Gender Mainstreaming in HIV-AIDS potx

Bridgette Prince, Sharon Kleintjes, Allanise Cloete and Alicia Davids Section A A gendered lens for vulnerability to HIV and AIDS 13 Paper 1 Mainstreaming gender in HIV/AIDS: why and how

Edited by Sharon Kleintjes,Bridgette Prince, Allanise Cloete

& Alicia Davids

Compiled by the Social Aspects of HIV/AIDS and Health (SAHA) Research Programme

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Bridgette Prince, Sharon Kleintjes, Allanise Cloete and Alicia Davids

Section A A gendered lens for vulnerability to HIV and AIDS 13

Paper 1 Mainstreaming gender in HIV/AIDS: why and how 15

Paper 3 Gender mainstreaming and HIV/AIDS: how important is male

involvement in accelerating gender equality? 29

Daniel Motsatsing and Keletso Makgekgenene

Paper 4 Building capacity for mainstreaming gender into HIV/AIDS

programming 35

Camille Antoine

Paper 5 The main challenges in mainstreaming gender 43

Nonhlanhla Dlamini

Paper 6 Opportunities and challenges for gender mainstreaming in

HIV/AIDS 49

Tammy Shefer

Conclusion: Lessons learnt and next steps 52

Sharon Kleintjes and Bridgette Prince

Acknowledgements

We wish to express our gratitude to the following institutions for their support and assistance in taking the debate around gender mainstreaming forward:

• the Commonwealth Secretariat

• Dalhousie University’s Atlantic Centre of Excellence for Women’s Health

• the Human Sciences Research Council

• the Social Aspects of HIV/AIDS and Health Research Alliance

ARV antiretroviral

ARASA AIDS and Rights Alliance of Southern Africa

BONASO Botswana Network of AIDS Service Organisations

CARICOM Caribbean Community and Common Market

CGDS Centre for Gender and Development Studies

GAD Gender Affairs Division

IIGHA International Institute on Gender and HIV/AIDS

MSA multi-sectoral approach

NGOs non-governmental organisations

PANCAP PANCaribbean Partnership for HIV/AIDS

PLWHA people living with HIV/AIDS

PMTCT prevention of mother-to-child transmission

SADC Southern Africa Development Community

SAHARA Social Aspects of HIV/AIDS Research Alliance

WHO World Health Organization

UNAIDS Joint United Nations Programme on HIV/AIDS

UNDP United Nations Development Programme

UNIFEM United Nations Development Fund for Women

VCT Voluntary Counselling and Testing

Preface

This report contains the presentations delivered at the Satellite Session

on Gender Mainstreaming, 7th AIDS Impact Conference, April 2005 All presentations provided a gendered perspective on the HIV/AIDS pandemic The conference aimed to promote an enhanced understanding of the concept

of ‘gender mainstreaming’ in relation to HIV and AIDS

The introduction to this collection of papers provides an overview of key meetings that have informed all the presentations These meetings include the Beijing Conference in 1995, the second annual conference of the Social Aspects of HIV/AIDS Research Alliance (SAHARA) held in May 2004, and the Launch of the International Institute on Gender and HIV/AIDS (IIGHA)

in June 2004

Section A of the report contains two papers that provide an in-depth overview

of gender mainstreaming and suggest tools for its application in working within the HIV/AIDS sector Section B provides three country-level examples

of the application of gender mainstreaming: the first provides an outline on advocacy work in civil society in Botswana, and also comments on the need

to include men more actively in gender-based work The second outlines the strategy for building gender-mainstreaming capacity in HIV/AIDS work

in the Caribbean, and the third provides an overview of the status of, and recommendations for, improving gender mainstreaming in Swaziland The report concludes with lessons learnt from the presentations, and briefly outlines practical ways of taking these lessons forward at the third annual HIV/AIDS SAHARA Research Conference to be held in Dakar, Senegal in October 2005

Bridgette Prince, Sharon Kleintjes, Allanise Cloete and Alicia Davids

Contextualising gender mainstreaming

The 2004 Report on The Global AIDS Epidemic (UNAIDS 2004) estimated

that in 2003, 4 million people globally became newly infected with HIV Moreover in 2004, 37.8 million people in the world were living with HIV (UNAIDS 2004:23) Of this global population of people living with HIV/AIDS in 2000, at least 24 million people were living in countries located

in the Southern Africa Development Community (SADC) (UNAIDS 2000, cited in Shisana 2002) The prevalence of HIV infection is higher among females than males, and the numbers of women living with HIV continues

to rise in every region of the world (Shisana 2002:41; UNAIDS 2004) Data revealed by the 2004 UNAIDS (Joint United Nations Programme on HIV/AIDS) report suggests that globally, in 1997, women comprised 47 per cent of people living with HIV; and by 2002, this figure rose to almost 50 per cent In sub-Saharan Africa, close to 60 per cent of adults living with HIV are women, and almost 75 per cent of young people living with HIV

in southern Africa are female The disproportion of female to male HIV prevalence is most marked in places where heterosexual sex is the dominant mode of transmission, particularly the Caribbean and sub-Saharan Africa (UNAIDS 2004:22)

