This summary article provides an overview of a luncheon “HIV is Sexist: Why Advancing Gender Equality is Essential to Ending the Epidemics” hosted by the Global Fund Secretariat during the Preparatory Meeting of the Global Fund 5th Replenishment held on the 17th December 2015 in Tokyo, Japan.
As noted in the Global Fund Investment Case for the Fifth Replenishment 2017-2019 “We have to find innovative solutions to end the epidemics. Investing in programmes that increase access to critical HIV prevention and treatment services is not enough; we also have to support programs that seek to change environmental and social factors that put women and girls at increased risk”.
The luncheon panel was facilitated by Mark Dybul, Executive Director of the Global Fund, and the speakers included:
- Ms Loyce Maturu, Global Fund Advocates Network (GFAN) Speakers Bureau, Zimbabwe
- H.E. Aaron Motsoaledi, Minister of Health, South Africa
- Mr Nick Dyer, Director General, Policy and Global Programmes, Department for International Development, United Kingdom
- Ms Deborah Dugan, CEO, Product (RED)
During the panel the following key issues were raised and/or discussed:
- Gender equality is important, as it is young women with lived experience in HIV and TB burdened countries that face challenges related to accessing services. Many young women are economically disempowered and do not have the financial resources to access far-away services, of which many remain sub optimal.
- Stigma and discrimination remains a serious barrier to accessing sexual and reproductive health (SRH) services for young women and services are often unfriendly to young unmarried women who are having sex and seeking contraceptives or HIV prevention methods. In addition to these complex issues – teenage pregnancy and abortions need to be addressed as part of a comprehensive approach to HIV that includes sexual and reproductive health and rights.
- Countries must provide gender transformative programmes that address the challenges of adolescent girls and young women. The quality of services requires attention and not just a focus on reaching numbers of people – behind the statistics are people struggling with institutional, social and structural barriers to accessing services and treatment.
- We need to increase quality life skills and education around informed decision-making on health, treatment and on gender based violence especially for those at risk of contracting HIV. Statistics of when women first encounter violence and abuse are frightening and not unique to Africa.
South Africa was highlighted as a positive example where various sectors are linking up and looking at health as a broader issue and starting to address the feminisation of HIV in the region. Young girls and adolescents between the ages of 15 – 24 are struggling the most and this is a human rights crisis that needs urgent attention.
Gender equality is unachievable if countries only focus on empowering women, but do not target men and boy. For example, Southern Africa struggles with the concept of Sugar Daddies, which is further compounded by fathers not providing good guidance, which will continue if men are not mentored to change their thinking.
It is well known that men – especially those who are married don’t want to use condoms and search for young girls who are willing to have unprotected transactional sex. This is something that must be addressed in the PEPFAR launched DREAMS project. The goal of DREAMS is to help girls develop into Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe women. The Global Fund and The Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) must build on this momentum and ensure that young women have the required resilience, safe environments that provide mentorship and empowerment.
The UK government has actively worked towards achieving gender equality in counties as a critical component to the HIV response and is an example of how bilateral funding can make a difference. Key to these discussions is Universal Health Coverage (UHC) which countries should make a legal requirement. Countries could – rather than thinking only about sexuality, also be addressing all of these issues through health and education, and rethinking the requirements needed to deliver an effective HIV response.
Countries should be tracking data through a life course approach and following the transition as young girls become young women and really understanding the impact of services on young women. This is especially important as populations are growing and are sexually active – even if the HIV rate declines by 50% we would still see a growth in the total number of new HIV.
South Africa also highlighted existing myths that continue to affect women and girls in the country such as ‘if a man has sex with a virgin he will be cured from HIV’. South Africa has now implemented a policy to ensure that 50% of councillors are women in all municipalities and changes are also happening in the South African parliament.
The DREAMS work will also focus on men as empowering women without addressing the beliefs of men will not be enough. The most important issue for women is economic equality, which needs to be achieved. Minister Motsoaledi provided an example of this “An eight-year-old girl was admitted after her uncle raped her and completely damaged her uterus. Her mother sat next to the uncle as we were trying to save this little girl and as the uncle was the only breadwinner the mother could not report him”.
This is also a challenge in the United Kingdom where 20 – 50% of women experience violence even though many women are economically empowered. We need to be innovation as we address and start to change the dogma and ensure that women have the financial security that they need. “If the Global Fund could treat girls and women as key populations, we could be much more assertive in earmarking resources for women and girls – carving out resources and disbursing these for achievement and progress against performance in changing norms and standards that support gender equality”.
There is also the importance of including the private sector in their operations to ensure workplace practices and their Corporate Social Responsibility (CSR) programmes address issues of gender inequality. There is huge room and space to grow in the private sector for more targeted focus, efforts, and funds for women and adolescent girls.
Loyce Maturu ended with a strong call around good mental health for all adolescents, which stems from policy, strategy and programmes that address reality.
“In Zimbabwe, high numbers of girls marry and do not disclose their HIV status. It is time to ensure that all the partners invest more in the Global Fund and to secure support to strengthen communities that women and adolescent girls are leaning on. Zimbabwe, will continue to face these challenges around access to treatment unless we find ways to make services available for all,” says Loyce, “Above all our language should not reinforce stigma and discrimination – HIV is not sexist, it is humans that are sexist!”