Below are a list of best practices and case studies on integrating gender into the design of HIV/AIDS programs. The best practices are divided by topic and the case studies by region. Examples and studies are extracted from the World Bank as well as UNAIDS, UNICEF, the International Research Center for Women (ICRW), Interagency Gender Working Group, Food and Agricultural Organization, and Human Rights Watch. Chosen resources address gender-related social and economic inequalities that can increase the likelihood of HIV/AIDS infection.
Case Studies by Region:
Magee Woman Care International: Belarus and Russia
Magee Woman Care International in collaboration with UNHCR consider HIV prevention for urban refugees as a high priority, especially women of childbearing age (aged 15-49). In addition to their work providing primary and basic medical care to asylum-seekers and refugees, Magee has also developed an HIV/AIDS prevention program that focuses on HIV transmission, prevention, and the risks associated with AIDS. The results of the program showed marked increases in HIV awareness and notable changes in teenage girl behavior.
Economic Empowerment and Security
Bomme Isago Association: Botswana
Bomme Isago Association is a Network for Women Living with HIV/AIDS in Botswana that addresses their financial, psychosocial, legal, and health challenges. In a recent project, the association assisted HIV-positive women to undertake and manage livestock and backyard gardening in order to improve their nutrition and food security and generate a source of income. This project aims at moving women from a state of vulnerability to sustainability, socially and economically.
Positive Women’s Group (PWG):Thailand
Positive Women’s Group is a community-based organization that advocates for the rights of women living with HIV in Thailand. PWG implements its programs by mobilizing women living with HIV, leading them toward self-reliance and sustainability. The overall goal of PWG is to improve the quality of life of women living with HIV by preventing HIV-related stigma and isolation. In northern Thailand, an abbot assisted 35 members of the Positive Women’s Group by funding their attendance in a government vocational training program on tailoring and handicraft. After the training, a workshop was constructed on the temple grounds through donations of the community, the temple, and the district administration. Through group income and product sales, sewing machines were bought. Today, with the investment of a Japanese consultant, the women are making and exporting Japanese kimonos.
Copperbelt Health Education Project (CHEP):Zambia
The Zambia Copperbelt Health Education Project focuses on health education and HIV/AIDS prevention. It works specifically with urban and rural boys and girls in out-of–school youth programs, in-school youth programs, and vulnerable children programs. The in-school program has been the most successful, using educational activities such as Anti-AIDS Clubs, the Sara Communication Initiative, and Games for Life to encourage boys and girls to re-consider deeply rooted gender-based stereotypes and stigmas.
The Sara Communication Initiative: Sub-Saharan Africa
In 2000, UNICEF launched the Sara Communication Initiative, a program designed to address the health and reproductive rights of children, particularly adolescent females, and the importance of receiving an education. Other issues such as sexual harassment, HIV/AIDS, early marriage, genital mutilation and girls' domestic workload, are woven into the stories about Sara and her friends. In addition to the radio series, the initiative has developed animated films, comic books, storybooks, audiocassettes, posters and guides.
Gender-Based Violence [i]
Raising Voices and the Gender-Based Violence Prevention Network: Uganda
In the past, HIV/AIDS has not received significant attention from violence- related organizations. This had been in part because of the Ugandan government’s focus on promoting abstinence and ‘fidelity’ as key strategies for HIV prevention, “and violence was seen as ‘too feminist’ a concern to be incorporated into HIV organization agendas.” In 2005, the Network put together the 16 Days Campaign: Joining Hands to Prevent HIV and Violence against Women. The program aimed to educate policymakers and decision makers about the link between both pandemics (violence and HIV). Throughout the region, the Network distributed Action and Advocacy Kits containing seminar information, press kits, and guidelines for participation. Similar campaigns have occurred since the first program in 2005. Some of the most notable successes have been the increase community-based support and action on preventing HIV and violence against women.
Mothertongue: South Africa
Mothertongue is a collective of women artists that explores the exploitation of women through the arts. They tell stories about abuse, the rape of lesbians, and dislocation and the connection with HIV/AIDS. Mothertongue frequently performs for large groups or small groups, with the idea of creating awareness and allowing women to share their stories. Originally, the collective started out with professional actors. Today, it now works with members from South African communities, frequently women who have experienced the violence or who are HIV-positive. Women from the communities have been provided with the opportunity to gain acting, voice-training, and on-stage body movement skills in order to create a theatrical production. Today, more than 80 percent of the women participating in the community-wider performances are HIV positive, and 95 percent are survivors of gender-based violence.
