Empowerment: Brazilian Project Offers Passage to a Better Life for Street Girls." Passages. Vol. 10. No. 4:3-6. International Center on Adolescent Fertility. 1991.

38. Slutkin, G. "What has been Learned in HIV Prevention Programmes." Presentation made at VIII International Conference on AIDS, Amsterdam. 1992.

39. Heise, Lori. "Violence Against Women: The Missing Agenda." in Woman's Health: a Global Perspective. Marge Koblinsky, Judith Timyan and Jill Gay (Eds). Westview press, 1992.

40. Heise, Lori. Personal Communication. 1992.

41. Orick, George. Interview with Margaret Mwangola and Rose Mulama. Kenya. UNDP HIV and Development Programme. Reflections on the Impact of the HIV Epidemic Project. Taped 1991.


This paper was first published as an insert in AIDS and Society, International Research and Policy Bulletin, Vol. 4 No. 1, October/November 1992.

Biographical Note

Elizabeth Reid is Senior Adviser, Bureau for Policy and Programme Support, United Nations Development Programme (UNDP), New York. Before joining UNDP, she worked closely with community groups working within the HIV epidemic in Australia and was responsible for the formulation of Australia's first National HIV/AIDS Strategy. She has extensive experience in development theory and practice in Africa, Asia, the Pacific, the Middle East and Latin America and the Caribbean.

Michael Bailey is a biologist specializing in sexual health in developing countries. He advises non-governmental organizations and government development agencies of Britain and the European Union.


Language and the images it evokes shape and influence behaviour and attitudes. The words used locate the speaker with respect to others, distancing or including them, setting up relations of authority or of partnership, and affect the listeners in particular ways, empowering or disempowering, estranging or persuading, and so on. The use of language is an ethical and a programmatic issue.

UNDP has adopted the following principles to guide its HIV-related language.

Language should be inclusive and not create and reinforce a Them/Us mentality or approach. For example, a term like "intervention" places the speaker outside of the group of people for or with whom he or she is working. Words like "control" set up a particular type of distancing relationship between the speaker and the listeners. Care should be taken with the use of the pronouns "they", "you", "them", etc.

It is better if the vocabulary used is drawn from the vocabulary of peace and human development rather than from the vocabulary of war. For example, synonyms could be found for words like "campaign", "control", "surveillance", etc.

Descriptive terms used should be those preferred or chosen by persons described. For example, "sex workers" is often the term preferred by those concerned rather than "prostitutes"; "people living with HIV" or "people living with AIDS" are preferred by infected persons rather than "victims".

Language should be value neutral, gender sensitive and should be empowering rather than disempowering. Terms such as "promiscuous", "drug abuse" and all derogatory terms alienate rather than create the trust and respect required. Terms such as "victim" or "sufferer" suggest powerlessness; "haemophiliac" or "AIDS patient" identify a human being by their medical condition alone. "Injecting drug users" is used rather than "drug addicts". Terms such as "living with HIV" recognize that an infected person may continue to live well and productively for many years.

Terms used need to be strictly accurate. For example, "AIDS” describes the conditions and illnesses associated with significant progression of infection. Otherwise, the terms used include "HIV infection", "HIV epidemic", "HIV-related illnesses or conditions", etc. "Situation of risk" is used rather than "risk behaviour" or "risk groups", since the same act may be safe in one situation and unsafe in another. The safety of the situation has to be continually assessed.

The terms used need to be adequate to inform accurately. For example, the modes of HIV transmission and the options for protective behaviour change need to be explicitly stated so as to be clearly understood within all cultural contexts.

The appropriate use of language respects the dignity and rights of all concerned, avoids contributing to the stigmatisation and rejection of the affected and assists in creating the social changes required to overcome the epidemic.



RECOGNIZING the impact that the HIV epidemic is having on all aspects of human life;

RECOGNIZING the need for an urgent response;

RECOGNIZING that the fundamental value of respect for human rights, life and human dignity provides the foundation on which all is built,

WE, the participants at the Intercountry Consultation of the African Network on Ethics, Law and HIV, affirm that any action, whether personal, institutional, professional or governmental, in response to the HIV epidemic, should be guided by the following principles:

THE PRINCIPLE OF RESPONSIBILITY: Every person, government, community, institution, private enterprise and medium must be aware of his or her responsibility and must exercise it in an active and sustainable manner.

THE PRINCIPLE OF ENGAGEMENT: Every person is affected, directly or indirectly, and therefore should respond with commitment, concern, courage and hope for the future.

THE PRINCIPLE OF PARTNERSHIP AND CONSENSUS-BUILDING: All persons, couples, families, communities and nations must work together with compassion to build and share a common vision. These partnerships must reflect and actively promote solidarity, inclusion, integration, dialogue, participation and harmony.

THE PRINCIPLE OF EMPOWERMENT: The empowerment of every person, but particularly women, the poor, the uneducated and children, is essential and must guide all action. Empowerment requires recognition of the right to knowledge, information and technology, freedom of choice and economic opportunity.

THE PRINCIPLE OF NON-DISCRIMINATION: Every person directly affected by the epidemic should remain an integral part of his or her community, with the right of equal access to work, housing, education and social services, with the right to marry, with freedom of movement, belief and association, with the right to counselling, care and treatment, justice and equality.

THE PRINCIPLE OF CONFIDENTIALITY AND PRIVACY: Every person directly affected by the epidemic has a right to confidentiality and privacy. It can only be breached in exceptional circumstances.

THE PRINCIPLE OF ADAPTATION: Every person and community should change and adapt social and cultural conditions to the new challenges of the epidemic in order to respond effectively.

