|Gender norms contribute to expectations and behavior for both men and women, and can either reinforce or detract from HIV prevention, care, and treatment efforts. In many of the countries where PEPFAR works, women and girls are disproportionately impacted by the epidemic. In sub-Saharan Africa, nearly 60% of those living with HIV are women3. In some countries, HIV prevalence among girls between the ages of 15 and 19 is three to four times higher than HIV prevalence among boys of the same age.4 |
Structural and cultural conditions at the country level contribute to these disparities. By working to change these conditions, both PEPFAR and the larger GHI will assist countries in improving overall health outcomes for women and girls. For example, PEPFAR’s prevention programs work to reduce cultural acceptance of crossgenerational sex with older, more sexually experienced, and potentially high-risk male partners. Research supported by the USG is helping to spur development of microbicides, a woman-controlled prevention method. In programs with women, law enforcement and community leaders, PEPFAR strengthens awareness of reporting, treatment services, and systems that address sexual and gender-based violence. Finally, PEPFAR’s work with peer education programs assist women in making decisions about their own health and relationships, and assist communities in supporting this role for women.
Gender inequities limit women’s power over family and sexual relationships. They contribute to economic, legal, and educational inequities that place women and girls in situations where they cannot protect themselves from HIV. Unequal land tenure laws may mean that widows cannot gain ownership of land following the death of their husbands, leading them to poverty and homelessness. Women who lack access to other economic opportunities may engage in transactional sex for motivations ranging from survival to obtaining status-enhancing material goods. Women and girls who are denied the opportunity to attend school miss important opportunities to learn about HIV and the ways it is transmitted.
The negative impacts of culturally-driven gender norms may be most apparent for women, but have a significant impact on men as well. For example, prevention efforts cannot work if men face pressure to engage in behavior that is risky for themselves and their partners. Cultural expectations around gender norms further stigmatize men who have sex with men (MSM) and transgender individuals, making it harder for these populations to access health services. PEPFAR’s behavior change communication efforts must work to reduce risky behavior, such as procuring commercial sex or abusing alcohol, and create broader support for men who engage in positive behavior. In addition, men are essential partners in efforts to engage in national and community-level changes that address the impact of gender norms. Male leaders are often the ones with the power and platform to convince others to change behavior, policies, and cultural norms.
Addressing gender in the health sector involves activities beyond providing health services to women. The benefits of helping women access care, legal rights, and economic opportunity are clear for both men and women. Through its gender efforts, PEPFAR is facilitating participation of women and men in work that helps their families and communities. PEPFAR’s gender work will be linked to efforts to strengthen health systems and engage greater involvement of women as leaders, health care workers and decision makers.
PEPFAR is committed to ensuring gender equity in its prevention, care, and treatment services. This concept of gender equity is one that PEPFAR strives to integrate within all of its programming, taking into account the ways in which gender norms and barriers contribute to epidemics at the country context. In addition to integrating gender throughout its prevention, care, and treatment activities, PEPFAR’s gender strategy focuses on five crosscutting areas:
Through its existing gender strategy PEPFAR has demonstrated, and will continue, its commitment to gender equity at the highest levels of leadership. What must now occur is a robust, country-specific gender response in its programs.
Despite the range of successes in recent years, gender disparities in HIV prevalence persist in most PEPFAR countries. Country-level programming and investments do not always meet the needs that exist at the community level. In addition, PEPFAR’s programs to address cross-cutting gender issues have not always successfully translated priorities into practice. Assessing gender equity in HIV/ AIDS programs and services requires careful analysis of gender disparities and programming to address those disparities. To date, data have been lacking to help PEPFAR and other programs assess the quality and true scope of gender programming.
Over the next phase of PEPFAR, and in conjunction with the GHI, the program is expanding, assessing, and improving its programming to target gender inequity and the needs of women and girls. Its work includes the following:
Increasing partner government commitment to supporting gender equity through bilateral and multilateral mechanisms
Ensuring gender-equitable access to prevention, care, and treatment programming under PEPFAR, as well as PEPFAR’s linkages to broader development programming
PEPFAR programs also address the detrimental impacts of negative gender norms upon men and boys. During its next phase, PEPFAR is working with countries to change cultural expectations that associate masculinity with behaviors, such as multiple concurrent partnerships, that put individuals at increased risk for HIV.
Helping countries and programs translate gender principles into operational programs
Expanding monitoring and evaluation, and increasing impact measurement
Scaling up national programs to address gender-based violence
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