Breakthrough is an India- and US-based international human rights organization that translates complex human rights issues into popular media-based messages in formats that capture the attention of people across South Asia and beyond. After doing some research on the HIV/AIDS cases among women in India, the executive director of Breakthrough realized that the women with the highest HIV infection rate were not commercial sex workers (CSW) but in fact married women. Through creative advertisements and music videos, Breakthrough designed a series of campaign that did not just “reinforce men’s use of condoms,” but instead, got to the heart of the problems: India women not having the ability to negotiate issues regarding sex and sexuality within marriage. This public service announcement (PSA) has now been translated into seven languages and continues to target stigma and discrimination issues involving women and HIV/AIDS.
Puntos de Encuentro: Nicaragua
Puntos de Encuentro is a communications organization that influences public opinion via participation in movements. Between 2001-2005, Puntos’ multimedia aired Sexto Sentido, a half-hour weekly telenovela that questioned the legitimacy of gender roles. The storyline portrays a young man who discovers he is HIV-positive as a result of having unprotected sex with Martha, a divorced woman, who is HIV-positive from her polygamous husband who refuses to wear a condom. Throughout the soap opera, explicit links are drawn as to why women are specifically more vulnerable to contracting and being exposed to the HIV virus (domestic violence, sexual violence, and economic/structural violence). It also draws attention to machismo, a frequently-cited phenomenon that increases the risk factor for the incidence of sexual abuse and HIV transmission.
Health and Nutrition
HIV Equity Initiative: Haiti
In the central region of Haiti, women and a few men, many of them HIV-positive, are bringing antiretroviral drugs (ART) to some 650 HIV patients. These ‘accompagnateurs’ distribute the antiretroviral drugs, food, and other medications twice daily to those who are not able to care for themselves and have no one to care for them. Based on the directly observed treatment (DOTS) method, health care is brought to the patient, rather than the patient seeking the care. The accompagnateurs factor women’s caring responsibilities into their treatment in various ways, including by providing money to help pay school fees when possible (so that girls don’t have to stay home). By using accompagnateurs, delivery of goods and services is done at a much lower cost, without having to pull the women out of an income-generating job. This is currently being implemented in other countries as well including Mexico, Guatemala, Rwanda, Peru, Russia, Lesotho, and the USA.
Law and Justice
Justice for Women and Orphans Project (JWOP):Zambia
JWOP is a non-profit organization that promotes human rights, advocates for legal reform and protects and safeguards the rights of widows and orphans in Zambia. JWOP recognizes that the stigmatization that results from HIV/AIDS-related deaths makes integration of surviving widows and orphans into the extended family system difficult. JWOP works with government leaders, community organizers, the general citizenry, and officials responsible for enacting and enforcing laws in order to uphold the rights of widows and orphans.
Grassroots Organizations Operating Together in Sisterhood (GROOTS) is an organization working in 14 regions of Kenya. The plight of widows in Kenya was discovered through GROOTS’ home-based care programs. Several cases of women chased from their homes after their husband’s death and forced inheritance practices contributed to high risk tendencies among these women, including their engagement in commercial sex. This situation created an incentive for women to come together and seek solutions. GROOTS Kenya partnered with Women Land Link Africa project (WLLA) and supported women in an exercise to document problems that women face when working in collaboration with village elders. Exchange visits among women have facilitated sharing of experiences and successes.
Zimbabwe Widows and Orphans Trust (ZWOT): Zimbabwe [ii]
Formed in 1996, ZWOT was created to assist the nearly one million widows and four million orphans currently living in Zimbabwe. The organization’s primary mandate is to support widows and orphans in the areas of inheritance, income generation, health, and psychosocial support. Currently, ZWOT is working within a number of target communities to assist women and orphans on land and property inheritance disputes between customary and civil law. As Laurel Rose (2006) points out, orphaned children are not in a good position to use either customary law or statutory law as a means of protecting or inheriting their parents’ property or inheritance rights because they lack information, time, and the financial means to pay the logistical and legal costs. ZWOT has been successful in helping widows and orphans gain access to the complex legal systems.
