Edited by Sharon Kleintjes, Bridgette Prince, Allanise Cloete & Alicia Davids Free download from www.hsrcpress.ac.za Compiled by the Social Aspects of HIV/AIDS and Health (SAHA) Research Programme of the Human Sciences Research Council (HSRC) on behalf of all the partners in the Social Aspects of HIV/AIDS Research Alliance (SAHARA) Published by HSRC Press Private Bag X9182, Cape Town, 8000, South Africa www.hsrcpress.ac.za © 2005 Human Sciences Research Council First published 2005 All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. ISBN 0-7969-2121-0 Cover by Jenny Young Cover photograph, ‘Courage’ by Bernard Weil, used with kind permission of PhotoSensitive/CARE Print management by comPress Distributed in Africa by Blue Weaver Marketing and Distribution PO Box 30370, Tokai, Cape Town, 7966, South Africa Tel: +27 +21 701-4477 Fax: +27 +21 701-7302 email: orders@blueweaver.co.za Distributed worldwide, except Africa, by Independent Publishers Group 814 North Franklin Street, Chicago, IL 60610, USA www.ipgbook.com To order, call toll-free: 1-800-888-4741 All other inquiries, Tel: +1 +312-337-0747 Fax: +1 +312-337-5985 email: Frontdesk@ipgbook.com Free download from www.hsrcpress.ac.za Contents Acknowledgements iv Abbreviations v Preface vi Introduction 1 Bridgette Prince, Sharon Kleintjes, Allanise Cloete and Alicia Davids Section A A gendered lens for vulnerability to HIV and AIDS 13 Paper 1 Mainstreaming gender in HIV/AIDS: why and how 15 Erika Burger Paper 2 Applying a gender lens to the HIV/AIDS multi-sectoral approach 22 Joseph K Amuzu Section B Country responses: examples of gender mainstreaming in HIV/AIDS 27 Paper 3 Gender mainstreaming and HIV/AIDS: how important is male involvement in accelerating gender equality? 29 Daniel Motsatsing and Keletso Makgekgenene Paper 4 Building capacity for mainstreaming gender into HIV/AIDS programming 35 Camille Antoine Paper 5 The main challenges in mainstreaming gender 43 Nonhlanhla Dlamini Section C Concluding reflections on mainstreaming gender into HIV/AIDS 47 Paper 6 Opportunities and challenges for gender mainstreaming in HIV/AIDS 49 Tammy Shefer Conclusion: Lessons learnt and next steps 52 Sharon Kleintjes and Bridgette Prince List of participants 60 References 62 Free download from www.hsrcpress.ac.za iv Acknowledgements We wish to express our gratitude to the following institutions for their support and assistance in taking the debate around gender mainstreaming forward: • the Commonwealth Secretariat • Dalhousie University’s Atlantic Centre of Excellence for Women’s Health • the Human Sciences Research Council • the Social Aspects of HIV/AIDS and Health Research Alliance • UNAIDS Photographs were sourced from The International Institute on Gender and HIV/AIDS and the 7th AIDS Impact Conference. The cover photograph, ‘Courage’ by Bernard Weil is used with the kind permission of PhotoSensitive/CARE. Free download from www.hsrcpress.ac.za INTRODUCTION v Abbreviations ARV antiretroviral ARASA AIDS and Rights Alliance of Southern Africa BONASO Botswana Network of AIDS Service Organisations CARICOM Caribbean Community and Common Market CGDS Centre for Gender and Development Studies GAD Gender Affairs Division GBA gender-based analysis GBV gender-based violence IIGHA International Institute on Gender and HIV/AIDS MSA multi-sectoral approach NGOs non-governmental organisations PANCAP PANCaribbean Partnership for HIV/AIDS PLWHA people living with HIV/AIDS PMTCT prevention of mother-to-child transmission SADC Southern Africa Development Community SAHARA Social Aspects of HIV/AIDS Research Alliance WAD Women’s Affairs Department WHO World Health Organization UN United Nations UNAIDS Joint United Nations Programme on HIV/AIDS UNDP United Nations Development Programme UNIFEM United Nations Development Fund for Women VCT Voluntary Counselling and Testing Free download from www.hsrcpress.ac.za vi Preface This report contains the presentations delivered at the Satellite Session on Gender Mainstreaming, 7th AIDS Impact Conference, April 2005. All presentations provided a gendered perspective on the HIV/AIDS pandemic. The conference aimed to promote an enhanced understanding of the concept of ‘gender mainstreaming’ in relation to HIV and AIDS. The introduction to this collection of papers provides an overview of key meetings that have informed all the presentations. These meetings include the Beijing Conference in 1995, the second annual conference of the Social Aspects of HIV/AIDS Research Alliance (SAHARA) held in May 2004, and the Launch of the International Institute on Gender and HIV/AIDS (IIGHA) in June 2004. Section A of the report contains two papers that provide an in-depth overview of gender mainstreaming and suggest tools for its application in working within