Held immediately before the start of the 17th International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA), 4-6 December 2013. The Women4GF Africa advocates workshop was organized to mobilize stronger action on gender equality through the Global Fund’s NFM. More than 40 individuals attended from over a dozen countries across Africa. Over a third are openly living with HIV, and many are young (including eight young women born with HIV) and from sex worker communities. All represent or work directly with and for populations vulnerable to and personally affected by HIV, TB and malaria, with most working at the grassroots level. The majority of participants were women, including transgender women, with a small number of men also attending.
Although progress in the HIV response is encouraging, nearly 16 million women throughout the world are living with HIV. In sub-Saharan Africa, the region that is home to 25 million people living with the virus, three out of five adults and three out of four young people living with HIV are female.
Gender inequalities and harmful gender norms continue to contribute to HIV-related vulnerability. A recent review found that women who have experienced intimate partner violence are 50% more likely to be living with HIV. Worldwide, seven out of ten women live on less than a dollar a day and at least one in three women has been beaten, coerced into sex, or otherwise abused in her lifetime. AIDS continues to be the leading cause of death and disease for women of reproductive age. The inequalities women face further compound these vulnerabilities as we are treated as second-class citizens. In our homes and communities, where our health care systems are overburdened, women have stepped in and are filling the gap—very often with limited funding and validation of this important work.
Despite the substantial impact, the HIV prevention, treatment and care rights and needs of women in all their diversity rarely receive the attention and resources required. A recent UNAIDS report found that fewer than half of countries allocate funds for women’s organizations; most also do not integrate HIV and sexual and reproductive health services or scale up initiatives to engage men and boys in national responses. There are many reasons for this intolerable situation, one of which is that women are rarely present at decision-making tables. As a result, programming and budget decisions are predominately made by men, and gender budgeting and reporting is rare. Community-based women who are willing to participate and who are enthusiastic about influencing policy are often ignored and find it difficult to have their voices heard.
In 2008, the Global Fund to Fight AIDS, TB and Malaria (Global Fund) adopted a Gender Equality Strategy (GES), which was designed to increase the scope and quality of programming that addresses gender inequality and the challenges women and girls face daily. Yet efforts have not moved forward due to poor implementation. The Global Fund’s new funding model (NFM) is an excellent opportunity for greater action. A key principle of the NFM is “investing for impact” to ensure that Global Fund support goes to where the epidemic is, and to programmes that can have the greatest impact on the three diseases. In sub-Saharan Africa, this mean that more programmes must reach women and girls, especially key affected women.
Priority demands
Participants identified priority demands in the following areas: meaningful engagement, inclusion and representation, human rights, good data and evidence, financing, and accountability and collaboration with women’s groups working in country.
1) Meaningful engagement, inclusion and representation: Women in all our diversity need to be meaningfully engaged, included and represented at all levels so that Global Fund resources support programmes that advance gender equality. Important steps have been taken, but more is needed so that gender equality advocates are engaged through all national and global processes that influence how Global Fund resources are allocated and used. Action is required to secure meaningful inclusion of women in all our diversity, in particular young women, transgender women and women who do not speak English.
Key action areas include:
- Fund portfolio managers (FPMs), other country team members and regional focal points should engage directly with gender equality advocates to ensure that the Global Fund supports gender- sensitive and transformative interventions in concept notes and eventual grant agreements, and to overcome challenges in the participation of women in all our diversity in Global Fund-related processes at country, regional and global levels. Gender equality advocates share responsibility and will act as ‘eyes and ears’ on the ground—watchdogs to ensure that Global Fund processes and programmes have maximal impact and work for women.
- Young women, transgender women and women who are sex workers face disproportionate vulnerability to HIV in many parts of Africa. Women in general are inadequately represented in Global Fund processes and structures, but further and active steps particularly must be taken to include young women, transgender women and sex workers in country processes and structures as well as in global governance.
- The Global Fund Secretariat should take steps to coordinate the GES and the SOGI (Sexual Orientation and Gender Implementation) strategies. There are important overlaps—especially for transgender women and sex workers—but these two strategies are usually treated and implemented separately. Language that explains these links and overlaps should be drafted and included in both documents.
- Global Fund-related meetings—including Women4GF workshops—need to be conducted in languages other than English, so that information about the NFM and GES reaches gender equality advocates in non-English-speaking nations and communities. Global Fund documentation should be available in several languages (and translated locally), as should be critical documents that help increase awareness and technical capacity. Women4GF Africa workshop participants called for priority efforts to mobilise advocates in the Francophone and Lusophone countries of Africa.
2) Human rights: Bold actions are essential to protect the human rights of women in all our diversity, and especially young and key affected women. The Global Fund stresses the importance of addressing human rights through its programmes to have maximum impact on HIV, TB and malaria, including the identification, tracking and redress of human rights violations. Technical partners in country—the UN family in particular—have a core mandate and responsibility to ensure that members of legally and socially oppressed populations, including sex workers, women who inject drugs, transgender women and people from LGBTI (lesbian, gay, bisexual, transgender and intersex) communities, are able to participate meaningfully and safely in Global Fund processes. In regards to the NFM, their high quality participation is especially essential in country dialogues and to ensure that concept notes include priority programmes.
3) Good data and evidence: Gender equality advocates in all our diversity need clear data and evidence to make a stronger case regarding vulnerability to, and impact of, HIV, TB and malaria and to advocate for the right programmes that respect our rights and respond to our needs. All workshop participants, and particularly those from the Francophone African region, called for greater information about existing evidence, and increased investment from a range of partners in research on gender-based violence and violence against other key populations including men who have sex with men (MSM), women who use drugs and sex workers. Only with stronger data and evidence can gender equality advocates make a stronger case for the inclusion of more extensive and better funded interventions to address key vulnerabilities, including gender-based violence, in national strategic plans (NSPs) as well as Global Fund concept notes.
4) Financing: All reviews of the GES have shown that the implementation of gender programmes is difficult to track if they have not been clearly budgeted in final grant agreements. Countries therefore must make gender budgeting and reporting standard practice. This will ensure that gender sensitive and gender-transformative programmes are costed and tracked in NSPs, and subsequently in Global Fund budgets, funding agreements and reports. Sufficient funding must be available to meet the full range of gender-transformative interventions needed to respond to the specific demands each country faces and to maximise the impact of Global Fund support.
5) Accountability and collaboration: To date, the Global Fund has not been successful in implementing its GES. Gender equality advocates and women in all our diversity commit to joining forces with the Secretariat and other partners to ensure implementation happens, to track processes, and to take the strong action required to increase the quality and success of gender programming in Global Fund grants. For this partnership to be meaningful, civil society groups (especially women’s groups) at country level need enhanced technical capacity and financial support to monitor both national and Global Fund-specific processes, including NSP development, policy dialogue, country coordination mechanism (CCM) selection, country dialogues, concept note drafting, grant negotiations, grant signings and programme implementation.
The Africa workshop was the fourth under the banner of an emerging project, Women4GF, launched in July 2013. This workshop was organised and facilitated by ASAP (AIDS Strategy, Advocacy and Policy) and supported by the Global Fund. Representatives from the Global Fund Secretariat joined the community-based participants to provide background information and better understand experiences and needs in implementing countries. Women4GF aims to coordinate and strengthen the ability of women’s rights advocates—in particular women living with HIV and personally affected by TB and malaria, and key affected women—to engage at country, regional and global (including Board) levels with the Global Fund and its NFM from a gender-equality perspective.