Specific Female-Targeted Approaches
National Strategic Framework: Botswana
In 2003, the National AIDS Coordinating Agency of Botswana authored their National Strategic Framework for HIV/AIDS 2003-2009. Within this policy, clear guidelines are set out to actively engage stakeholders from Ministries, NGOs, districts, and the Private Sector. One of the six priorities is mainstreaming gender into HIV/AIDS policy. Women are viewed as a critical target group to be considered when designing and implementing HIV/AIDS policy. Some of the interventions that the government has focused on are income generation programs (working with the Ministry of Labor), inheritance rights and legal status of women, power inequalities in gender relations, and women’s education. There is also a focus on building cross- Ministry partnerships to encourage that different sectors are gender-sensitivity in sectoral ministries.
Shaping the Health of Adolescents in Zimbabwe (SHAZ): Zimbabwe [iii]
Shaping the Health of Adolescents in Zimbabwe (SHAZ) has been successful at addressing the growing issue of many young females orphaned by AIDS and now heads of households. Often to make ends meet, these orphans resort to sleeping with older rich men as a form of payment for her expenses. SHAZ gives young girls a different option. It is one among many projects that works to empower girls and women to protect themselves. It offers young women, many orphaned by AIDS and now heads of households, reproductive health services and classes on HIV prevention and how to use a condom. Likewise, it offers vocational training, classes in entrepreneurship and help in developing a business plan. Each girl is mentored by a local businesswoman.
Specific Male-Targeted Approaches
The Shosholoza AIDS Project: South Africa
Initiated in 1998, Targeted AIDS Interventions (TAI) uses football (soccer) as a means of mobilizing men to become involved in the fight against HIV/AIDS. The South African Football Association (SAFA) selected eight teams for a three-day training workshop which focused on issues like sexuality, puberty, STIs, HIV/AIDS, and communication skills. The teams then held local workshops for neighboring football teams and organized HIV-oriented football events (distributing condoms and media awareness). The outreach program has reached over 2,000 men, providing basic HIV information and prevention. The key to this project was reaching men where they are; not waiting for the men to arrive at the clinics or VCT centers.
Working for Change with Men in Fighting HIV/AIDS in Kenya (KANCO): Kenya
Orchestrated throughout much of Kenya, this project aims at incorporating and promoting male participation in the fight against HIV/AIDS. It primarily targets government, community, and religious leaders, policy makers in NGOs and other sectors to promote their roles in advocating for HIV/AIDS prevention, care and support activities among men. The project also targets young men in the armed forces, prisoners, and truck drivers. Through engaging men, the project hopes to encourage men to identify and prioritize their own issues in HIV/AIDS.
Hospice Association of Zimbabwe (HOSPAZ): South Africa
Taking care of an HIV-positive family member usually has large implications for gender roles. In Zimbabwe, men have become increasingly more involved in caring for AIDS patients, challenging the stigma that men typically do not take on this role. With the support of HOSPAZ, district councilors helped men form a group that would complement the efforts of women providing home-based care. For many men, HOSPAZ has challenged them to recognize that AIDS is “one of those diseases that needs to be fought by society as a whole.” This project has helped break down stigmas and stereotypes, addressing gender roles in the fight against HIV/AIDS.
Men As Partners (MAP):South Africa
Men as Partners is an organization that promotes men’s involvement in care and support activities with people living with HIV/AIDS. It currently challenges gender roles and behaviors that typically exacerbate the HIV-infection rate disproportionately among women and men. The program aims to reach nearly 60,000 men of the armed forces, about 800,000 male union members, and young boys in order to create an environment where men can talk comfortably about masculinity without feeling threatened. Through engaging men in dialogues, MAP has closely documented lessons learnedfrom working with men within communities and clinics.
The Railway Women’s Empowerment and AIDS Prevention Society (REAPS)
In 2002, a three-year project set out to strengthen the Railway community’s capacity to understand the link between gender and HIV/AIDS as a means to prevent the spread of the virus in the division of the Railway. REAPS encouraged gender-sensitive peer counseling services, policy-level advocacy and communication campaigns. The project was implemented in the Vijayawada Division, a location with the highest prevalence rate in the state of Andhra Pradesh. One of the major successes of the project was the use of the multi-sector approach. Today, there is better access to information on prevention, more HIV-positive women are accessing hospital services, and a special curriculum has been developed for young boys and girls. This curriculum is used in Railway schools to challenge gender stereotypes.