The ‘feminisation’ of the HIV epidemic is fuelled by both biological and socio-cultural factors, which put women more at risk of infection than men According to Shisana and Simbayi (2002) the physiology of women’s reproductive systems, which have a large surface area, makes it easier for them to be infected with HIV than it is for men Furthermore, because of the high concentration of HIV that can be carried in semen, infected men are more effective at transmitting the virus to uninfected partners than vice versa (2002:20) Women’s vulnerability to HIV infection is increased by systems

of oppression and subjugation that legitimise male domination Women’s

marginalised status can mean that women have less power to negotiate sexual and reproductive health matters, less economic independence, less education and less access to health care Thus women’s increased risk of HIV infection can be seen as a reflection of gender inequality in society (UNAIDS 2004:12)

The most important HIV risk factor for many women is their male partner’s sexual behaviour, and many women are infected while involved in what they consider to be a monogamous relationship (2004:12) The linkage between constructions of gender and the transmission of HIV/AIDS is acknowledged through the findings of a number of evidence-based research projects However the gap between research, intervention and policy remains huge There is

a need to support efforts to augment research on the gender dimensions of HIV/AIDS; to incorporate new and existing research into policy; to translate policy into action; and to integrate good practice into policies The current trends of HIV transmission and prevalence clearly reflect that the epidemic

is fuelled by gender-based vulnerabilities Taking this into consideration, it is clear that mainstreaming gender within HIV prevention strategies needs to become integral to attempts to curb the further spread of the HIV epidemic

It is clear that sub-Saharan Africa has the largest number of people living with HIV/AIDS, and the epidemic is affecting women and girls in increasing numbers This trend underscores the fact that, in 2005, serious gaps still remain in the gender-based response to AIDS, despite efforts to address gender-related concerns in the past decade

Gender mainstreaming is a key strategy to address the gender imbalances which still permeate societies Gender mainstreaming is defined by UNDP (United Nations Development Programme) as taking account of gender relations in all policy, programme, administrative and financial activities and organisational procedures It comprises two processes, (a) being informed about relevant gender issues, and (b) incorporating this information into our work

In the health sector, as early as 1995, the issue of gender mainstreaming was highlighted by global advocates for women’s health Gender mainstreaming is not a new priority However, because of the impact of HIV/AIDS and the role

of gender in this context, there is now a renewed urgency to build capacity and awareness of the need for gender mainstreaming, and increased recognition of the gender-based health needs of women and men, boys and girls

The remainder of this introduction charts the growth of gender mainstreaming

in policy and practice over the past ten years with a focus on the impact of HIV/AIDS on gender-based issues, as reported in several key conferences and interventions

Setting the scene: the Beijing Conference

The Fourth World Conference on Women was held in Beijing in 1995, where

‘Women and Health’ was defined as a critical area of concern in the Platform for Action In accordance with its multi-year programme, in the follow-up

to the Beijing Conference, the United Nations Commission on the Status of Women considered ‘Women and Health’ as a priority theme at its forty-third session in March 1999 To prepare for consideration by the Commission, an expert group meeting on ‘Women and Health – Mainstreaming the Gender Perspective into the Health Sector’ was held from 28 September to 2 October

1998 in Tunis, Tunisia Dr Olive Shisana, then Executive Director of Family and Health Services of the World Health Organization (WHO), opened the meeting She highlighted the roles and responsibilities assigned to women and men in different cultures, racial and age groups that shape the development

of different skills and abilities and channel their application to specific life spheres Key issues that were discussed are outlined below

Occupational and environmental health

Women are more likely to suffer from occupational stress and musculoskeletal disorders because of their work as unskilled or semi-skilled workers in agriculture and the informal sector It was recommended that more research be carried out on the environmental and other risks posed to women’s health by their occupational activities in rural and urban settings, alongside the synergistic effects

of heavy household work, malnutrition, multiple pregnancies and adverse climatic conditions as they affect millions of poor women in developing countries

Sexual and reproductive health

Socio-economic differences between women and men may be even more important than biological ones in determining the sexual and reproductive

health status of women Lack of autonomy, failure to enforce laws in women’s favour, discrimination in laws such as the criminalisation of abortion, inadequate allocation of health resources, and failure by government to implement remedial measures sanctioned by international agreements, all contribute to the relatively poor health status of women in many societies Women should be fully involved, to the highest level of health service planning, to ensure that their sexual and reproductive health needs are met from infancy to old age The same applies to decisions taken on funding research on women’s health.

