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HEALTH: Gender Finally Moving to Forefront of AIDS Fight

WASHINGTON, Jul 7 2009 (IPS) - With women now comprising 61 percent of all people infected with HIV in Sub-Saharan Africa, international donors, governments and advocacy organisations are looking more closely at the connections between HIV/AIDS and gender inequality.

A new report released last week by two Washington-based think tanks, the Centre for Global Development (CGD) and the International Centre for Research on Women (ICRW), more closely explores the connection between HIV/AIDS and gender inequality, and to what extent donors and countries are using this knowledge to help in the fight against AIDS.

Representatives from a host of gender advocacy, development, governmental, and donor groups gathered on Jul. 1 at the National Museum for Women in the Arts in Washington to discuss the findings.

The report, “Moving Beyond Gender As Usual”, scrutinises three major AIDS donors – the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR); the Global Fund to Fight AIDS, Tuberculosis, and Malaria; and the World Bank’s Africa Multi-Country AIDS Programme (MAP) – and their treatment of gender in three AIDS-afflicted countries in which they all work, Mozambique, Uganda, and Zambia.

HIV-infection rates among women have steadily risen since the start of the epidemic. According to the UNAIDS 2008 Report on the Global Aids Epidemic, in the 1980s, around one-third of all HIV-infected people were women.

By the late 1990s, that number surpassed 50 percent. Though this figure has been stable for several years, women’s infection rates in some countries have continued to rise.

In some sub-Saharan African countries, the infection rates of young women far surpass the rates of their male counterparts. The number of HIV-infected women age 15-24 in Zimbabwe is double that of men in the same age group. In South Africa, triple the number of women 15-24 are infected.

In Swaziland, infection rates for women age 15-24 are quadruple those of men of the same age group.

One of the major themes addressed by many of the speakers at Wednesday’s report launch was the need to look at the global HIV/AIDS epidemic holistically, putting the disease within a regional and cultural context before creating strategies to fight it.

“If we only attack the HIV virus and not real life, then we won’t be successful in the fight against AIDS,” said Nandini Oomman, one of the report’s authors and the director of HIV/AIDS Monitor, a CGD project that works to track the effectiveness of aid given toward easing the HIV/AIDS epidemic.

Factors that contribute to gender inequality, such as gender-based violence, unequal access to resources, and cultural gender norms, can all contribute to greater infection risk and fewer treatment options for women.

Cultural norms and values, for example, can prevent infected women in some societies from seeking HIV/AIDS treatment. For example, a woman in a society in which HIV carries a heavy stigma might choose not to disclose to her partner that she is infected, for fear of violent retaliation. The expectation for a woman to stay home can likewise prevent her from seeking anti-retroviral medications (ARV).

“How can a program succeed in preventing mother-to-child infection if such gender-based violence, stigma, discrimination, and unequal access to resources – all aspects of gender inequality – prevent such women from openly taking the medicine they are given?” wrote Oomman in a Huffington Post editorial on Jun. 30.

Lack of women’s access to education can also be a major contributor to the spread of AIDS. Karen Hardee of Population Action International cited the figure that for every year of education a woman receives, she has a 7 percent decreased risk of HIV infection.

Gender norms also make HIV transmission to women happen more easily.

“Gender norms often limit women and girls’ ability to negotiate the limits of their sexual behavior,” noted Kim Ashburn, a gender, HIV and AIDS scientist at ICRW.

Societies in which men view forced sexual intercourse as acceptable, women engage in commercial sex work, or women are not able to negotiate safer sex will naturally have elevated HIV-transmission rates.

Likewise, the expectation of women to continue having children and to breast-feed, even once infected, causes many pediatric HIV infections via mother-child transmission.

One less-explored HIV-prevention option is birth control. A 2007 study by Family Health International, a North Carolina-based NGO, found that while ARVs prevented 101,000 child cases of HIV over a seven-year period, contraception prevented the births of 173,000 infected babies each year.

Under President George W. Bush, PEPFAR was notably reluctant to provide funding for contraceptives.

The linking of AIDS and gender inequality is coming to the forefront of the AIDS dialogue as efforts move more towards prevention. Though PEPFAR successfully treated and extended the lives of hundreds of thousands of Africans since its founding by President Bush, it was also criticised for its failure to effectively prevent new infections with its ABC (Abstinence, Be faithful, Condom use) approach.

Though the Obama administration professes different attitudes towards providing contraception as a part of PEPFAR, no PEPFAR legislation thus far has explicitly addressed family planning. Thus, while it is not restrictive on the subject, it also does not explicitly recommend contraceptives as an HIV prevention measure.

In an interview with IPS, Oomman said that, though this does not mean that the programme will not address family planning, it is up to the administration’s interpretation of that legislation to determine the place of contraceptives within PEPFAR.

In her remarks last week, Oomman added that, because gender inequality is such a major contributing factor to HIV transmission, she also considers addressing gender inequality in AIDS prevention a simple way to increase the efficiency of aid use during the global recession.

The three countries that the report examines all have policies that express the need to address the gender-AIDS link. Jane Mpagi, the director of gender and community development in Uganda’s Ministry of Gender, Labour, and Social Development, agreed that gender is an integral factor in preventing the spread of HIV/AIDS in her country, because “women are affected, and the factors that lead to their vulnerability are rooted in gender inequality”.

Yet implementation seems to be lacking. The report calls the national gender-based AIDS policies of Mozambique, Uganda, and Zambia “high-level rhetoric with few objectives or actions and little follow-through”.

One major hindrance to any AIDS relief effort is the fear of governmental corruption in aid-receiving countries.

Some African governments which are marked by corruption are also countries with high HIV-infection rates. For example, a new report released this week by the New Partnership for Africa’s Development showed Mozambique to have high levels of corruption among its civil servants.

As the only representative of an aid-receiving country represented on the panel, Mpagi chose her words carefully when asked about donor fears of corruption.

“No country would like to be termed as corrupt,” she said. “Corruption is everywhere, and we need to combat it together.”

The report made several specific recommendations for each donor it examined, addressing four areas: gender analysis, gender-related programming, gender-sensitive monitoring and evaluation, and gender capacity. One of the common recommendations, however, is the need for greater collaboration with country stakeholders so that analysis might better be implemented.

Another hindrance at the governmental level can be attitudes about gender. At any level, the pervasiveness of social norms is difficult to measure and evaluate.

So although donors “do find that there are policies on the national level,” as Oomman told IPS, individual government officials can at the same time themselves hold views on gender that promote inequality.

“These are social norms that individuals either follow or don’t follow,” said Oomman. “You will have government officials who don’t understand the importance of gender inequality… But change is slow because it’s about changing people’s ideas about men and women and their roles in society.”

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