A dive into gender (in)equality and HIV prevention, treatment, care and support in times of COVID-19
How gender transformative HIV programming leads to a more sustainable, adaptive and effective response
Von Henriëtte van Gulik & Roanna van den Oever
Since the outbreak of COVID-19 many UN Agencies have released guidance, policy briefs and collected data about the impact of the pandemic on women and girls, and gender equality. Evidence demonstrates that the impacts of COVID-19 are exacerbated for women and girls simply by virtue of their gender, and this too affects HIV prevalence, for example through increased levels of intimate partner violence. Aidsfonds is of the opinion that a gender transformative HIV response will achieve better and more sustainable results (PITCH 2020).
Four young people in a group. Photo: © Eva de Vries
Overlapping epidemics: COVID-19 and HIV
Young women are disproportionately affected by the HIV epidemic. In 2019, they accounted for 24% of new HIV infections in sub-Saharan Africa, despite making up only 10% of the population (UNAIDS 2020). They are twice as likely to acquire HIV as young men, and 80% of new adolescent HIV infections are among girls aged 10–19 years. Moreover, AIDS is the leading cause of death for women globally. The current COVID-19 pandemic is deepening such pre-existing inequalities, exposing vulnerabilities in social, political and economic systems (UNWOMEN 2020), as published on 9 April by the Secretary-General of the United Nations published in a policy brief on the impact of COVID-19 on women. The policy brief explores how women and girls’ lives are changing in the face of COVID-19.
The United Nations Inter-Agency Network on Women and Gender Equality (IANWGE), chaired by UNWOMEN, has responded to the call of the Secretary-General for coordinated action during the pandemic. IANGWE developed a practical Compendium with key messages to address the gender dimensions of COVID-19 and efforts of UN agencies (Partnerships for gender mainstreaming within the UN system 2020).
UNAIDS recently published a report addressing the impact of COVID-19 on women and girls in all their diversity. The guide proposes concrete measures to governments to confront the gendered and discriminatory impact of the pandemic and highlights lessons learned from the HIV response and the importance of community engagement. “The gender-specific analysis and recommendations are informed by valuable insight from the global HIV response recognizing that many of the same structural drivers of inequality in the HIV epidemic are the same as those driving inequality in the current COVID-19 pandemic” (UNAIDS 2020).
The cross section of gender inequality & HIV
Gender inequality is a root cause of the HIV epidemic worldwide. There is not a single country in the world that has achieved gender equality: equal rights and opportunities within all areas of life and valuing different behaviours, aspirations and needs equally, regardless of gender. As a result, women in all their diversity are disproportionately affected by the HIV epidemic and violated in their sexual and reproductive health and rights.
Activist at protest by sex workers AIDS2018 Amsterdam. Photo: © Aidsfonds
Gender norms restrict women’s decision-making power and control over their bodies, which reduces their ability to protect their sexual health and limits their access to services. As the COVID-19 pandemic deepens, economic and social stress coupled with restricted movement and social isolation measures, gender-based violence is increasing exponentially (UNAIDS 2020). Intimate partner violence increases susceptibility to HIV, and (fear of) violence is associated with lower treatment access, treatment adherence and viral suppression rates among women and girls. Moreover, living with HIV increases one’s risk of experiencing gender-based violence.
Harmful gender norms do not only relate to women: it affects everyone. While norms vary from place to place, and over time, they have very powerful influences on us. Norms around masculinity also imprison men and boys. For example, men can be hesitant to seek healthcare in order not to seem weak, leading to late HIV diagnosis. Not conforming to society’s gender norms can lead to stigma or even persecution. Daily discrimination is a fact of life for gender diverse communities such as LGBTQ+ people and sex workers. Sex work and homosexual sex are criminalised in many countries. Such discrimination increases violence-related HIV infections and limits access to basic treatment, and is, therefore, a structural driver of the HIV epidemic for key populations.
A sustainable solution is needed to eradicate this source of injustice. Are gender transformative approaches the answer?
Are Gender Transformative Approaches the answer?
At Aidsfonds we believe that through gender transformative HIV programming, we can improve HIV and sexual and reproductive health outcomes in a more sustainable way. This can be achieved by working on the underlying gender norms that shape health-seeking behaviour; uptake of HIV prevention, care and treatment services; and experience of stigma and discrimination. It is crucial to consider these layered realities when creating effective interventions that transform harmful gender norms and redistribute power. This entails working to promote changing gender roles and developing relationships that are fair and just in the distribution of benefits and responsibilities between men and women. As such, a gender transformative approach can make HIV prevention, care and treatment programming more effective and sustainable.