Mainstreaming the gender perspective in health care

Two particularly critical issues emerged during the discussions First, that there is a great need for sensitisation and training of actors at all levels of the health sector, government and public administration in gender concepts, which are generally poorly understood Second, that the degree of political commitment at the highest levels is the single most important determinant

of progress External actors such as international organisations and local players such as non-governmental organisations can play a vital catalytic role

in helping secure this political commitment

Other topical issues included: controlling tuberculosis, malaria and other diseases, including HIV and AIDS; mental health; integrating the gender perspective in medical education and research; health reform and financing: introducing a gender-based analysis; and partnership for health: actors and key stakeholders

Dr Shisana highlighted the question of how we know that we have mainstreamed

gender into the health sector Considering that work in gender mainstreaming

is currently in its infancy in the African context, Dr Shisana’s assertion

as quoted below becomes an important framework for evaluating and monitoring the process of gender mainstreaming:

Gender mainstreaming has happened when policy planners and researchers have internalised the gender perspective and no longer have to be conscious of their behaviour; when their behaviour

pattern has changed and become natural; when they can identify the conditions that affect men and women differently, those that affect men more than women and those that affect women more

than men; when they can identify risk factors for men and women for each of their conditions and develop different interventions

for men and women accordingly When this approach is

used routinely in developing health policies and plans in an

organisation, then gender will have been mainstreamed

SAHARA: a gender perspective

SAHARA (Social Aspects of HIV/AIDS Research Alliance) is a key response

to the HIV/AIDS epidemic in Africa; a network for facilitating the sharing

of HIV/AIDS-related research expertise and knowledge, and conducting multi-site and multi-country exploratory, cross-sectional, comparative or intervention-based research projects, within an African context As part of its concerted action, an annual conference is convened to foster the effective integration of the activities of the Alliance research partners and of other organisations and individuals active in HIV and AIDS control within the African continent and abroad

At the second conference of SAHARA held in Cape Town, South Africa in May

2004, presentations highlighted several key gender-related concerns:

• Care-giving is traditionally done by women, with women bearing a greater burden of caring for the sick in the family and community Yet, because women have the lowest incomes, their own access to care (and those who depend on them for care) is constrained by care options that are costly, highly technical and not readily accessible from the living environments

of women and their families

• The continuous nature of household work, limitations on the scope of and bases from which women may acceptably conduct their activities, cultural norms that discourage females from discussing sexuality or sexual health or from attending and participating in mixed-gender initiatives, all severely limit women’s participation in (health) education, planning and practice, which then affects their roles as primary care-givers

• Fear of violence or abandonment may further impede women’s disclosure

of (and help seeking for) their positive status Programmes need to address the power imbalances that permeate individual, interpersonal, and community-level gender relations The mobilisation and empowerment of the women of Africa is central to HIV/AIDS-related strategies

• Programmes should also be aware of cultural practices that separate male and female domains of interaction, and ensure women’s participation

by locating activities within those settings and constraints, rather than targeting only those settings where men are more likely to participate Women’s organisations must be empowered as vehicles to drive such initiatives

• Simultaneously, attention must be given to promoting pro-social, and addressing socially-alienating, masculine socialisation constructs and practices These impact on the health, well-being and mutual support of women, children and men, both in communities at large and in regard to their impact on HIV/AIDS-related strategies Programmes also need to engage men to promote alternative models of masculinity that support men’s positive involvement in prevention, care and treatment of HIV

A gender round-table hosted at the conference argued along similar lines for mainstreaming gender This satellite session illustrated through evidence-based research that women are more susceptible to HIV infection than men Another important issue raised was that it is important to stress constructions

of gender and not only focus on biological factors that differentiate women and men Gender inequality as one of the precipitating factors to HIV infection was also discussed, with specific reference to women being economically dependent on men and forming 70 per cent of the world’s poor Through discussion, it also became evident that programmes need to address these power imbalances at an intervention level

The third annual conference of the Alliance will take place in Dakar, Senegal

in October 2005 and will take forward the above concepts and concerns in working groups and skills-building sessions, with a view to facilitating the development of an effective, Africa-wide response to gender mainstreaming

Launch of the International Institute on

Gender and HIV/AIDS

The International Institute on Gender and HIV/AIDS was launched from

7 to 11 June 2004 in Johannesburg, South Africa It aims to strengthen practice, policy and research to enhance existing efforts in tackling issues

of gender and HIV/AIDS in southern Africa and beyond The Institute, a

virtual and flexible transformative learning experience rather than a and-mortar centre, was co-hosted by the Social Aspects of HIV/AIDS and Health Research Programme (SAHA) of the Human Sciences Research Council (HSRC), the Commonwealth Secretariat, and the Atlantic Centre of Excellence for Women’s Health at Dalhousie University It brought together

bricks-88 policy-makers, civil society representatives, academics and researchers from Botswana, Canada, Lesotho, South Africa and Swaziland to discuss the successes and challenges of integrating a gender perspective into work

on the HIV/AIDS pandemic The project was undertaken in collaboration with regional partners such as SAHARA and the AIDS and Rights Alliance of Southern Africa (ARASA) Nancy Spence, Director of the Secretariat’s Social Transformation Programmes Division summed it up in this way:

