Gender inequality and unequal gender dynamics mean women and girls are more vulnerable to HIV. In sub-Saharan Africa, three in four new infections in 15-19 year-olds are among girls, and AIDS-related illness remains the second largest killer of women of reproductive age globally, and the first in Africa.
For many women and girls, a lack of power in personal, institutional and political spaces impacts on when, where, how and with whom they have sex; their choice and agency regarding the access and use of contraception; when and whether to have children; and their ability to protect themselves and their children from harms relating to sexual and reproductive health (SRH) such as HIV, other sexually transmitted infections (STIs) and unwanted pregnancy.
Many women and girls face alarming levels of intimate partner violence, other forms of gender-based violence, and harmful practices including child, early and forced marriage, and female genital mutilation. As well as being a human rights challenge in its own right, violence against women disrupts or blocks access to HIV prevention, treatment and care and sexual and reproductive health and rights (SRHR) services.
Women are marginalised further if they are sex workers, use drugs, identify as lesbian or transgender, are young, or are living with HIV. Here, gender inequality intersects with other forms of discrimination, underpinned by laws that criminalise sex work, drug use, same sex relationships and the transmission or exposure of HIV and stigma relating to these identities. These multiple, overlapping inequalities fuel the HIV epidemic.
We take a gender-responsive and gender-transformative approach to our HIV and SRHR programming.
Our starting point is to understand that effective gender-responsive approaches to HIV address women and girls in all of their diversity. We use this phrase to capture the idea that the intersection between someone’s gender and other aspects of their identity – for instance, their race, gender identity or expression, sexual orientation, ethnicity, language, marriage or partnership status, their education level or their health, job or (im)migration status – will shape the way they behave, the risks they take and their ability to use and access SRHR and HIV prevention, care and treatment services, and their experiences of stigma and discrimination.
In particular, it means we understand that women who sell sex, women who use drugs, women who have sex with women, women living with HIV and young women face additional barriers that need to be thought through and overcome. We strive to take these layered realities into consideration at every level of our programming.
Taking a gender-transformative approach means we also work to challenge unequal gender dynamics by promoting relationships that are fair and just in their distribution of benefits and responsibilities, as well as advocating for laws and policies that promote and protect gender equality, human rights and public health.
For instance, we recognise that, in certain contexts, a young woman’s age and gender means she will be unable to negotiate condom use with her older male partner or for an exclusive sexual partnership, so a blanket, ‘one size fits all’ approach to promoting condom use and reducing the number of sexual partners will fail her.
Instead, our gender-responsive approach means we may look at providing female condoms, while our gender-transformative approach may lead us to compliment this with interventions to empower this young women to understand her SRHR, and the way both she and other people in her life approach intimate, family and community relationships.
- KP Connect is a five-year initiative in partnership with Positive Vibes to develop the capacity of civil society actors in Botswana, Zambia, Zimbabwe, South Africa, Kenya, Tanzania, Uganda, Burundi, Senegal and Côte d’Ivoire to more productively engage with key populations. A substantial strand of this work is with female sex workers, women who use drugs, women living with HIV and women from LGBTI communities. For example, KP Connect is building the capacity of sex workers to represent and advocate for their interests and is enabling them to work with HIV service providers to challenge their perceptions of women who sell sex.
- The Rapid Response Fund provides grants for interventions that respond to new or worsening situations that impact HIV services provided to LGBTI and MSM communities. Grants have been provided to train members of the South African police force to provide women who have suffered 'corrective rape' because they are lesbian with access to PEP (Post-Exposure Prophylaxis). The fund has also supported programmes with transgender women and the provision of security for lesbian women threatened with violence.
- In 2016, the Alliance supported 1.5 million people to access HIV treatment, care, and support services. Of these, just over 643,000 were female, 639,550 were male and 3,390 were transgender or identified as non-binary.
- In the same year, the Alliance reached more than 838,200 people from key populations with HIV prevention services, including more than 67,800 women who use drugs, 236,090 female sex workers, and 17,600 transgender people.
This technical brief explores the main challenges in measuring and quantifying the positive impact of human rights and gender programmes and interventions on the HIV response.
This case study focuses on gender-sensitive, integrated, HIV, harm reduction and SRH programmes introduced by Alliance for Public Health in Ukraine to support the health and rights of women who use drugs.
Although sex work is not illegal in Ethiopia, sex workers have long faced stigma and discrimination that impedes their ability to access SRH services and information, legal protection, equal economic opportunities and community acceptance. This case study explores the work of the Alliance-led Link Up programme in supporting young women in Ethiopia who sell sex and, in particular, the use of a radio programme to combat stigma and discrimination.