Gender Inequality and its Impact on Women's Risk of HIV and Access to HIV Services
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Gender Inequality and its Impact on Women's Risk of HIV and Access to HIV Services

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  • This presentation will provide an overview of the evidence of gender inequality and its impact on women’s increased vulnerability to HIV and uptake of HIV prevention, testing, care and treatment services.
  • This is the definition of gender from the WHO.
  • This is the definition of gender from the WHO.
  • These are some of the links between gender inequality and women’s risk of HIV infection
  • The results of the WHO Multi-Country study suggest evidence that gender-based violence is prevalent all over the world and has detrimental impacts on women’s health, including increasing women’s risk of HIV.
  • Evidence suggests that levels of GBV increase during pregnancy when women are physiologically more vulnerable to HIV.
  • Evidence suggests that levels of GBV increase during pregnancy when women are physiologically more vulnerable to HIV.
  • This is some of the research pertaining to gender inequality and its impact on women’s uptake of HIV testing
  • This is some of the research pertaining to gender inequality and its impact on women’s uptake of ARV prophylaxis, ART and Adherence
  • In 2008, 45% of HIV-positive pregnant women received antiretrovirals for PMTCT, up from 33% in 2007 and 14% in 2004. However 2008 data indicates that only 24% women testing positive for HIV at ANC were assessed (by CD4 cell counts) for their own eligibility for ARVs. Although 24% is low, it actually represents a big increase from 2007, where only 12% of women were assessed by CD4 count. PMTCT programmes must do better in assessing women’s needs for treatment beyond prevention of vertical transmission
  • But to what extent are women-sensitive programmes actually being implemented? While 83% of responding countries report having women included as a specific “sector“ in their multi-sectoral strategic framework, only slightly more than half of countries (53%) report having a budget attached to programmes which address women’s issues. Those countries which have provided specific, budgeted support for such programmes are mostly in North America, Asia, the Caribbean and sub-Saharan Africa. (NOTE NORTH AMERICAN CASE)
  • -A tool for the UN system, CSOs (women's organizations), and governments to mobilize country action for making the AIDS response better meet the needs and rights of women and girls -Outline the principles of the OP: participation, evidence-informed responses, engagement of men, leadership, multisectorality, accountability

Gender Inequality and its Impact on Women's Risk of HIV and Access to HIV Services Gender Inequality and its Impact on Women's Risk of HIV and Access to HIV Services Presentation Transcript