This Institute is without walls, without borders It will move from

region to region, acting as a catalyst in the sharing of knowledge

and experience for effective strategies that address the

multi-faceted and complex dimensions of gender and HIV/AIDS The

Institute will play a vital role in the ongoing response to HIV/

AIDS across the Commonwealth

Participants at the International Institute on Gender and HIV/AIDS, June 2004

Dr Barbara Clow, Executive Director of the Atlantic Centre of Excellence for Women’s Health, stated:

Significant work is being done to set policies, implement

programmes and mitigate the impact of the pandemic across

the region, yet the challenge of translating policies into effective practice, ensuring policies address gender, and establishing

the evidence base for gender sensitive policies and practice

still remains

The Institute was developed over four years through a process of extensive consultation with international experts in the field, and face-to-face discussions with representatives from governments, research institutions and civil society throughout southern Africa In a communiqué issued at the conclusion of the inaugural Institute meeting, the five participating countries announced the development of national plans of action, which included the development of

‘National Institute Chapters’ in each country Each country’s chapter reflected the tripartite structure of government, civil society and research Chapter representatives will work together to ensure that interventions to address gender and HIV/AIDS at policy and programme levels will be more clearly informed, monitored and evaluated through their close partnerships

Another regional collaborator, ARASA, has been established to share information, materials and expertise and act as a regional alert network

to respond to human rights issues related to HIV/AIDS One of its major initiatives is to develop a SADC code on gender and HIV/AIDS, which it hopes all governments in the region will adopt Marlise Richter, a researcher with the AIDS Law Project of South Africa, and a member of ARASA, feels the Institute is coming at a critical time for the region: ‘Whether you look

at human rights, access to treatment and care, prevention strategies or the impact of the infection itself, the gender dimension is essential to understand but is too often overlooked or given a secondary status.’

The keynote speaker at the opening of the inaugural meeting, Dr Olive Shisana, Executive Director of the HSRC and a founder of SAHARA, gave a brief discussion of the meaning of gender in her presentation, underscoring the cultural construction and the cultural specificity of the roles and responsibilities assigned to females and males ‘In every society, including ours in South Africa,’ she observed, ‘males and females who by nature are biologically different are expected to behave in accordance with prescribed

ways of life From childhood, girls and boys are expected to exhibit traditional practices, which might be harmful or protective’ Male and female roles and responsibilities are not only defined differently, they are also valued differently When the abilities and work of men are more highly regarded than those of women – as they are in many societies – women have less access to and control

of the resources necessary to protect their own health and the health of their families (Shisana 1998)

In the context of the HIV/AIDS pandemic, unequal power translates into hugely increased risks of infection and death for women and girls According

to Shisana and Davids (2004), ‘for every 15- to 19-year-old boy that is infected [in sub-Saharan Africa], there are five or six girls infected in the same age group.’

Different types of gender inequality contribute to heightened vulnerability for women and girls For example, women and girls are more likely than men or boys to be victims of sexual violence, in part because many cultures around the world embrace the idea that men are not able to control their sexuality and have a ‘right’ to sex Coercive sex tends to be more dangerous because it

is often unprotected and because it can damage delicate tissues in the female reproductive tract, thereby facilitating the spread of HIV

Olive Shisana, Executive Director of SAHA, HSRC and Nancy Spence, Director of the Social Transformation Division, Commonwealth Secretariat, at the inaugural launch of IIGHA.

Similarly, women who are economically dependent on men may find it difficult or impossible to insist on safe sex practices In Lesotho and Swaziland, for instance, a woman married in community of property is considered a legal minor and cannot sign a contract without her husband’s permission

In Mozambique, a woman’s property is turned over to her husband and he alone can authorise her to enter into commercial transactions In such cases,

a woman who refuses sex or tries to insist on condom use may sacrifice financial security for herself and her family

In addition to conditions of poverty and violence, common and customary law may also put women and girls at greater risk of HIV infection While most

of the SADC countries have either ratified or acceded to the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW), common and customary laws in many countries entrench gender inequality

In Botswana, for example, some tribal courts treat adultery as a female crime only, tacitly sanctioning multiple sexual partners for men and thereby encouraging the spread of HIV Similarly, in many southern African countries, women are forbidden by customary law to inherit property, making it difficult for them to head a household or keep a family together after the death of a husband or father Dr Shisana points out: ‘even where legal frameworks foster good gender relations, harmful traditional practices remain A social and legal environment that encourages gender discrimination is a fertile ground for the spread of HIV.’

