A gender-responsive approach to achieve an AIDS-free generation
Women account for an estimated 58% of the total number of people living with HIV globally and according to the UNAIDS GAP Report, close to 60% of all new HIV infections among young people ages 15-24 were among girls and young women, with 80% of these HIV positive girls and young women living in Sub-Saharan Africa. Other at-risk groups which have disproportionately higher rates of HIV include sex workers, drug users, men who have sex with men and other LGBTI persons, among others. It is critical that HIV/AIDS programs and services employ a gender-responsive approach that identifies and responds to the specific needs, barriers, and issues affecting each at-risk group, based on the socially constructed roles, behaviors, attributes, and activities that a community considers appropriate for each group, in order to provide the best quality of care.
Last December (2014) PEPFAR released a new report, PEPFAR 3.0, which highlights the need to shift geographic and programmatic focus and reinvestment in areas with high HIV prevalence and among specific at-risk populations to successfully reduce HIV rates. PEPFAR lists five action agendas to achieve the goal of an AIDS-free generation: Impact, Efficiency, Sustainability, Partnership, and Human Rights. The agendas include advancing a number of principles outlined in the PEPFAR Blueprint, including increasing gender equality and a focus on women and girls in HIV services through a human rights agenda.
The strategy pushes a gender-responsive agenda which includes decreasing gender-based violence (GBV), and mitigating stigma and discrimination, and other barriers to HIV prevention, treatment and care. The action agenda targets key populations who can be doubly disadvantaged, both at a higher risk for acquiring HIV and also least likely to receive HIV services. Priority groups for increasing access to combination HIV include sex-workers, men who have sex with men and LGBTI people, drug users, and adolescent girls. Access to combination HIV treatment and prevention services can be increased by working cross-sectorally through education, health, community, economic and psychosocial interventions to develop a package of evidence-based interventions. Another report published recently by UNAIDS titled Gender Matters echoes the need for the new PEPFAR guidance. The report discusses harmful gender norms and practices and unequal power relations and stigma that create barriers to HIV prevention and treatment for women and lead to poorer health outcomes for women and their children.
Through the USAID ASSIST Project, our improvement approach includes systematically identifying and addressing gender issues to respond to the needs of women, men, girls, and boys in the HIV/AIDS services we support. We build the capacity of teams to collect and analyze sex- and age-disaggregated and gender-sensitive HIV indicators to identify gender-related barriers and issues affecting service utilization. We promote equitable access to and retention in antiretroviral therapy services. Within the activities of the Partnership for HIV-Free Survival, ASSIST has supported teams to identify and respond to gender-related issues preventing enrollment and affecting retention rates among mother-baby pairs, including stigma and discrimination issues, and lack of male involvement. We also promote female partner engagement in voluntary medical male circumcision services, at the discretion of the male patient, as a means of improving health outcomes.
Through conducting gender sensitization trainings and building local capacity to identify gender-related issues affecting outcomes, we work with communities to utilize locally-owned, culturally-sensitive, and innovative models to respond to gender inequalities in order to improve health outcomes and promote gender equality.