Geeta Rao Gupta, currently a co-convener of the Social Drivers Working Group of aids2031, an international initiative to chart a course for a global response to AIDS over the next 25 years, spoke to Ranjita Biswas about new trends in AIDS strategy to address gender inequality
The importance of women’s role in the fight against HIV/AIDS, the gender inequities that makes this campaign difficult, and new strategies were highlighted by speakers at the plenary session on the second day of the 9th ICAAP in Bali recently. Geeta Rao Gupta in her plenary address, ‘Closing the Gender Gap: Where Have We Been? Where Are We Going?’ put the ‘gender’ question firmly on the agenda.
Rao Gupta is president of the Washington based International Centre for Research on Women (ICRW). She is also currently a co-convener of the Social Drivers Working Group of aids2031, an international initiative commissioned by UNAIDS to chart a course for a global response to AIDS over the next 25 years.
What change, if at all, have you seen in the fight against HIV/AIDS?
It was at the XVIIIth International AIDS Conference in Durban, South Africa [with the theme Breaking the Silence]that the relationship between women’s unequal status and HIV infection came to the fore. But it took some time to convince donors and policymakers that we could actually do something to address the relationship between gender inequality and vulnerability to HIV. Today, gender has become a central theme in analysis and action related to HIV prevention, care and treatment. In fact, the AIDS epidemic has also proved catalytic to other gender issues.
So what sort of framework should there be?
We need a comprehensive, multi-pronged response to gender-related vulnerabilities to HIV. While strategising prevention of the disease, the emphasis in the past has been mainly on condom use. But though technology has its own role, it is not a ‘magic bullet’ to take care of such complex issues. We have also to recognise men’s and women’s sexual identities and sexual practices, and try to understand more about the social and structural factors that influence them.
So the problem of gender inequality continues to affect the AIDS campaign?
Yes, but gender inequities are of many kinds. The epidemic is just feeding on the fault lines of inequality and discrimination that already existed in our society.
What does a multi-pronged response consist of?
A multi-pronged response will be different in each country. One of the most important lessons learned over the last decade of the AIDS response is that responses to structural factors, including gender inequality, must be rooted in a comprehensive analysis of the context. It is commonly said, but less commonly practised, that we must “know our epidemic.”
Nevertheless, we can recommend some common elements of a multi-pronged response:
- Integrated programmes that will jointlypromote the economic empowerment of women, protect women and girls from violence, address harmful male norms, provide education and awareness on different sexual practices and sexual identities, and other programme interventions that are relevant in the given context;
- An enabling legal and policy framework, which would include the decriminalisation of HIV status, transmission of exposure; decriminalisation of same-sex relationships or diverse gender identities; decriminalisation of sex work; anti-discrimination and equal opportunity for HIV-positive people, and for sexually diverse populations; an enabling legal environment for harm reduction for drug users; and laws that promote the equal rights of women and men;
- Meaningful engagement of affected communities to build social capital at the national and local planning levels, especially among HIV-positive people and young people.
There has been a lot of talk about male participation in the new approach. Is it something new? In Asia-Pacific countries especially, with their patriarchal societies, the male’s participatory role cannot be ignored.
Yes, that’s what we are talking about. Gender is not just women. Without looking at men, their role in their relationships with women, a change of attitude and behaviour cannot be achieved. In fact, it will be a disservice to the women if their male partners’ roles are ignored. Besides, as we see in less developed countries, the highest proportion of infections occur through sexual transmission in heterosexual relationships. So how can you leave out the other half?
Have you seen some of these thoughts articulated in practice and with success?
Yes, in some cases. For example, in the IMAGE project and the Stepping Stones project in South Africa, and also in the Avahan project involving commercial sex workers in South India. These are community responses to the epidemic and involve both men and women in trying to make a difference.
What was different about these projects? What exactly was the impact?
These projects were different because they addressed “structural” factors contributing to vulnerability to HIV; adopted multi-faceted approaches to prevention of HIV; effectively mobilised community members; and they were or are being rigorously evaluated for impact. The Intervention with Microfinance for AIDS and Gender Equity (IMAGE) study combined a poverty-focused microfinance initiative that targeted the poorest women in communities in South Africa, with a participatory curriculum of gender and HIV education. Over the two-year period, levels of intimate partner violence decreased by 55% in women in the intervention group relative to the comparison group.
The Stepping Stones project, also implemented in South Africa, aimed to improve sexual health by using participatory learning approaches to build knowledge, awareness of risk, and communication skills, and to stimulate critical reflection among participants in a community. This approach resulted in a 33% reduction in the incidence of HSV-2 among participants, alongside reported decreases in violence, transactional sex and alcohol abuse among men.
The Avahan programme uses peer-led outreach and community mobilisation activities, among other interventions, to prevent HIV among highest-risk groups in high-prevalence states in southern India. One of the issues addressed by Avahan is violence against sex workers, which is a key factor contributing to sex workers’ vulnerability to HIV. Although complete impact data is not yet available, data from some of Avahan’s target areas suggest that sex workers have become more likely to use condoms and rates of sexually transmitted diseases have decreased. Moreover, community members have become mobilised and more empowered to address the biggest problems affecting their own lives.
These results indicate that community-based, participatory programmes can reduce the incidence of violence against women, a known co-factor of HIV risk, and bring about other changes that reduce HIV vulnerability and enhance resilience among women and men.
Could you tell us more about the Social Drivers Working Group of aids2031?
Aids2031 is a global, multidisciplinary initiative set up in 2007 to chart a global response to AIDS over the next 25 years. There are nine working groups of aids2031, and each one has a different mandate to explore a particular aspect of the AIDS pandemic and the appropriate response. The products published so far from all the working groups, including the Social Drivers Working Group, can be accessed at www.aids2031.org. The main recommendations from all the working groups will be collected in a document called Agenda for the Future, which will be published in late 2009.
Can you tell us something about the ICRW and your role in it?
The International Center for Research on Women’s mission is to empower women, advance gender equality and fight poverty in the developing world. To accomplish this, ICRW works with partners to conduct empirical research, build capacity and advocate for evidence-based, practical ways to change policies and programmes. I am president of the organisation and responsible for ensuring that our work advances our mission. More information is available at www.icrw.org
Lastly, what do you view as the shortcomings of the HIV/AIDS campaign and the lessons to learn?
We must recognise that piecemeal and short-term approaches do not change the fundamental imbalances between women and men, and the many factors that contribute to vulnerability. We should promote long-term approaches that are integrated into national programmes.
InfoChange News & Features, September 2009