Dr Shisana concluded her presentation with seven key recommendations:

1 Encourage government and civil society to join hands in the creation of social and legal environments that discourage men from engaging in risky behaviour and that eliminate discrimination against women;

2 Adopt community-based strategies, involving traditional leaders, to change traditional practices and stereotypes that increase the vulnerability

of women and men to HIV;

3 Use the education system to help change social norms that increase risk for women and men, particularly the risk of HIV;

4 Develop appropriate gender-sensitive training programmes for members

of the judicial system, to help reduce sexual violence against women and girls and the spread of HIV;

5 Intensify efforts to meet international targets for reducing HIV/AIDS prevalence among young women and men aged 15 to 25, including

challenging gender stereotypes and gender inequalities, and encouraging the active involvement of men and boys;

6 Mainstream gender into HIV prevention, care and treatment activities; and

7 Support the adoption of the Proposed Code for the SADC on the ‘urgent measures needed to promote the equality of women and the reduction of women’s risk of HIV infection’, developed by ARASA

This analysis of the gender dimensions of HIV/AIDS in southern Africa and

Dr Shisana’s recommendations for change provided a critical context for four days of intensive dialogue and planning By ‘taking stock’ of existing challenges

in the region, she set the stage for delegates to add their own interpretation of events and conditions in their own countries In outlining some possibilities for change in the region, she encouraged delegates to think concretely about what they could do to address the gender dimensions of HIV/AIDS when they returned home after the launch of the Institute

Gender mainstreaming satellite session at the 7th AIDS Impact Conference, 2005

Building on the work of the last decade, SAHARA, in consultation with its partners (Commonwealth Secretariat, UNAIDS and Atlantic Centre

of Excellence for Women’s Health) convened a satellite session on gender mainstreaming during the 7th AIDS Impact Conference in Cape Town, South Africa The meeting brought together policy-makers and public sector practitioners, non-governmental organisations (NGOs), researchers working

in the field of gender, health and development, and donors who fund work that promotes gender equality Participants from the International Institute

on Gender and HIV/AIDS were also represented at the session The aim

of the meeting was to explore successes and challenges in mainstreaming gender and to consider how to improve current national responses in southern Africa The session focused on key issues, such as the following:

• Has gender mainstreaming worked, in health and HIV/AIDS in particular? And if not, what are the main challenges?

• What are the recommendations to ensure that the translation of gender mainstreaming policies into practice occurs?

• What are the models or tools that can help to facilitate gender mainstreaming and ensure that we adequately address the gender-based impact of HIV/AIDS?

Outcomes

The session aimed to:

• Promote an enhanced understanding of the concept ‘mainstreaming gender’ in relation to HIV/AIDS;

• Provide insight into some of the challenges experienced in mainstreaming gender, as well as practical and theoretical insights on alternative models and approaches to mainstreaming; and

• Identify models or tools for the facilitation of gender mainstreaming with

a view to extending this understanding to a skills-building workshop at the SAHARA Conference in Dakar, Senegal in October 2005

Bridgette Prince is SAHARA Coordinator: Gender and Networking and

is based in the Social Aspects of HIV/AIDS and Health Research Programme

at the HSRC

She may be contacted at bprince@hsrc.ac.za

Sharon Kleintjes is a Research Manager in the Social Aspects of HIV/AIDS and Health Research Programme at the HSRC

She may be contacted at skleintjes@hsrc.ac.za

Allanise Cloete and Alicia Davids are Research Interns in the Social Aspects of HIV/AIDS Research Programme at the HSRC.

Section A

A GENDERED LENS FOR VULNERABILITY

TO HIV AND AIDS

Paper 1 Mainstreaming gender in

HIV/AIDS: why and how

Paper 2 Applying a gender lens to the

HIV/AIDS multi-sectoral approach

Free download from www.hsrcpress.ac.za

PAPER 1

Mainstreaming gender in HIV/AIDS:

why and how

Erika Burger

To understand issues relating to the theory and practice of mainstreaming gender in HIV/AIDS, we must first be grounded in an understanding of and appreciation for the gendered dimensions of HIV and AIDS globally, as well

as the regional and local contexts of gender-based vulnerability We need

to be able to look at the epidemic through a lens that allows us to see how masculinities and femininities obstruct or advance our work on HIV/AIDS prevention, treatment, care and support As an introduction to the overall session, we must consider:

• What are the global trends for HIV infection for women, girls, men and boys?

• What do these trends tell us about gender-based vulnerability to HIV and AIDS?

• Why should approaches to HIV/AIDS prevention, treatment, care and support integrate a gender-based perspective?

• How is it done?

