Author: Shannon Kowalski
Posted on the IWHC website, October 20, 2015

The world has made much progress in curbing three infectious, but preventable, diseases: HIV, tuberculosis (TB), and malaria. But not enough. Women and girls remain among the most affected and most vulnerable. This is especially true in eastern and southern Africa, where women over the age of 15 comprise 58 percent of all people living with HIV. Adolescent girls and young women are particularly affected: they account for 40 percent of all new HIV infections among women in the region. HIV prevalence rates among adolescent girls and young women ages 15–24 are as much as five times higher than those of their male counterparts. They tend to become infected with HIV 5–7 years earlier, and AIDS-related illnesses remain their leading cause of death. TB is among the top killers of women of reproductive age overall. With malaria, women are also at heightened risk; pregnant women are among the most vulnerable.

The Global Fund to Fight AIDS, Tuberculosis, and Malaria is a global partnership of governments, civil society organizations, and businesses that mobilize to end these epidemics. Earlier this year, IWHC worked with the Global Fund to seek feedback from women and girls affected by the three diseases on how the organization can better meet their needs.

Through an online survey conducted in four languages and in-person consultation, we gathered information from almost 350 stakeholders globally, including women and young people living with HIV, sex workers, women who use drugs, health service providers, technical assistance providers, and donors.

We sought to know three things:

  1. How women and girls were benefitting from Global Fund resources;
  2. How women and girls were influencing policies and programs in their countries through their participation in country dialogues and country coordinating mechanisms that prepare proposals and oversee implementation of Global Fund Grants; and
  3. What more the Global Fund could do to increase investments in women and girls through their strategies, policies, and processes.

The report from the consultations has just been published and will influence the Global Fund’s new strategic plan for the period 2017–2019, as well as their ongoing work.

So, how is the Global Fund doing?

Participants in the consultations told us that they felt that the Global Fund was making a real effort to address the needs of women and girls through their funding, policies, and programs. More than ever before, women are participating in decision-making processes at the country level. Concept notes submitted to the Global Fund analyze how the three diseases differently impact women and girls. And more resources are going toward programs that address women’s and girls health.

The Global Fund’s work in prevention of mother-to-child transmission (PMTCT) of HIV was an oft-cited case in point: when the Global Fund recognized that its investments in PMTCT programs were not at scale, they worked with technical partners and a set of 21 priority countries in Africa to significantly increase its funding in that area. In Zimbabwe, for example, coverage of PMTCT increased from just 9 percent to 78 percent of eligible women between 2009 and 2013.

However, participants also felt that many of these improvements have not yet translated into meaningful change. Despite an increase in women’s participation in country dialogues and country coordinating mechanisms, many felt that their involvement had little impact on outcomes. The gender analysis in concept notes for projects often didn’t translate into concrete programs with budgets. And the programs the Fund is investing in, while increasing women’s access to treatment and prevention services, often do not address the underlying factors that drive women’s and girls’ vulnerability to the three diseases in the first place, such as gender-based violence or gender-based barriers to health services and education.

The good news is that participants felt that the Global Fund has the fundamentals in place in order to significantly improve its impact on the lives of women and girls. For example, many felt that the process of developing Global Fund proposals could be used to ensure that programs that promote gender equality and address women’s and girls’ health needs are adequately prioritized, measured, and budgeted for. Further, participants noted that the Global Fund’s existing country coordinating mechanism assessments and improvement plans could be used as tools to address gaps in the participation of women living with or affected by the three diseases and women in key populations.

In terms of programming, the consultations identified some broad areas where the Global Fund can and must invest more, and more strategically. These include integrating HIV, TB, and malaria services with sexual and reproductive health services—so that women and girls are able to receive comprehensive, holistic care. The Fund should also address the needs of adolescent girls; tackle gender social norms and gender-related barriers to health care services; and strengthen community systems and the role of women’s community-based organizations.

Finally, participants felt strongly that if the Global Fund made a specific commitment to address gender equality in its new strategic plan with appropriate targets, strategic actions, and key performance indicators, it would catalyze action to improve the lives of women and girls from the global level to the grassroots.

World leaders just committed to end AIDS by 2030 in the Sustainable Development Goals. In order to meet this goal, addressing the HIV prevention, treatment, care, and support needs of women and girls in east and southern Africa must become an urgent priority. The Global Fund to Fight AIDS, Tuberculosis and Malaria should take this opportunity to step up to the challenge by putting women and girls at the center of its new strategy and ongoing programs.