Sex workers in front of house 2012. Photo: © Aidsfonds
In addition, gender transformative HIV approaches fit well within the global HIV response. In preparation of the twenty-fifth anniversary of the Beijing Declaration and Platform for Action, UNAIDS released a publication on women, adolescent girls and the HIV response, entitled: We’ve got the power. It is dedicated to “the women leaders and allied community mobilizers who have devoted their lives to advancing the human rights and dignity of all people affected by the HIV epidemic, and to opposing social injustice, gender inequality, stigma and discrimination, and violence” (UNAIDS 2020).
Aidsfonds’ Gender Transformative Approach in HIV programming
Aidsfonds’ gender transformative approach is about responding to the ‘big picture’ as detailed in our renewed Big Picture: A guide for gender transformative HIV programming (Aidsfonds 2020). A gender transformative approach focuses on reducing inequality and seeks long-term changes in gender relations and power dynamics at all levels of society. It challenges harmful gender norms and requires adjustment of policies and practices. It tackles discrimination that women and LGBTQ+ people in all their diversity face in terms of their opportunities, resources, services, benefits, decision-making, and influence.
However, gender-based discrimination and inequality are complex. Therefore, gender transformative approaches are often complex, keeping in mind various intersecting factors. There is no single strategy or ‘magic bullet’ for promoting gender equality. Transformative approaches seek change at all levels, from personal and intimate relationships up to community and societal levels. A great example of our transformative work is the Hands Off! programme reducing violence against sex workers in South Africa by working with the police and developing the programme with sex workers in the lead (Hands Off - Effectively reducing violence against sex workers 2020).
During the COVID-19 crisis, Aidsfonds launched its COVID Response Fund available to all existing Aidsfonds grantees and partners. This allowed for adaptive programming to a changing context. Multiple grantees used this fund to improve the safety of women, for example, in Mozambique, where field activists are trained to detect domestic violence during their work and educate on how to use the help-line of the ‘Integratied Services for Dealing with Victims of Sexual Violence’. This help-line includes domestic violence in Mozambique.
Transformative change will only take place with and by the entire community. Hence, it is important to engage men and boys in all their diversity to work towards gender equality. Additionally, gender transformative approaches can lead to increases in violence against women. When women begin to take a greater role in decision-making and challenge how power is distributed, those with more power may feel their status is being threatened and respond with violence. This is another reason why it is important to engage men and boys in working towards gender equality.
In conclusion, the gendered impact of the COVID-19 and HIV epidemics are rooted in gender inequality. Based on the Aidsfonds experience in community-led HIV programming, we are convinced that a transformative gender approach is the best way to address this. It will lead to more sustainable impact in better HIV and sexual and reproductive health outcomes. If you are interested in the intersection of HIV, gender and COVID-19, visit our website and read the Big Picture guide. / https://bit.ly/2YRSfRZ
- PITCH 2020, COVID-19: 4 ways to keep gender in focus, Aidsfonds, viewed 31 August 2020, https://aidsfonds.org/assets/resource/file/COVID-19%20and%20Gender.pdf
- UNWOMEN 2020, Policy Brief: The Impact of COVID-19 on Women, viewed 31 August 2020, https://www.unwomen.org/-/media/headquarters/attachments/sections/library/publications/2020/policy-brief-the-impact-of-covid-19-on-women-en.pdf?la=en&vs=1406
- Partnerships for gender mainstreaming within the UN system 2020, viewed 31 August 2020, https://www.unwomen.org/en/how-we-work/un-system-coordination/gender-mainstreaming/partnerships-for-gender-mainstreaming-within-the-un-system
- UNAIDS 2020, Six concrete measures to support women and girls in all their diversity in the context of the COVID-19 pandemic, viewed 31 August 2020, https://www.unaids.org/sites/default/files/media_asset/women-girls-covid19_en.pdf
- UNAIDS 2020, Seizing the moment - Tackling entrenched inequalities to end epidemics, viewed 31 August 2020, https://www.unaids.org/sites/default/files/media_asset/2020_global-aids-report_en.pdf
- Young people, HIV and AIDS 2020, viewed 31 August 2020, https://www.avert.org/professionals/hiv-social-issues/key-affected-populations/young-people
- UNAIDS 2020, We’ve got the power - women, adolescent girls and the HIV response, viewed 26 August 2020, https://www.unaids.org/sites/default/files/media_asset/2020_women-adolescent-girls-and-hiv_en.pdf
- Aidsfonds 2020, Big Picture: A guide for gender transformative HIV programming, viewed 24 August 2020, https://aidsfonds.org/assets/resource/file/0464_The%20Big%20Picture%20Revisted_WEB.pdf
- Hands Off - Effectively reducing violence against sex workers 2020, viewed 20 August 2020, https://aidsfonds.org/hands-off-effectively-reducing-violence-against-sex-workers
Furthermore, key populations in HIV often face overlapping forms of oppression for their intersecting identities. To mention some: gender, class, ethnicity, sexuality, (dis)ability, and (im)migrant-status. Marginalised communities facing multiple, overlapping forms of discrimination are thus disproportionately impacted by HIV and AIDS.