These issues are explored in this presentation in order to provide a common understanding and appreciation of the main issues guiding this session

Global trends of HIV infection

In November 2004 UNAIDS (Joint United Nations Programme on HIV/AIDS) reported that the number of women living with HIV had risen in each region

of the world over the previous two years, with the steepest increases in East Asia (with a 56 per cent increase) followed by Eastern Europe and Central Asia (UNAIDS and WHO 2004)

Women are increasingly affected, now making up half of the approximately

40 million adults (aged 15–49) living with HIV worldwide In sub-Saharan Africa, close to 60 per cent of adults living with HIV are women Also alarming

is the statistic that three-quarters of all 15- to 24-year-olds living with HIV in southern Africa are female

This trend is not only being seen in endemic countries, but also in incidence countries, such as Canada, where the rate of new HIV infections has been declining among men who have sex with men and among injecting drug users, while infections from heterosexual contact have been rising steadily (Health Canada 2003a and b) For example, in Canada, the greatest increase in new infections has been among young women, aged 15 to 29, and heterosexual transmission now accounts for nearly 75 per cent of all new infections

low-in women

Gender-based vulnerabilities to HIV and AIDS

These changing trends in the global HIV/AIDS pandemic indicate that women and girls face particular and differential vulnerability

Biological factors

We can look at this vulnerability from the biological perspective, in that

physiological differences between females and males – sex differences – make

women more physically susceptible to HIV infection than men Delicate tissues in the female reproductive tract and high concentrations of HIV in semen mean that it is easier for infected males to transmit the virus to their female sexual partners, than vice versa Male to female HIV-transmission during sex is about twice as likely to occur than female to male transmission

Social and cultural factors

Social roles for women and men and culturally-defined expectations – gender

differences – are also key factors in the differential vulnerabilities to HIV and

AIDS of women and girls, men and boys, in that they create vulnerability

by defining roles and behaviours which people are expected to follow: for example, how a man should act or how a woman should behave

The concept of gender allows us to approach all of the complicated aspects

of sexual behaviours and sexual relationships that make people vulnerable

to HIV infection It allows us to examine what it means for men and boys when society says they must be sexually confident, aggressive and all-knowing Similarly, it allows us to look at how women and girls face vulnerability through the passive role of the sexually inexperienced which society places upon them A gender lens allows us to look at how power imbalances, economic dependency, educational discrepancies and systemic gender inequality all combine to create vulnerability to HIV infection It also

allows us to look at the differential impact of care and support on women and girls, the traditional care-givers in most societies.

A gendered lens for vulnerability to HIV and AIDS:

from recognition to action

If gender is such an integral part of understanding the global impact of HIV and AIDS, then it must be integrated into the planning process of all prevention, care, treatment and support programmes and policies for those infected and affected by HIV and AIDS However, programmes continue

to ignore the particular gender-based vulnerabilities faced by women and girls, men and boys, and gender continues to be seen as a women’s issue with little uptake of the principles of gender beyond those working in the field of women’s health It follows that gender must be recognised as a key social determinant of health and that the broader gendered vulnerabilities experienced by women, girls, men and boys must be addressed

Finally, after an understanding of the gendered aspects of the HIV/AIDS

pandemic, must come action We need practical approaches to mainstreaming

gender in all work relating to HIV and AIDS prevention, treatment, care and support in both high and low incidence countries

Gender-based analysis and gender mainstreaming

Gender-based analysis (GBA) and gender mainstreaming are tools that can be used for integrating gender into HIV/AIDS programmes Once we understand and appreciate what gender means in HIV/AIDS and why it is important, we need to know how we can incorporate this knowledge into our work Gender-based analysis and gender mainstreaming are technical approaches that

facilitate the move from recognition to action.

GBA is an analytical tool It uses sex and gender as an organising principle, or

way of conceptualising information, a way of looking at the world It helps to bring forth and clarify the differences between women and men, the nature

of their social relationships and their different social realities, life expectations and economic circumstances It identifies how these conditions affect women and men’s health status and their differential vulnerability to HIV and AIDS

GBA provides a framework for analysing and developing policies, programmes and legislation, and for conducting research and data collection; a framework that recognises that women and men are not all the same.

GBA is a systematic process that takes place through the course of a given

activity, whether it is the analysis or development of policy, programmes, research or legislation As it becomes standard practice to integrate a gender-based perspective into our work, from beginning to end, gender-based analysis should become an essential tool in our work on HIV and AIDS (Health Canada 2000)

Integrating a GBA into HIV/AIDS work performs the challenging function that is essential to sound policies and programmes It challenges the assumption that everyone is affected in the same way by policies, programmes and legislation, or that health issues such as causes, effects and service delivery are unaffected by gender It probes concepts, arguments and language used, and makes underlying assumptions and values transparent and explicit Where these are revealed to be biased or discriminatory, a GBA points the way

to more equitable, inclusive and effective options

Integrating gender into HIV and AIDS

programmes, policies and planning

There are many readily available gender-based analysis checklists and how-to guides for conducting GBA that are helpful in the actual process of integrating gender into HIV planning They ask questions such as:

1 Have you ensured that women, girls, men and boys are fully represented in the data, as appropriate?

2 Have you designed programmes with input from women and girls, men and boys who will use them?

3 Does this programme avoid perpetuating stereotypes about women, girls, men and boys?

Another tool that has been developed by the WHO and the International Centre for Research on Women (ICRW) categorises different approaches

to integrating gender into HIV/AIDS policies and programming along

a continuum that ranges from harmful to empowering This framework

is useful in tackling the ever evasive ‘how’, as it allows us to evaluate our

to market condoms throughout southern Africa To be useful, interventions

must, at a minimum, do no harm.