THE PRINCIPLE OF SENSITIVITY IN LANGUAGE: Language should uphold human dignity, reflect inclusion, be gender sensitive, accurate and understandable.

THE PRINCIPLE OF ETHICS IN RESEARCH: The interests of the research subjects or communities should be paramount. Research should be based on free and informed consent, be non-obtrusive and non-coercive, and the results should be made available to the community for timely and appropriate action.

THE PRINCIPLE OF PROHIBITION OF MANDATORY HIV TESTING: HIV testing without consent should be prohibited. HIV testing should also not be a pre-requisite for access to work, travel or other services.

This Declaration was drafted and endorsed by participants at the Intercountry Consultation of the African Network on Ethics, Law and HIV, organized in Dakar, Senegal, from 27 June to 1st July 1994, by the UNDP HIV and Development Programme (Dakar and New York). Participants came from Central African Republic, Cd'Ivoire, Ghana, Kenya, Rwanda, Senegal, South Africa, Uganda, Zambia, the WHO Global Programme on AIDS, the WHO Regional Office for Africa, the UNDP Management Development and Governance Division, the UNDP HIV and Development Project in Asia and the Pacific, the Asian and Latin American Networks on Law, Ethics and HIV, the African Council of AIDS Service Organizations (AFRICASO), the Association of African Jurists (AJA), ENDA Tiers Monde, the Network of African People Living with HIV/AIDS (NAP+), the Organisation Pan-Africaine de Lutte contre le SIDA (OPALS) and ORSTOM.

Some of the documents listed below are available on the HIV and Development Programme World Wide Web Page:

Issues Papers

1. The HIV Epidemic and Development: The Unfolding of the Epidemic, 1992 (Also available in French, Spanish)

2. The Economic Impact of the HIV Epidemic, 1992 (Also available in French, Spanish)

3. Female Genital Health and the Risk of HIV Transmission, 1991 (Also available in French)

4. People Living with HIV: The Law, Ethics and Discrimination, 1992 (Also available in French, Spanish)

5. Sharing the Challenge of the HIV Epidemic: Building Partnerships, 1992 (Also available in French)

6. Placing Women at the Centre of the Analysis, 1990 (Also available in French, Spanish)

7. Behaviour Change in Response to the HIV Epidemic: Some Analogies and Lessons from the Experience of Gay Communities, 1991 (Also available in French)

8. Women, the HIV Epidemic and Human Rights: A Tragic Imperative, 1991 (Also available in French)

9. "A Tora Mousso Kele La" A Call Beyond Duty: Often Omitted Root Causes of Maternal Mortality in West Africa, 1991

10. Gender, Knowledge and Responsibility, 1992

11. The Role of the Law in HIV and AIDS Policy, 1991 (Also available in French)

12. Young Women: Silence, Susceptibility and the HIV Epidemic, 1992 (Also available in French, Spanish)

13. Children in Families Affected by the HIV Epidemic: A Strategic Approach, 1993 (Also available in French)

14. Approaching the HIV Epidemic, 1993

15. HIV and the Challenges Facing Men, 1995

16. Development Practice and the HIV Epidemic, 1995

17. Development as a Moral Concept: Women's Practices as Development Practices, 1994

18. Meanings of Sustainability for HIV Programmes: From Financial Independence to Long Term Behaviour Change, 1995

19. Living With HIV, 1994

20. HIV Prevention in Multicultural Contexts, 1996

21. Women and HIV: Our Silences and Our Strengths, 1995

22. The Impact of HIV on Families and Children, 1996

23. HIV Epidemic and Development in Nicaragua, 1996

24. What Constitutes Effective IEC Programmes?, 1997

25. Neurological Disorders of HIV Infection and AIDS in Africa: Clinical Diagnosis, Treatment and Care, 1997

26. National Strategic Planning and the HIV Epidemic, 1996

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United Nations Development Programme
HIV and Development Programme

The UNDP HIV and Development programme draws together UNDP's headquarters, regional and country programming and other initiatives designed to strengthen the capacity of nations and organizations to respond effectively to the HIV epidemic. The activities covered in this programme include:

· establishing priority needs through consultations with those directly affected by the epidemic;

· national capacity building through field missions, consultations and HIV and development workshops on multisectoral programme development and coordination;

· development of gender-sensitive and community-based approaches through pilot programmes, consultations, workshops and publications;

· multisectoral policy development and advocacy through intercountry consultations, colloquia, the establishment of regional networks (legal, economic, for example), publications and technical assistance;

· programme development through workshops and facilitated study tours which explore innovative ways of increasing and measuring programme effectiveness and sustainability;

· mainstreaming HIV in key programming areas, for example, in village self-help schemes, food security systems, regional planning approaches, etc., through studies, workshops, training and technical assistance;

· establishing operational research priorities relevant to effective and sustainable programme and policy development and evaluation through colloquia, commissioned reviews and consultations; and

· mobilising and coordinating the response of the UN system and other players at the national level to maximise the effectiveness of their support for the national response to the epidemic.

The work of the UNDP HIV and Development programme is coordinated within the UN system by the Joint United Nations Programme on HIV/AIDS (UNAIDS). The HIV and Development Programme was established by the UNDP Governing Council and its mandate is contained in its Policy Framework and Guiding Principles (DP/1991/57). UNDP works in close collaboration with UNAIDS and other multilateral and bilateral agencies, national governments, non-governmental and community based organizations, and academic and private sector institutions to contribute towards an effective, sustainable and coordinated response to the HIV epidemic.