Abidjan-Lagos Transport Corridor
In 2004, the World Bank launched an HIV/AIDS project for the Abidjan-Lagos transport sector. The project focused largely on increased access to HIV/AIDS prevention, basic treatment, and support and care services to a targeted group of individuals: females. Unique to the project are the gender-specific components. Female commercial traders are educated about their rights and the documentation required for crossing borders. This is an important component, especially since women are frequently sexually harassed at border check points. The second gender-related activity informs female sex workers about HIV/AIDS prevention, offers free female condoms, and offers grants if they want to take up formal jobs. The project also contributes to strengthening the capacity of women’s associations legally constituted to fight against the discrimination of people living with HIV/AIDS.
Youth and Children
Empowering Africa’s Young People Initiative:Tanzania, Uganda, and Zambia.
The International Youth Foundation (IYF) has partnered with a number of organizations to scale up education and awareness initiatives among youth, aged 10-25 in sub-Saharan Africa about HIV prevention and reducing the number of cases of sexual exploitation. Some expected outcomes include: increase the number of youth, aged 18-24, seeking clinical services and VCT; increase the percentage of youth who are confident that they can implement safer sexual practices; accuracy of knowledge of primary prevention methods. Successful outreach has been most notable among trainers who reach out to young women while they participate in recreational activities (i.e. clubs, drama outreaches, dance, art, and youth gatherings).
Straight Talk: Uganda
The Straight Talk Foundation aims to increase the understanding of adolescence, sexuality and reproductive health, and to promote the adoption of safer sex practices. Targeting youth aged 10-24, educational programs that are taught by trained adolescents empower youth to address the risks and gender-based vulnerabilities associated with HIV/AIDS. Straight Talk uses a variety of media tools (youth-run newspapers, websites, and radio shows) to promote HIV/AIDS awareness and to discuss related issues such as conflict and food deprivation. One of its key publications, Tree Talk and Farm Talk, is an educational tool that addresses the importance of sustainable agriculture and nutrition among HIV-positive children.
Case Studies by Region
Epidemic of Inequality: Women’s Rights and HIV/AIDS in Botswana and Swaziland. 2007. Physicians for Human Rights. Cambridge, Massachusetts.
Currently, Botswana and Swaziland have two of the highest HIV/AIDS prevalence rates in Sub-Saharan Africa. Both countries also have legal systems that grant women lesser status then men, restricting property rights, inheritance, and health care services. Social, economic, and cultural practices create, enforce and perpetuate these gender inequalities. Through a series of interviews and surveys, local field researchers collected relevant information on HIV/AIDS prevalence rates, current practices, and gender equity. This report addresses the inequalities between men and women in Botswana and Swaziland and makes realistic policy recommendations such as strengthening legal/policy reform to eliminate gender discrimination, incorporating gender and human rights awareness into basic education, and enacting legislation against domestic violence.
The Impact of HIV/AIDS and Drought on Local Knowledge Systems for Agrobiodiversity and Food Security. 2005. Food and Agriculture Organization. Hlanze, Z., Gama, T., Mondlane, S.
Low amounts of rainfall and high incidence rates of HIV/AIDS are both long-term crises that have led to acute situations of poverty, vulnerability, and food security in much of Swaziland. In this case study, the Food and Agricultural Organization focuses primarily on the effects of drought and HIV/AIDS on local knowledge systems for agro-biodiversity and food security in Swaziland. Recommendations are made addressing health care, nutrition, labor shortages and skills, gender inequalities and knowledge.
A Social and Gender Assessment of HIV/AIDS among Refugee Populations in the Great Lakes Region.2005. The World Bank, Washington, DC.
In the Great Lakes Region of Africa, forced migration and displacement have become an increasingly complex problem. Internal conflict often displaces individuals, leading to greater economic and social vulnerability, especially among women and children. This assessment portrays the perceptions and realities of HIV/AIDS among internally displaced persons in Tanzania, Democratic Republic of Congo, and Uganda and makes recommendations based on local, cultural and regional knowledge of the current situation.