The next step up on the continuum are gender-sensitive interventions which

recognise that men and women’s needs often differ and find ways to meet those needs differentially The female condom and microbicides would fall into this category

The third category are those gender transformative interventions, which

not only recognise and address gender differences, but go a step further by drafting the conditions whereby women and men can examine the damaging aspects of gender roles and experiment with new behaviours to create more equitable roles and relationships The ‘Men as Partners’ programme within the International Institute on Gender and HIV/AIDS (IIGHA) would fall into this category

Finally, the most evolved set of interventions are structural interventions that

go beyond health interventions to those which reduce gender inequalities by fundamentally changing the economic and social dynamics of gender roles and relationships

Recognising that there is no single way to address gender, this framework also advocates a multi-level approach such that policies and programmes must address individuals’ vulnerability in a variety of ways In the short term, gender-sensitive policies and programmes are the best hope and we must continue to address women and children’s vulnerability by continually adapting to and meeting women’s and men’s gender and age-specific needs within their current social and cultural context

However, this framework also advocates long-term planning sensitive programming will not change the gender-based realities that fuel the epidemic and make women and men vulnerable Transformative and empowering policies and programmes must be implemented alongside

gender-sensitive ones in the hope of ultimately challenging the veryfoundations of the epidemic.

Conclusion

This presentation outlined the background, theories and rationale for the integration of a gender-based perspective in HIV/AIDS research, policies

and programmes A common understanding of the ‘why’ and ‘how’ of

mainstreaming gender provides a framework against which to engage with the actual experiences in mainstreaming gender, and the challenges and successes which are captured in the remaining presentations

Erika Burger is Gender and HIV/AIDS Programme Officer and Co-ordinator

at the International Institute on Gender and HIV/AIDS, Atlantic Centre of Excellence for Women’s Health, Dalhousie University in Halifax, Canada

She may be contacted at erika.burger@dal.ca

PAPER 2

Applying a gender lens to the

HIV/AIDS multi-sectoral approach

Joseph K Amuzu

Why a focus on gender?

There are several important reasons to focus on gender:

• More than half of all people living with HIV/AIDS globally are female;

• Women are twice as likely as men to contract HIV;

• The HIV/AIDS epidemic is driven by men;

• Men make the key decisions in heterosexual relationships, with implications for women’s ability to exercise safety in sexual and social intercourse;

• Women lead in domestic work and the provision of care, with implications for HIV/AIDS-induced increases in the burden of care for many women;

• There is a lack of or minimal support from men;

• Poverty and lack of access to public services; and

• Reduced girls’ enrolment in school

Gender mainstreaming in HIV/AIDS

multi-sectoral policies and programmes

Because HIV/AIDS impacts on every aspect of human well-being, a sectoral approach (MSA) to dealing with the pandemic is essential Gender-related issues need to permeate all aspects of this multi-sectoral approach to

multi-be addressed effectively The Commonwealth MSA is outlined multi-below, with gender as a key cross-cutting issue embedded within this approach

Table 1: Gender mainstreaming in HIV/AIDS multi-sectoral approach: the

Commonwealth Secretariat’s approach

Steps Lead agencies

Inter-disciplinary and multi-sectoral

team:

• to provide guidance to government

on the MSA; and

• to begin to draft/adopt a national

HIV/AIDS policy.

UNAIDS (Joint United Nations Programme

on HIV/AIDS), other development partners, Ministries of Health, and National AIDS Commissions.

National, regional and lower level

structures (e.g National AIDS

• to conduct an HIV/AIDS situational

and response analysis; and

• to draft a strategic response

Monitoring and evaluation system

Applying a gender lens:

the eight critical questions

Eight key questions should be used to ensure that, and to analyse the degree

to which, gender mainstreaming is underway within the process outlined on page 23:

1 Is there an understanding of the gender issues and dimensions of HIV/AIDS in the analysis of causes and contributory factors, as well as within the planning and execution of national responses?

2 Is the concept of gender included in every stage of developing and applying the MSA?

3 Are concrete activities effectively targeting women and girls, men and boys?

4 Is there an understanding of culture, gender and social issues and the relations between them in the context of HIV/AIDS?

