Select Committee on International Development Minutes of Evidence

Annex 2



  There is evidence to suggest that gender roles and relations influence:

    —  risk of infection;
    —  the burden of HIV/AIDS;
    —  diagnosis and treatment;
    —  state and health system responses.

Gender and risk of infection

  Individual risks of HIV/AIDS infection are influenced by knowledge, attitudes and practices and socio-cultural, economic and political factors which limit an individual's options for reducing risk. Both of these aspects are strongly influenced by gender. In all societies, gender is important in determining what women and men are expected to know about sexual matters, how they are expected to behave and their attitudes in relation to sex:

    —  women and women are often poorly informed about reproduction and sex and therefore risk and risk reduction;

    —  men, rather than women are expected to take the initiative in sexual matters, so women may face abuse for trying to suggest preventive measures such as condom use;

    —  the high value on virginity in some contexts may encourage older men to pursue younger women or it may encourage unmarried women to have anal rather than vaginal sex;

    —  rape, coercion and violence against women have clear consequences for women's risk of HIV infection.

  Social and economic circumstances may lead to conditions of particular risk for both women and men and women's ability to refuse sex or insist on condom use may be severely constrained by their socio-economic position:

    —  high levels of male migration often disrupts marital ties and encourages the growth of sex work in centres for in-migration, leading to risk for male migrants, sex workers and the partners of male migrants who become infected on their partner's return home;

    —  the "feminisation" of the labour force in some areas such as export processing in Newly Industrialised Countries has led to women and adolescent girls having their first sexual experiences younger, when they may not be aware of the potential risks;

    —  in some contexts, women are forced into sex work while in others they may take it up voluntarily through economic necessity;

    —  women's bargaining position to negotiate safe sex with husbands or other partners may be limited by their socio-economic dependence on them;

    —  the importance of parenthood, both to women's and men's gender identities and the importance of motherhood in providing women with security, status and access to resources discourages the use of barrier methods in many contexts.

  A study in Senegal found that for 50 per cent of women living with HIV/AIDS, their only risk factor had been their monogamous sexual relationship with their husband or partner (UNAIDS, 1999 Gender and HIV/AIDS: Taking Stock of Research Programmes).

Gender and the impact of HIV/AIDS

  Gender also plays a significant part in how women and men are able to cope with the epidemic, in terms of social and economic impacts, burdens of care and accessing care and support:

    —  in communities where women are responsible for subsistence farming, if a woman becomes ill, the food security of the household is severely affected. Similarly where men are the main earners of cash, their illness will reduce the access of the household to cash.

    —  available evidence suggests that girls are more likely to be pulled out of school to cope with a mother's illness.

    —  adolescent girls may be forced into early marriage or sex work to support families.

    —  women may have lower access to resources in the household for medical treatment than men.

  A study in Kagera, Tanzania, found that households tended to spend more on both medical and funeral expenses for men than for women:

    —  men may face barriers to seeking care where services are perceived as being directed towards women.

    —  the burden of caring for the sick and orphaned in the household and community usually falls on women.

    —  women widowed as a result of AIDS may be particularly vulnerable. Studies show that many women face loss of social support from their family, ostracism by the community and lack of legal protection to inherit land and property.

    —  where blame for the epidemic has explicitly or implicitly been placed on women, violence and abuse have been reported where women disclose their HIV status to partners or communities

Gender and Quality of Care for HIV/AIDS

    —  much of the early knowledge of HIV/AIDS was based on the effect of the virus on men. Until recently the clinical definition of AIDS was based on male symptoms, and excluded many gynaecological and other symptoms unique to women. Women were excluded from the clinical trials of new drugs because of the possibility of them becoming pregnant.

    —  women's groups in many developing countries have found clear gender differences in advice given during counselling. Women are more likely to be advised not to have sex at all unless their partner is positive, whereas men are told to practice safe sex.

    —  AIDS care policies have tended to rely on individual patients to notify their partners of their condition, and mandatory partner notification has been suggested in some contexts although this may have severe negative consequences for women.

    —  a culture of blaming women for the epidemic has led to particularly hostile reactions to infected women by health care workers.

    —  policies regarding pregnancy and childbirth in the light of HIV have been prescriptive and often unsupportive to women. For example because of the fears of transmission to the foetus HIV positive women are usually advised to avoid or terminate pregnancies. HIV positive women have also been discouraged from breastfeeding despite evidence that the risk of transmission is low. These policies are problematic in circumstances where childbearing is important for women's status and access to resources and where it is difficult to provide safe alternatives to breast-milk.

What can be done?

  Short-term strategies may focus on meeting women and men's immediate needs in specific communities, including:

    —  providing basic sexual health education and information about risk and risk prevention which is provided in a non-judgmental way and made accessible to neglected groups such as adolescents;

    —  providing HIV pre-test and post-test counselling and care programmes which make available information about all aspects of living positively with AIDS, including sexual relations and recognise women's potential problems with partner notification;

    —  forming and supporting self-help groups for people living with HIV/AIDS. Many self-help groups provide holistic care in the community, including counselling, information, health care, legal assistance (for example for workers who are discriminated against, or widows who need to stake a claim to land), income generating activities and micro-credit schemes.

  Gender awareness in the development of policies and programmes for AIDS control and care:

    —  all prevention and care programmes should take measures to ensure the full participation of women and men in their design;

    —  programmes which develop and support community based or home based care need to recognise that care has a cost and that it is usually carried out by women. Programmes should identify how they can support women as carers and encourage men to take on a more caring role;

    —  policies on pregnancy, childbearing and breastfeeding should be informed by the fundamental right to form a family and should recognise the importance of children for women's position in society. Awareness of women's rights and circumstances should be raised with health care workers. Information on risk reduction in conception and pregnancy should be made available to women.

  In the longer term, measures to address the gender aspects of risk include general long term measures to improve women's position. Specific empowerment strategies which have been pursued with relation to HIV/AIDS are:

    —  community work with women and men challenging gendered norms, helping women and men to redefine their relationships in a mutually beneficial way and developing individual negotiating skills—see Stepping Stones case study.

    —  measures to improve women' access to resources—eg through credit, marketing support.

Useful sources of information:

  UNAIDS, 1999 Gender and HIV/AIDS: Taking Stock of Research Programmes Gilks, C, Floyd, K, Haran, D, Kemp, J, Squire, B, Wilkinson, D, 1998, Sexual Health and Health Care: Care and Support for People with HIV/AIDS in Resource Poor Settings. Liverpool School of Tropical Medicine, DFID Health and Population Occasional Paper. Especially Appendix 2: HIV/AIDS and Gender.

  UNAIDS/KIT (Royal Tropical Institute Amsterdam)/ SAfAIDS (South Africa AIDS Information Dissemination Service), Facing the Challenges of HIV/AIDS/STDS: a gender based response.

previous page contents next page

House of Commons home page Parliament home page House of Lords home page search page enquiries index

© Parliamentary copyright 2001
Prepared 29 March 2001