Transcript Gender Dynamics and HIV in Vulnerable Populations: action

Juliette Bynoe-Sutherland
Head, Policy Analysis Division PANCAP
for
Caribbean HIVAIDS Alliance November 12th 2010 St. Kitts & Nevis
Can you describe your organization's
gender response?
Classic Responses:
 We are really please to report that we are able to share
with you the number of girls and boys who are….
 We have established a programme for women and girls
in …..
 Our Mens’ Health clinic provides services each
Wednesday …
Gender Responses are more
than …..
 Counting numbers of men and women in activities or
programmes.
 Designing programmes focused on women are CRITICAL
but gender based responses requirement engagement with
this issue of masculinity and the incorporation of
masculinity in women's programmes.
 Doing Men’s heath programming without routinely
addressing the range of male sexual and reproductive
issues including the needs of Most at Risk Groups: gay,
bisexual, transgendered men, sex workers.
Why don’t some of us get it?
 Clouded by views of feminism and female
empowerment.
 Gender Advocates challenged to translate analysis
into pragmatic programmes of action.
 Gender outcomes seen as vague, immeasurable,
illegitimate.
 Biomedical model/medicine/science - training
has not dealt well with the social dimensions of ill
health.
Why do some of us get it e.g CHAA
& Local partners in SISTA
 Treatment acts on the symptoms – what about the cause?
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(UNAIDS: For every 2 persons on treatment - 5 new
infections).
Research: some persons to be more vulnerable to HIV (or
ill health) than others? (St. Kitts – epidemic concentrated
in Most at Risk Populations/MARPS & generalized
epidemic has not taken route)
Research & Experience: Social factors influence health
status, health seeking behavior, and allocation of resources
e.g poverty/social class, age, sexual orientation and gender.
Without addressing causal issues: gender and sexual
determinants of HIV transmission – frustration & futility
We can’t all do the same thing and expect different results!
Who am I? Who are you?
My Labels
 Barbadian
 Black
 Graduate
 Married Woman
 Attorney
 Mother
 Human Rights Advocate
 Heterosexual
 Regional Advisor
 Christian
What can I
share with
you?
The keys to
understanding
Gender &
Vulnerability as
it operates in
relation to the
HIV epidemic
What can I
share with
you?
Information
to shape and
mould a call
to action!
1. Gender is socially constructed
 Sex = male and female (hormones/chromosomes)
 Gender refers to the roles that men and women play and
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the relationships that arise out of these roles which are
socially constructed and not biologically determined
(PAHO 1997)
Perceptions of Gender (masculinity & femininity) are
deeply rooted in socio-cultural factors – underlying beliefs
about how society should be.
However, dominant ideology/perception is that gender
roles in our society are hierarchical.
Generally : There is an unequal power relationship
between men to women - favoring men.
NO ABSOLUTES: Gender roles are learnt and can be
affected by class, education and economics AND can evolve
over time.
2. Sexuality impacted by gender
 The unequal power balance between men and women directly
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impacts sexuality - who one has sex with, in what ways and
why and under what circumstances and with what
consequences
Power plays a role in how sexuality is expressed in
heterosexual, homosexual or transgendered relations – whose
pleasure is given priority.
Sexuality compounded by social and moral norms about
“right and wrong” leading to stigma, discrimination,
criminalization and its resulting marginalization and
isolation of groups.
Social stigma makes it difficult for sexual minorities,
commercial sex workers, transactional sex practitioners to be
open, drives them underground, or into risky behavior.
Upshot: Our societies institutionalize inequality – individuals
and groups can’t access services OR services not reaching them
3. Vulnerability
 Vulnerability to HIV – the likelihood that some groups are at greater risk
of exposure to HIV due to biological, structural and infrastructural .
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Most at risk populations are /can be economically marginalized women
and girls, MSM, sex workers, drug users, migrants - country specific!
Biology of women, young girls, anal sex
Socio-cultural – lack of autonomy of some women, multiple partnering,
unprotected marital sex, hidden sexuality, cultural stigmas & taboos,
religious principles & moral views, gender based violence against
women & men e.g direct transmission/ reduced ability to negotiate
Economic: poverty, migration e.g a woman /person who lacks access to
resources/ economically dependent could fear and loss of financial
support if they seek to negotiate safe sex.
