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Complacency, the United Nations warned in its latest report on AIDS, constitutes a grave threat to decades of progress against HIV. The report, a self-proclaimed “wake-up call,” was directed at the entire global health community. But its message is particularly urgent and personal for African women, who bear the brunt of the HIV pandemic but who are also in the vanguard of the fight against it.

In sub-Saharan Africa, women between the ages of 15 and 24 years represent just 10% of the population, but 25% of new HIV infections. In West and Central Africa, two thirds of new adolescent infections are among young women. Access to the antiretroviral drugs that fight HIV, which pregnant and breastfeeding women need to stay healthy and protect their babies from infection, has barely budged over the past three years.

Gender inequality is a proven barrier to progress on these fronts. Intimate partner violence, lack of financial freedom, unequal access to education, and harmful gender norms are risk factors for contracting HIV and not taking lifesaving antiretroviral drugs. And when women face a greater risk of infection and difficulty taking antiretroviral drugs, their children are more likely to contract the virus as well.


Yet women have never been passive victims of this epidemic. Look at Elizabeth Glaser, whose advocacy accelerated research on pediatric HIV. Or at Auxilia Chimusoro, the first HIV-positive woman in Zimbabwe to publicly disclose her status, who triggered a national reckoning with stigma and discrimination. Or at the thousands of women who steadfastly bear the daily responsibilities of frontline health care. According to UNICEF, women “constitute by far the largest share of caregivers, community-level workers, and volunteers who provide critical HIV treatment, prevention and support …”

There are many reasons why women need to lead on HIV/AIDS. A personal understanding of gender inequality and disempowerment gives them greater insight into overcoming those obstacles and better serving vulnerable populations. For mothers, the motivation is particularly strong. Glaser, who unknowingly transmitted HIV to her children after being infected through a blood transfusion, credited her advocacy to maternal instinct: “I want to save my family, but to do that I have to change the world.”


As Quarraisha Abdool Karim, the special ambassador to the Joint United Nations Program on HIV/AIDS, writes of women’s outsized role in caregiving, “[t]he extent and immediacy of the HIV challenge, with its very visible impact on mothers and infants, may have served as an impetus for the early engagement of women.”

First ladies and the sprint towards an AIDS-free generation

From Barbara Bush to Margaret Kenyatta, first ladies have a special place in the rich history of women’s leadership on AIDS. In Africa, that expertise and authority are formalized through the Organization of African First Ladies for Development. Its latest effort, the Free to Shine campaign, seeks to keep mothers healthy and end AIDS among African children by 2030. The campaign was launched in Zimbabwe last year, and other countries are rolling out their own plans.

This campaign demonstrates why the global health community, in answering the UN’s wake-up call and re-energizing its fight against AIDS, should foster women’s leadership at the national level.

Citizens often see their first ladies as role models and moral leaders — a natural advantage in delivering sociocultural messages to the public. Free to Shine offers first ladies guidance on using public events, the press, and social media to encourage their constituencies to get tested for HIV and, if infected, to stick with the treatment. First ladies also can leverage their authority to publicly denounce stigma and discrimination — social forces that interfere with diagnosis and care by forcing people living with HIV into the shadows. As HIV/AIDS activist Keren Dunaway has said, first ladies are capable of “raising awareness and decreasing taboos about HIV… more than many men in power are able to do.”

First ladies can have a unique influence, sharing the visibility and clout of high office without the same political charge that can hamstring other leaders. In a report on first ladies’ leadership, the George W. Bush Presidential Center and the International Center for Research on Women explains that “as apolitical influencers, first ladies have a powerful opportunity to unite people and/or groups and encourage cooperation” that can, in turn “offset resource limitations and other barriers.” Zimbabwe’s first lady, Auxillia Mnangagwa, recently seized that “powerful opportunity” by securing a donation of machines that can diagnose HIV infection in infants faster and earlier than ever before. This new technology will enable Zimbabwe’s rural clinics to begin treating HIV-positive infants before it is too late.

Perhaps most importantly, first ladies can play a crucial role in amplifying all women’s voices. Through their positions in national leadership, they have a natural platform for speech and advocacy that other women may struggle to access. Such privilege bestows opportunity — not just to make a difference themselves, but to make heard the voices and empower the actions of women of all ages who are living with and affected by HIV.

Graça Machel, the former first lady of South Africa, wrote of such women that “they are the ones on whose shoulders we stand as we continue to work towards an AIDS-free generation.”

Agnes Mahomva, M.B.Ch.B., is the Zimbabwe country director for the Elizabeth Glaser Pediatric AIDS Foundation and was president of the Zimbabwe Medical Association from 2014 to 2018. She was recently appointed permanent secretary of Zimbabwe’s Ministry of Health and Child Care.