the HIV/AIDS sector. Section B provides three country-level examples of the application of gender mainstreaming: the first provides an outline on advocacy work in civil society in Botswana, and also comments on the need to include men more actively in gender-based work. The second outlines the strategy for building gender-mainstreaming capacity in HIV/AIDS work in the Caribbean, and the third provides an overview of the status of, and recommendations for, improving gender mainstreaming in Swaziland. The report concludes with lessons learnt from the presentations, and briefly outlines practical ways of taking these lessons forward at the third annual HIV/AIDS SAHARA Research Conference to be held in Dakar, Senegal in October 2005. Free download from www.hsrcpress.ac.za Introduction Bridgette Prince, Sharon Kleintjes, Allanise Cloete and Alicia Davids Contextualising gender mainstreaming The 2004 Report on The Global AIDS Epidemic (UNAIDS 2004) estimated that in 2003, 4 million people globally became newly infected with HIV. Moreover in 2004, 37.8 million people in the world were living with HIV (UNAIDS 2004:23). Of this global population of people living with HIV/ AIDS in 2000, at least 24 million people were living in countries located in the Southern Africa Development Community (SADC) (UNAIDS 2000, cited in Shisana 2002). The prevalence of HIV infection is higher among females than males, and the numbers of women living with HIV continues to rise in every region of the world (Shisana 2002:41; UNAIDS 2004). Data revealed by the 2004 UNAIDS (Joint United Nations Programme on HIV/AIDS) report suggests that globally, in 1997, women comprised 47 per cent of people living with HIV; and by 2002, this figure rose to almost 50 per cent. In sub-Saharan Africa, close to 60 per cent of adults living with HIV are women, and almost 75 per cent of young people living with HIV in southern Africa are female. The disproportion of female to male HIV prevalence is most marked in places where heterosexual sex is the dominant mode of transmission, particularly the Caribbean and sub-Saharan Africa (UNAIDS 2004:22). The ‘feminisation’ of the HIV epidemic is fuelled by both biological and socio-cultural factors, which put women more at risk of infection than men. According to Shisana and Simbayi (2002) the physiology of women’s reproductive systems, which have a large surface area, makes it easier for them to be infected with HIV than it is for men. Furthermore, because of the high concentration of HIV that can be carried in semen, infected men are more effective at transmitting the virus to uninfected partners than vice versa (2002:20). Women’s vulnerability to HIV infection is increased by systems of oppression and subjugation that legitimise male domination. Women’s 1 Free download from www.hsrcpress.ac.za marginalised status can mean that women have less power to negotiate sexual and reproductive health matters, less economic independence, less education and less access to health care. Thus women’s increased risk of HIV infection can be seen as a reflection of gender inequality in society (UNAIDS 2004:12). The most important HIV risk factor for many women is their male partner’s sexual behaviour, and many women are infected while involved in what they consider to be a monogamous relationship (2004:12). The linkage between constructions of gender and the transmission of HIV/AIDS is acknowledged through the findings of a number of evidence-based research projects. However the gap between research, intervention and policy remains huge. There is a need to support efforts to augment research on the gender dimensions of HIV/AIDS; to incorporate new and existing research into policy; to translate policy into action; and to integrate good practice into policies. The current trends of HIV transmission and prevalence clearly reflect that the epidemic is fuelled by gender-based vulnerabilities. Taking this into consideration, it is clear that mainstreaming gender within HIV prevention strategies needs to become integral to attempts to curb the further spread of the HIV epidemic. It is clear that sub-Saharan Africa has the largest number of people living with HIV/AIDS, and the epidemic is affecting women and girls in increasing numbers. This trend underscores the fact that, in 2005, serious gaps still remain in the gender-based response to AIDS, despite efforts to address gender-related concerns in the past decade. Gender mainstreaming is a key strategy to address the gender imbalances which still permeate societies. Gender mainstreaming is defined by UNDP (United Nations Development Programme) as taking account of gender relations in all policy, programme, administrative and financial activities and organisational procedures. It comprises