Political: laws and policies reinforce social norms – ignore
discrimination, criminalize sexual behaviors and actions of consenting
adults, refusal to provide social protection, condone abuse by law
enfocement
Access to prevention treatment care and support : gender shapes content
and quality of programmes, scaled up targeted interventions increase
visibility of stigmatized groups
5. Gender & Vulnerability applied to Health
 All players in the health sector have gender roles and views. The
processes and environments in which people work and receive
care can also be gendered:
 Are we adequately meeting individual needs - exploration
of the different roles that masculinity and femininity play in
health behavior e.g women as “vectors of disease” in PMTCT
 Do providers acknowledges the ways in which both the sex or
gender of the provider impacts on the health care event e.g
attitudes to HIV positive women with repeat pregnancies
 Does training and education identify the gendered nature of
medical and nursing knowledge/education/texts/teaching styles
and environments
 Are we researching clinical practice to address the way in
which the sex or gender of the patient impacts on clinical testing,
diagnostics, treatment and outcomes e.g adhearance
4. HIV: a national development
issue
 Gender factors underlie vulnerability to HIV and AIDS
 Response cannot be medicine or public health driven –
need to address the social –cultural, economic political
and legal factors that create vulnerability.
 PRECONDITION - Refine epidemiology to better
identify at risk communities. (Not rocket science!)
 Underlying prejudices and inequalities must be
address through national leadership, dialogue,
specially designed health and social service responses
and engagement of community actors e.g CBO, FBOs
Adapted from AIDS WOMEN CAUCUS & Caribbean Regional Strategic
Framework on HIV and AIDS 2008 - 2012
A: ACCESS
 Effective Partnerships – can reduce barriers to
universal access to a comprehensive set of
INFORMATION & SERVICES in prevention, treatment
care and support.
 Policies & Systems - to improve the socio-economic
conditions and reduce the risk circumstances of
MARPS – moral and political imperative – we are all
potentially vulnerable
 Service provision premised on OUTCOMES rather
than judgment based on Sexual & Reproductive
Health models
R: RIGHTS
 Promote and guarantee human rights as a conditionality of
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the rule of law in a country. Human Right for ALL must be
at the centre of a national HIV response:
Low hanging fruits – legal literacy of women, girls,
children, MARPs, Human Rights awareness raising,
Litigation strategies – push from below
Constitutional interpretation and law reform – leadership
from above to declare otherwise legal laws: bad law
Model Policies & Legislation – advocacy for
implementation!
Zero tolerance for state sponsored violations and in the
private sphere – gender based violence.
I: Investment
 “I hear the thunder but feel no rain” – investment is the best
evidence of interest and commitment.
 Investment in HIV prevention are investments in gender based
programmes, poverty alleviation, micro-finance, legal literacy.
 Increased funding needed by public, private, NGOs on
harm reduction, social protection, needs of women and girls.
 Invest based on comparative advantage – role for the State and
community based organizations e.g churches
S: Security
 The mental, physical, psychological and financial
security of ALL human beings should concern us .
 Shifting locus of vulnerability in an interdependent
globalized environment. (African-American &
Caribbean American infection rates in the USA)
 Interventions/activities should promote choice,
control, personal autonomy and empowerment.
 Social mobilization (i.e active engagement &
organization into sustainable responses) of at risk
communities should be a pillar of all initiatives.
E: EQUITY
 Education, Empowerment, Resources for MARPs
 Equality and Equity: MARPs do not need an equal
allocation of resources – their circumstances require d
MORE resources – an equitable response.
 To do otherwise endangers national gains made.
 Promote community participation and dialogue
particularly the involvement of women – community
leaders, faith based leaders, opinion leaders must be
champions for change
References
 International Council of AIDS Service Organizations
CASO – Gender, Sexuality, Rights and HIV (2007)
 UNAIDS – Handbook for Legislators in HIV/AIDS
law and human rights (1999)
 PANCAP - Caribbean Regional Strategic
framework on HIV and AIDS 2008 - 2012
 Inter Agency Coalition on AIDS and Development:
Gender Analysis for Project Planners. (2007)
For full text of presentation:
www.pancap.org
www.caribbeanhivaidsalliance.org