Using Participatory Media to Explore Gender Relations and HIV/AIDS amongst South African Youth: the example of DramAidE. 2004. DramAidE. Botha, P. and Durden, E.
In 1992, DramAidE was established to encourage young people to communicate effectively about issues relating to sex, sexuality, and HIV/AIDS. Based in KwaZulu Natal, the Province with the highest HIV prevalence rate, the project focuses on peer education in secondary schools, promoting healthy lifestyle decisions, and addressing cultural beliefs regarding polygamy and deeply entrenched gender roles. Two programs specifically cited are: Mobilizing Young Men to Care and Woza Nazo. The case study provides insight into the effectiveness of these two programs and how each gender has been empowered to change the pandemic.
The Effect of HIV/AIDS on Land: Case Studies from Kenya, Lesotho, and South Africa.2002. A Synthesis Report prepared for the Southern African Regional Office of the Food and Agricultural Organization Scott Drimie.
This document focuses on the policy implications of HIV/AIDS as a means of development and poverty reduction. Drawing from three cases, the paper specifically addresses the impact of land use, land rights, and land administration in South Africa, Lesotho, and Kenya. In each of the case studies, the author points out the different gender-based risks and vulnerabilities on the household level.
Double Standards: Women’s Property Rights Violations in Kenya. 2003. Human Rights Watch. Volume 15, No.5.
Women’s property rights in Kenya are inherently unequal because of customary and statutory laws that prevent women from owning, inheriting, managing, or selling property. This report looks specifically at Kenyan property rights, policies and laws and how women are explicitly denied property rights because of their marital status. The study also touches on customary sexual practices (wife inheritance or ritual cleansing) that are frequently tied to property rights and their impacts on the epidemic.
Children’s Property and Inheritance Rights and Their Livelihoods: The Context of HIV and AIDS in Southern and East Africa. 2006. Food and Agriculture Program. Laurel Rose.
As the HIV pandemic sweeps across sub-Saharan Africa, millions of orphans are being left homeless and impoverished. Recent work in Southern and East Africa suggests that orphans are not only compelled to support themselves, but they often have to defend their property and inheritance rights. This paper presents case studies from five different countries: Zambia, Uganda, Swaziland, Rwanda, and Kenya.
HIV-Positive Women Report More Lifetime Partner Violence: Findings from a Voluntary Counseling and Testing Clinic in Dar es Salaam, Tanzania. 2002. Journal of Public Health. Mamen, S. et. al.
In many HIV/AIDS related cases there is growing evidence to support the strong link between HIV/AIDS prevalence among women and domestic violence. This case study covers HIV-positive women who seek voluntary counseling and testing, and who live in the urban areas of Dar es Salaam, Tanzania. Through VCT and other questionnaires, researchers present a case that ties the relationship between physical and sexual gender-based violence and HIV/AIDS infections. Interviews reveal that the embedded social norms related to sexuality and physical violence often contribute to gender-based violence.
Multi-country HIV/AIDS Program (MAPs) Examples
Angola: HIV/AIDS, Malaria and Tuberculosis Control Project (HAMSET) (2004)
A central component to Angola’s multi-sectoral HIV/AIDS project is strengthening the public sector response, with particular focus on supporting line ministries to reduce the impact of AIDS. This includes training trainers at the national level, training ministry staff at the district levels, developing information, education and communication campaigns, and strengthening and reviewing gender-specific policies and programs that affect both ministry staff and populations served. One of the policies recognized as needing immediate attention is the design and implementation of a policy on breast feeding and prevention of mother-to-child transmission (PMTCT). The project also seeks to improve access to VCT, treatment, and care, specifically targeting teenage girls and pregnant women.
Tanzania: Multi-sectoral AIDS Project (2003)
In 2003, Tanzania launched a multi-sectoral HIV/AIDS project that aimed at strengthening and expanding HIV/AIDS activities being carried out by communities and NGOs. Funded activities largely focused on vulnerable groups including hospital workers, orphans, youth, commercial sex workers, and truck drivers. The gender dimensions of the epidemic are addressed in the need for support for different groups of women, particularly widows and female commercial sex workers. The project recognized that women, in particular, need household support because of their lack of access to household income and assets. The MAP also recognizes the need for policy implementation supporting orphans and vulnerable children (OVC). This project supports community-based initiatives that focus on making it possible for OVCs to stay in school, with particular attention to attendance among females.
