Gender (Updated January 2009)

The U.S. President's Emergency Plan for AIDS Relief is the largest commitment ever by any nation for an international health initiative dedicated to a single disease. U.S. Department of State U.S. Agency for International Development U.S. Department of Defense U.S. Department of Commerce U.S. Department of Labor U.S. Department of Health and Human Services Peace Corps Mailing address: SA-29, 2nd Floor 2201 C Street, NW Washington, DC 20522-2920 www.PEPFAR.gov

Gender and HIV/AIDS  Addressing gender issues is essential to reducing the vulnerability of women and men to HIV infection. PEPFAR proactively confronts the changing demographics of the HIV/AIDS epidemic, integrating gender throughout prevention, care, and treatment activities with a focus on the five cross-cutting, gender strategic areas highlighted here. PEPFAR Gender Strategies Increasing gender equity in HIV/AIDS programs and services These programs are designed to provide equitable access to services for both women and men. Specific approaches include: collecting disaggregated data by sex to monitor the number of women and men receiving services; designing treatment service delivery to reduce barriers to women’s access and participation; reaching out to men through prevention of mother-to-child HIV transmission centers and offering them HIV counseling and testing services; and mitigating the burden of care on women and girls by linking treatment and care programs with community efforts that provide resources such as food, support for school expenses, household help, farm labor and child care.   Reducing violence and coercion Sexual and other forms of abuse against women and girls fuel the spread of HIV. The practice or threat of sexual violence against women and girls puts them at increased risk of HIV infection by creating situations in which women are unable to voluntarily abstain from sex or negotiate condom use. PEPFAR supports the activities of community- and faith-based organizations to change social norms that perpetuate male violence against women, train couples in negotiation and conflict resolution, and strengthen policy and legal frameworks that outlaw gender-based violence. It also supports HIV post exposure prophylaxis in clinical settings for survivors of violence; development of couples HIV counseling; partner notification strategies; health workers’ awareness of and skills to address violence; and links with community and social services that provide protection and care for victims of violence.   Addressing male norms and behaviors Practices such as multiple and concurrent sex partners, cross-generational sex, and transactional sex increase vulnerability to HIV infection, particularly among women and girls. To address these issues, PEPFAR supports community-based prevention programs and media messages with a focus on positive norms for boys and men; couples HIV counseling and testing as an opportunity to address gender norms and reach men; programs to address alcohol and substance abuse; and special programs with the armed services focusing on responsible male behavior.   Increasing women’s legal protection Many of the practices that increase women’s vulnerability to HIV and limit their capacity to manage its consequences are reinforced by policies, laws and legal practices that institutionalize discrimination against women. PEPFAR supports efforts to review, revise and enforce policies that protect victims of sexual violence; support women’s property and inheritance rights; enhance women’s access to legal assistance; and eliminate gender inequalities in civil and criminal codes.   Increasing women’s access to income and productive resources PEPFAR recognizes that a lack of economic assets increases the vulnerability of women and girls to HIV infection. PEPFAR supports efforts to provide women with economic opportunities to empower them to avoid high-risk behaviors, seek and receive health care services, and care for their families. Such efforts include micro-enterprise and micro-credit activities for HIV-positive women, programs to ensure that girls are given equal opportunity to attend school and vocational training, and skills and management training targeted to offer economic alternatives to prostitution. Additionally, links between PEPFAR and other U.S. Government-supported education, economic development and microfinance programs are being strengthened.

The Power of Partnerships In fiscal year 2008, more than $1 billion were dedicated to over 1,000 activities that included interventions to address one or more gender focus areas. As of September 30, 2008, approximately 63% of the individuals on antiretroviral treatment as a result of direct PEPFAR support were women and girls. PEPFAR Gender Initiatives In addition to the more than $1 billion in country funding dedicated to prevention, care, and treatment programs that integrate gender components, PEPFAR supports special gender initiatives, including: The PEPFAR Male Norms Initiative: The Male Norms Initiative aims to scale up coordinated, evidence-based interventions to address male norms and behaviors in an effort to reduce HIV risk in Ethiopia, Namibia and Tanzania. A collaborative effort by PEPFAR, EngenderHealth, Instituto Promundo, PATH and local organizations in-country, the initiative is providing technical assistance that allows organizations to integrate male norms work into existing HIV programs and helps to develop synergic strategies to combat gender issues within a local context.   The Sexual and Gender-Based Violence (SGBV) Initiative: In response to growing concerns about sexual violence in Africa and its impact on HIV/AIDS, PEPFAR launched the SGVB Initiative. This initiative complements ongoing efforts to develop an evidence base on sexual violence programming in Africa, while simultaneously strengthening health services for victims, referrals from health facilities to other support services, and linkages between communities and health services in order to facilitate access to services. The SGBV Initiative will be implemented with technical assistance by the Population Council and Constella Futures in Rwanda, South Africa, and Uganda.   The PEPFAR Vulnerable Girls Initiative: The PEPFAR Gender Initiative to Reduce Adolescent Girls’ Vulnerability to HIV, also known as the Go Girls! Initiative is being implemented by Johns Hopkins University’s Center for Communication Programs in Mozambique, Botswana, and Malawi. This PEPFAR initiative seeks to develop, implement and test multifaceted interventions to reduce girls’ susceptibility to HIV infection. Programmatic approaches for the initiative include working with a wide range of stakeholders to inventory interventions and identify gaps; introduce innovative approaches and strengthen existing programs that address key drivers of the epidemic for vulnerable girls; promote multifaceted and integrated programming with consideration of structural factors (such as access to education, health services and economic opportunities); and conduct a rigorous evaluation.   Intervention with Microfinance for AIDS and Gender Equity (IMAGE): This South African community-based initiative supported by PEPFAR combines a microfinance program with a gender and HIV curriculum. By doing so, the intervention is helping to reduce HIV vulnerability and gender-based violence against women, promote women’s empowerment, improve family well-being, and raise awareness about HIV. Results from the program have shown a significant decrease in intimate partner violence for participating women and a significant decrease in risky sexual behavior among younger participants.   Integrating Multiple Gender Strategies to Improve HIV/AIDS Interventions: This PEPFAR Gender Initiative examines promising practices in programs that address multiple gender interventions in the context of HIV/AIDS. Implemented through the International Center for Research on Women (ICRW), efforts are underway to develop a compendium of programs in sub-Saharan Africa that describe, analyze and categorize programs to better understand the advantages of comprehensive gender interventions. Additional activities include in-depth case studies of select best practices and evidence-based recommendations that would maximize the success of gender programs.