two processes, (a) being informed about relevant gender issues, and (b) incorporating this information into our work. In the health sector, as early as 1995, the issue of gender mainstreaming was highlighted by global advocates for women’s health. Gender mainstreaming is not a new priority. However, because of the impact of HIV/AIDS and the role of gender in this context, there is now a renewed urgency to build capacity and awareness of the need for gender mainstreaming, and increased recognition of the gender-based health needs of women and men, boys and girls. GENDER MAINSTREAMING IN HIV/AIDS 2 Free download from www.hsrcpress.ac.za INTRODUCTION 3 The remainder of this introduction charts the growth of gender mainstreaming in policy and practice over the past ten years with a focus on the impact of HIV/AIDS on gender-based issues, as reported in several key conferences and interventions. Setting the scene: the Beijing Conference The Fourth World Conference on Women was held in Beijing in 1995, where ‘Women and Health’ was defined as a critical area of concern in the Platform for Action. In accordance with its multi-year programme, in the follow-up to the Beijing Conference, the United Nations Commission on the Status of Women considered ‘Women and Health’ as a priority theme at its forty-third session in March 1999. To prepare for consideration by the Commission, an expert group meeting on ‘Women and Health – Mainstreaming the Gender Perspective into the Health Sector’ was held from 28 September to 2 October 1998 in Tunis, Tunisia. Dr Olive Shisana, then Executive Director of Family and Health Services of the World Health Organization (WHO), opened the meeting. She highlighted the roles and responsibilities assigned to women and men in different cultures, racial and age groups that shape the development of different skills and abilities and channel their application to specific life spheres. Key issues that were discussed are outlined below. Occupational and environmental health Women are more likely to suffer from occupational stress and musculoskeletal disorders because of their work as unskilled or semi-skilled workers in agriculture and the informal sector. It was recommended that more research be carried out on the environmental and other risks posed to women’s health by their occupational activities in rural and urban settings, alongside the synergistic effects of heavy household work, malnutrition, multiple pregnancies and adverse climatic conditions as they affect millions of poor women in developing countries. Sexual and reproductive health Socio-economic differences between women and men may be even more important than biological ones in determining the sexual and reproductive INTRODUCTION 3 Free download from www.hsrcpress.ac.za health status of women. Lack of autonomy, failure to enforce laws in women’s favour, discrimination in laws such as the criminalisation of abortion, inadequate allocation of health resources, and failure by government to implement remedial measures sanctioned by international agreements, all contribute to the relatively poor health status of women in many societies. Women should be fully involved, to the highest level of health service planning, to ensure that their sexual and reproductive health needs are met from infancy to old age. The same applies to decisions taken on funding research on women’s health. Mainstreaming the gender perspective in health care Two particularly critical issues emerged during the discussions. First, that there is a great need for sensitisation and training of actors at all levels of the health sector, government and public administration in gender concepts, which are generally poorly understood. Second, that the degree of political commitment at the highest levels is the single most important determinant of progress. External actors such as international organisations and local players such as non-governmental organisations can play a vital catalytic role in helping secure this political commitment. Other topical issues included: controlling tuberculosis, malaria and other diseases, including HIV and AIDS; mental health; integrating the gender perspective in medical education and research; health reform and financing: introducing a gender-based analysis; and partnership for health: actors and key stakeholders. Dr Shisana highlighted the question of how we know that we have mainstreamed gender into the health sector. Considering that work in gender mainstreaming is currently in its infancy in the African context, Dr Shisana’s assertion as quoted below becomes an important framework for evaluating and monitoring the process of gender mainstreaming: Gender mainstreaming has happened when policy planners and researchers have internalised the gender perspective and no longer have to be conscious of their behaviour; when their behaviour pattern has changed and become natural; when they can identify the conditions that affect men and women differently, those that affect men more than women and those that affect women more GENDER MAINSTREAMING IN HIV/AIDS 4 Free download from www.hsrcpress.ac.za [...]