  • Gender inequality and its impact on women’s risk of HIV and access to HIV services Dr Jantine Jacobi Team Leader, Women, Girls and Gender Equality Director, Global Coalition on Women and AIDS UNAIDS [email_address]
  • HIV statistics
    • About 16 million women are living with HIV, most of them in Sub-Saharan Africa
    • Globally, women make up 50% of the global epidemic
      • In sub-Saharan Africa 60 % of the people living with HIV are female;
      • Young women account for 75% of HIV infections in the 15-24 years old age group
      • In Asia, the percentage of women living with HIV rose from 19% in 2000 to 35% in 2008
  • Young women are particular vulnerable to HIV infection young women are particular vulnerable to HIV infection HIV infection rates, by age group in selected countries Women 15-19 (%) Men 15-19 (%) Women 20-24 (%) Men 20-24 (%) Botswana 5.0 2.4 16.0 7.4 Kenya 3.5 1.0 7.4 1.9 South Africa 6.7 2.5 21.1 5.1 HIV infection rates, by age group in selected countries Women 15-19 (%) Men 15-19 (%) Women 20-24 (%) Men 20-24 (%) Botswana 5.0 2.4 16.0 7.4 Kenya 3.5 1.0 7.4 1.9 South Africa 6.7 2.5 21.1 5.1 Source : Global Report, 2008, UNAIDS 5.1 21.1 2.5 6.7 South Africa 1.9 7.4 1.0 3.5 Kenya 7.4 16.0 2.4 5.0 Botswana Men 20-24 (%) Women 20-24 (%) Men 15-19 (%) Women 15-19 (%) HIV infection rates, by age group in selected countries
  • HIV infections detected in Papua New Guinea, by age, 1987 – 2006 Source : Papua New Guinea National AIDS Council and Department of Health. Figure 29 0 500 1000 1500 2000 2500 3000 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 Over 60 Unknown Male Female Sex not Stated Number Age group
  • Unequal status
    • HIV infection is often related to the unequal status of women, present in many parts of the world - similar trend for violence
    • Societies have collective ideas about the status of women and men in relation to one another, including appropriate roles, rights, responsibilities and accepted behaviors (WHO)
      • These ideas vary within and between cultures
    • Societal norms and rules are often hierarchal and unequal for women in general populations
    • Women often don’t have the same access to resources, power and influence in comparison with men.
  • Clear link between gender inequality and women’s risk of HIV
    • Gender-based unequal power pose barriers to the adoption of safer sex practices in relationships (USAID 2009)
    • Even with known risk of HIV/STIs, it is often not possible for women to insist on faithfulness or condom use in the relationship (Dunkle 2007)
    • Recent data on violence against young women in South Africa shows that power inequity and intimate partner violence increase women’s incidence of HIV (Jewkes 2010)
  • Violence affects women and girls all over the world
    • A multi-country study revealed that between 15% and 71% of women (15-49) had experienced physical and/or sexual violence (WHO, 2005)
    • Between 11% and 45% of adolescent girls report that their first sexual experience was forced.
  • Swaziland: 2007 study on sexual violence against adolescent girls
    • 25% of girls 13-17 years of age reported experiencing some form of sexual violence
    • 66% of young women 18-24 years of age years of age reported experiencing some form of sexual violence
    Source : Government of Swaziland, UNICEF, CDC
  • Violence during pregnancy
    • Data suggest that violence increases during pregnancy, increasing risk of HIV infection for the woman and her infant (WHO 2005, Martin 2004, Valladares 2005, Gray 2005)
    • 10% pregnant women in Zambia, 7% of pregnant women in South Africa, 77% of women in Ethiopia have been physically assaulted during pregnancy (Watts and Mayhew 2004)
    • Mostly by the father of the baby
  • Gender inequality and HIV testing
    • Male partners influence women’s uptake of HIV testing, especially in antenatal services (Bajunirwe 2005, Maman 2008)
    • Women’s perception of husband’s approval was the strongest predictor of her willingness to accept a HIV test (Bunjunirwe 2005)
    • Opposition from male partners was one of the major reasons for low uptake of HIV counseling and testing in some contexts (Sarker 2007)
    • Women’s fear of a negative reaction (violence) from her partner emerged as a key theme in a multi-study review of factors influencing pregnant women’s HIV uptake
  • Disclosure and ART
    • Between 16-51% of women in Tanzania, South Africa and Kenya cited fear of violence as a major barrier to disclosure (Medley 2004)
    • Women may experience difficulty with adherence to ARV prophylaxis and treatment because of concerns related to disclosure (WHO 2009)
    • The highest rates of disclosure-related violence were encountered in ANC, with violence reported to be an obstacle to ART (WHO 2004) (Human Rights Watch 2007)
  • PMTCT increase: 43% in 2008 from 15% in 2005 However, in 2008, only 24% women testing positive for HIV at ante-natal clinics were assessed for their own eligibility for ARVs. Source : UNAIDS, UNICEF & WHO, 2008; data provided by countries. 4.13
  • Source : UNGASS Country Progress Reports 2008. 83% of countries report having women included as a specific “sector“ in their multisectoral strategic framework Only 53% report having a budget attached to programmes which address women’s issues Caribbean (12) East Asia (3) Eastern Europe and Central Asia (16) Latin America (19) Middle East (4) North America (1) Oceania (7) South and South- East Asia (13) Sub- Saharan Africa (41) Western and Central Europe (14) 0 20 40 60 80 100 Percentage of countries (%) Women are addressed as a specific component of multisectoral HIV strategy (Number of countries reporting) Women are addressed as a specific component of multisectoral HIV strategy with a budget
  • UNAIDS Agenda for Women and Girls
  • Thank you Merci