Mark Heywood stood to ask his question in Johannesburg last week at the launch of the Guttmacher–Lancet Commission on Sexual and Reproductive Health and Rights for All. He observed that we were in a country blighted with a “rape culture”—the epicentre of an epidemic of violations against sexual and reproductive rights. The country had no strategy for dealing with these violations. Only recently was a draft policy on teenage pregnancy written. Regression is taking place in access to abortion. And what, he asked, did we think about the present crisis engulfing UNAIDS? Michel Sidibé, its Executive Director, was arriving in South Africa that same day. And yet wasn't he guilty of failing to deal with the same issues we were urging others to address? What message did we have for him? The launch of our Commission was held in Constitution Hill, a former jail where many anti-apartheid campaigners were once incarcerated. We were in the Women's Prison, now converted into a museum and memorial to South Africa's tortured past. The violent imposition of white racial power. Black women registered in blue ink, white women in red. Physical and psychological humiliation. Dehumanisation. Mindless and repetitive tasks, such as washing, scrubbing, and shining floors with cloths and brushes, working on bleeding knees. Doctors and nurses employed in the prison colluded with the racist regime, inflicting additional cruelties. “I wanted nothing to do with their doctors. I thought they would poison me”, said one prisoner. Another: “There was one black woman who slipped in the shower and broke her hip. The doctor wouldn't come out at night to see her. He made her stand in the queue and he swore at her. Her face was swollen with pain.” South Africa today is free. But violence against women and girls has assumed new forms. Karabo Mokoena, 22 years old and murdered in Johannesburg. Her killer doused her body in acid and set it ablaze. He was sentenced to 32 years in prison just days before we arrived. Zolile Khumalo, a 21-year-old student in Durban. Zolile's former partner shot her dead in her dormitory. In South Africa, the frequency of femicide is five-times the global rate. Every 4 h a woman is murdered. One in five women over the age of 18 years has experienced violence by their partner. A newspaper, The Star, called femicide, “a South African curse”. The health and rights of women and girls worldwide are under attack. The purpose of the Guttmacher–Lancet Commission, co-chaired by Ann Starrs and Alex Ezeh, was to write a new manifesto to advance sexual and reproductive health and rights. We want to take advantage of the opportunities presented by the Sustainable Development Goals. We want to insist on a package of essential and cost-effective interventions as part of universal health coverage. And we want to fight against the forces of conservatism that are killing women, especially young women, today. This struggle is political as well as technical. As Justice Edwin Cameron noted, “Speaking about sex is a political act.” And Mark Heywood's question? Michel Sidibé has done much that is good at UNAIDS. He is a compelling activist. He commands respect and admiration among politicians. His ability to communicate the continued urgency of the AIDS epidemic has saved countless lives. And yet his responses to allegations of sexual misconduct at UNAIDS have been disappointing. He has supporters. But the growing schism over his leadership only shows how divided the AIDS community has become through statements and decisions that many view as ambivalent and ambiguous. There are calls for Sidibé to resign or to be fired. Neither outcome should happen. The UNAIDS Programme Coordinating Board last week issued its terms of reference for an Independent Expert Panel on sexual harassment, bullying, and abuse at the UNAIDS secretariat. The panel will deliver its report by December. UN Secretary-General António Guterres must then decide Sidibé's fate. In the meantime, the right response should surely be that Sidibé voluntarily suspends himself during the period of this inquiry. Voluntary suspension would enable an acting Executive Director (possibly Gunilla Carlsson, who only joined UNAIDS in February) to defuse a disablingly acrimonious dispute and restore confidence in UNAIDS. Defending sexual and reproductive health and rights leaves no room for hypocrisy.
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