Burkina Faso: HIV/AIDS Disaster Response Project (2003)
In 2003, the World Bank supported a multi-sector response to the growing AIDS epidemic in Burkina Faso. The project specifically targeted high-risk and vulnerable groups, including commercial sex workers, miners, orphans, youth, and pregnant women. In 2005, the World Bank partnered with NGOs, to ensure that there was sustained focus and action on awareness and prevention among the groups most likely to engage in high-risk sexual behavior through community care micro-projects and training of peer educators. Training of health personal led to the piloting prevention of mother to child transmission in two districts as well as counseling for pregnant women contributing to a successful gender-focused HIV/AIDS project.
The Gambia: HIV/AIDS Rapid Response Project (2000)
In 1991, a group of women operated a one-room clinic to improve health outcomes for women and combat HIV/AIDS in their village. Today, the Foundation for Research on Women’s Health, Productivity, and the Environment (BAFROW) is a fee-for-service network of clinics that operates in three districts, and plans to replicate its programming in additional districts. BAFROW offers services and preventative care to women, men, and youth, with support systems focusing on economic sustainability through entrepreneurial education and full beneficiary participation. As of March 2006, more than 60% of grants had been awarded to women’s groups.
LATIN AMERICA AND THE CARIBBEAN
Programa H:Bolivia, Brazil, Colombia, Jamaica, Perú and México
After studying and analyzing the impact evaluation of the interventions within Rio de Janeiro, Brazil, Instituto Promundo started to provide training and technical assistance on how to engage young men in HIV/AIDS prevention and the promotion of gender equality and prevention of violence in Brazil (in partnership with non-governmental organizations from the Northern, Northeastern, and central-western regions of the country); in Asia (India, Thailand, and Nepal); in Central America (Nicaragua, Costa Rica, and Panama); and in the United States and Canada. Program H has been successful because of the engagement of men and young boys, a high risk target group in Latin America and the Caribbean. The website provides a host of information for monitoring and implementation. Currently this program is also being used in the Ivory Coast, Kenya, Uganda, and Tanzania.
HIV/AIDS and Internally Displaced Persons in 8 Priority Countries. 2006. UNHCR. Spiegel, P. and Harroff-Tavel, H.
This report assesses eight different National Strategic Plans and Proposals on HIV/AIDS on the inclusion of internally displaced persons (IDP) and women in the strategy. It examines the relationship between HIV and IDPs in the media and provides recommendations on how to improve HIV policies for IDPs, especially those who are most vulnerable. The data and findings from the 8 priority countries, Burundi, Colombia, Democratic Republic of the Congo (DCR), Liberia, Nepal, Somalia, Sudan, and Uganda, illuminate the need for further data collection on HIV/AIDS in IDP camps in order to develop and implement efficient policy. Further, the paper points out the need for a more strategic policy that is targeted specifically at high risk groups.
Educational Responses to HIV and AIDS for Refugees and Internally Displaced Persons: Discussion Paper for Decision- Makers. 2007. UNESCO and UNHCR.
In 2005, the UN reported that there are nearly 44 million people that have been forcibly displaced by conflict, violence, persecution or crisis. Currently, data show that most refugees are migrating from countries in conflict with lower HIV prevalence to more stable countries with higher HIV prevalence. While migrants may not arrive HIV-positive, the absence of basic services and limited opportunities for economic stability make women and children most vulnerable to domestic abuse, rape, and possibly HIV. This case study concludes by suggesting entry points for responses to HIV/AIDS for refugees and internally displaced persons.
[i]Rothschild, C., Reilly, Mary Anne, and Nordstrom, S. 2006. “Strengthening Resistance: Confronting Violence against Women and HIV/AIDS.” Center for Women’s Global Leadership, New Brunswick, New Jersey.
[ii]Rose, Laurel. 2006. Children’s Property and Inheritance Rights and their Livelihoods: The context of HIV and AIDS in Southern and East Africa. Food and Agriculture Organization of the United Nations, Geneva.
[iii]UNAIDS/UNFPA/UNIFEM. 2004. Women and HIV/AIDS: Confronting the Crisis. United Nations, New York, New York.