... important is male involvement in accelerating gender equality? Paper 4 Building capacity for mainstreaming gender into HIV/AIDS programming Paper 5 The main challenges in mainstreaming gender 27 Free download from www.hsrcpress.ac.za Free download from www.hsrcpress.ac.za PAPER 3 Gender mainstreaming and HIV/AIDS: how important is male involvement in accelerating gender equality? Daniel Motsatsing and Keletso... understanding of the concept mainstreaming gender in relation to HIV/AIDS; • Provide insight into some of the challenges experienced in mainstreaming gender, as well as practical and theoretical insights on alternative models and approaches to mainstreaming; and • Identify models or tools for the facilitation of gender mainstreaming with a view to extending this understanding to a skills-building workshop... following: • Has gender mainstreaming worked, in health and HIV/AIDS in particular? And if not, what are the main challenges? • What are the recommendations to ensure that the translation of gender mainstreaming policies into practice occurs? 11 GENDER MAINSTREAMING IN HIV/AIDS • What are the models or tools that can help to facilitate gender mainstreaming and ensure that we adequately address the gender- based... approaches to mainstreaming gender in all work relating to HIV and AIDS prevention, treatment, care and support in both high and low incidence countries Gender- based analysis and gender mainstreaming Gender- based analysis (GBA) and gender mainstreaming are tools that can be used for integrating gender into HIV/AIDS programmes Once we understand and appreciate what gender means in HIV/AIDS and why it is... WHO and the International Centre for Research on Women (ICRW) categorises different approaches to integrating gender into HIV/AIDS policies and programming along a continuum that ranges from harmful to empowering This framework is useful in tackling the ever evasive ‘how’, as it allows us to evaluate our 19 GENDER MAINSTREAMING IN HIV/AIDS successes and failures in ensuring that gender is an integral... support genuine change Joseph K Amuzu is an Adviser in the Health Section of the Commonwealth Secretariat, London He may be contacted at j.amuzu@commonwealth.int 25 Free download from www.hsrcpress.ac.za GENDER MAINSTREAMING IN HIV/AIDS Section B COUNTRY RESPONSES: EXAMPLES OF GENDER MAINSTREAMING IN HIV/AIDS INTERVENTIONS Free download from www.hsrcpress.ac.za Paper 3 Gender mainstreaming and HIV/AIDS:... as within the planning and execution of national responses? 2 Is the concept of gender included in every stage of developing and applying the MSA? 3 Are concrete activities effectively targeting women and girls, men and boys? 4 Is there an understanding of culture, gender and social issues and the relations between them in the context of HIV/AIDS? 5 Are skills for gender mainstreaming available in countries?... in working groups and skills-building sessions, with a view to facilitating the development of an effective, Africa-wide response to gender mainstreaming Launch of the International Institute on Gender and HIV/AIDS The International Institute on Gender and HIV/AIDS was launched from 7 to 11 June 2004 in Johannesburg, South Africa It aims to strengthen practice, policy and research to enhance existing... development partners 23 GENDER MAINSTREAMING IN HIV/AIDS Applying a gender lens: the eight critical questions Free download from www.hsrcpress.ac.za Eight key questions should be used to ensure that, and to analyse the degree to which, gender mainstreaming is underway within the process outlined on page 23: 1 Is there an understanding of the gender issues and dimensions of HIV/ AIDS in the analysis of causes... download from www.hsrcpress.ac.za PAPER 1 Mainstreaming gender in HIV/AIDS: why and how Erika Burger To understand issues relating to the theory and practice of mainstreaming gender in HIV/AIDS, we must first be grounded in an understanding of and appreciation for the gendered dimensions of HIV and AIDS globally, as well as the regional and local contexts of gender- based vulnerability We need to be . examples of gender mainstreaming in HIV/AIDS 27 Paper 3 Gender mainstreaming and HIV/AIDS: how important is male involvement in accelerating gender equality?. understanding of the concept mainstreaming gender in relation to HIV/AIDS; • Provide insight into some of the challenges experienced in mainstreaming gender,