5 Are skills for gender mainstreaming available in countries? Are these embedded in skills for analysis and planning?

6 Is there the capacity to collect and interpret sex-disaggregated data?

7 Is there a commitment on the part of governments to achieve gender equality?

8 Are there human, technical and financial resources to effect gender mainstreaming?

This checklist can be used at each step/level of the MSA, including policy development, the establishment of structures to effect policy directives, the development of sectoral plans, the setting up of programmes and related activities for, importantly, the monitoring and evaluation of these Programmes and activities should include, for example:

• Skill building for women and girls;

• Income generation projects;

• Gender equality programmes;

• Men’s programmes;

• Programmes for men and women, boys and girls;

• Programmes to enhance the mobilisation of men in care-giving roles;

• Training in the impact of the positive and negative dimensions of current expressions of masculinity on HIV and AIDS

The effective use of these eight questions as a checklist for gender-based analysis (GBA) was shown to be useful in Botswana in 2003, where it offered

a platform for exchange of ideas and decisions at policy and programme levels (Commonwealth Secretariat 2003) Bringing together representatives from the lead agencies and key structures involved in a MSA to HIV/AIDS can elucidate and quickly engender needed action at different levels, both regarding the countries’ overall HIV/AIDS approach, and in terms of the gender mainstreaming issues of urgent concern within that overall approach Needless to say, the identification of needs and strategies is not necessarily complemented by present country capacity to effect the needed action There

needs to be a combination of the above and training

Conclusions

An effective response to HIV/AIDS requires a multi-sectoral response with

a gender lens There is the need to deal with the many inequalities that are driving the epidemic, and to involve men in programmes that challenge the gender status quo, to enable the mantra that ‘men need to change themselves’:

to effect a change of mindset, attitude, and behaviour, to improve interpersonal communication in relationships, to reduce domestic violence and alcohol and drug abuse and to take good care of their own health

A radical change is needed to transform the unequal power balance between women and men To this end we need to take steps to build alliances, influence public opinion through advocacy and ensure cultural change in the community At societal level, we need to address systems, mechanisms, policies and practices that support genuine change

Joseph K Amuzu is an Adviser in the Health Section of the Commonwealth Secretariat, London.

He may be contacted at j.amuzu@commonwealth.int

GENDER MAINSTREAMING IN HIV/AIDS

Free download from www.hsrcpress.ac.za

Section B

COUNTRY RESPONSES: EXAMPLES

OF GENDER MAINSTREAMING IN

HIV/AIDS INTERVENTIONS

Paper 3 Gender mainstreaming and HIV/AIDS:

how important is male involvement

in accelerating gender equality?

Paper 4 Building capacity for mainstreaming

gender into HIV/AIDS programming

Paper 5 The main challenges in

mainstreaming gender

Free download from www.hsrcpress.ac.za

PAPER 3

Gender mainstreaming and HIV/AIDS:

how important is male involvement in

accelerating gender equality?

Daniel Motsatsing and Keletso Makgekgenene

Historical context

BONASO (Botswana Network of AIDS Service Organisations) was set up

in 1997 as a vehicle for the mobilisation of civil society action responses

to HIV/AIDS in Botswana It was set up in response to the realisation that the response to HIV/AIDS needs to go beyond a medical response, to a development perspective requiring a multi-sectoral response At that time the national response to HIV/AIDS was selective and resources were not adequately mobilised and distributed Since, there has been recognition of the importance of a civil society and public sector partnership to address HIV and AIDS, and BONASO has enabled the necessary close collaboration between government and civil society It has as one of its outcomes supported the development of Botswana’s Strategic Framework for HIV/AIDS 2003–9

Within this framework, BONASO’s mandate is to coordinate and facilitate the response of civil society in HIV/AIDS and the National Strategic Framework follows the Medium Term Plan 2, which gave rise to the need for a multi-sectoral and coordinated national response

Gender-related factors which influence

in risky behaviour and having multiple sexual partners is generally condoned Boys are encouraged to engage in free activity outdoors, with some risk-taking, while women have their activities limited, and under the control

of their family Men may have greater influence in matters of sexuality than women, in that it is often men who determine when and how to have sex, have greater influence on the number of children in the family, exert influence

on the practice of (un)safe sex, and on the decision to use contraception

or not Although not readily recognised, societal expectations of men in matters of sexuality are demanding and create stress, without any effort to alleviate this

Constraints in programming in HIV/AIDS responses

There are numerous examples of current initiatives within the HIV/AIDS response framework which maintain the historical gender-insensitive status quo:

• International agencies’ gender focal areas still tend to place emphasis on the girl child, focusing on girls, women and HIV, with insufficient attention given to the men and boys who will later be making the actual decisions which impact on their and women’s sexual experiences and potential risk for infection Health infrastructure still tends to design its services