Bindura University of Science Education
• Gender refers to sexual identity or the condition of
being male or female or being masculine or feminine.
• Gender inequity and inequality are critical in the
spread of HIV. This explores the need to involve
men in problem solving rather than seeing them as
part of the problem. The inequalities between men
and women aggravate the situation for women with
HIV and AIDS.
• In many cultures, ideals of manhood include
strength, courage and dominance and critically
accept men as having an uncontrollable sex drive
that let them off the hook of responsibility.
• Alcohol is a major contributing factor reducing the
sense of responsibility further.
• Little blame or stigma is attributed to men when men
says he had sex when he was drunk. On the other
hand if it is a woman she is labeled by both men and
women as a whore.
Men & HIV & AIDS
• Gender norms related to masculinity can encourage men
to have more sexual partners and older men to have
sexual relations with much younger women.
In some settings, this contributes to higher infection rates
among young women (15-24 years) compared to young
Norms related to masculinity, i.e. homophobia,
stigmatizes men having sex with men, and makes them
and their partners vulnerable to HIV.
Women & HIV & AIDS
• According to the latest (2008) WHO and UNAIDS
global estimates, women comprise 50% of people
living with HIV.
In sub-Saharan Africa, women constitute 60% of
people living with HIV. In other regions, men having
sex with men (MSM), injecting drug users (IDU), sex
workers and their clients are among those most-atrisk for HIV, but the proportion of women living
with HIV has been increasing in the last 10 years.
Women & HIV & AIDS
This includes married or regular partners of clients
of commercial sex, IDU and MSM, as well as female
sex workers and injecting drug users.
Women & HIV & AIDS
• Gender inequalities are a key driver of the epidemic
in several ways:
• Aiming for two Millennium Development Goals
• HIV/AIDS programmes that promote and invest in
gender equality contribute to both MDG 6 on
combating HIV/AIDS, TB and malaria and to MDG
3 on promoting gender equality and women's
Norms related to femininity can prevent women –
especially young women – from accessing HIV
information and services. Only 38% of young women
have accurate, comprehensive knowledge of
HIV/AIDS according to the 2008 UNAIDS global
HIV/AIDS programmes can address harmful gender
norms and stereotypes including by working with
men and boys to change norms related to
fatherhood, sexual responsibility, decision-making
and violence, and by providing comprehensive, ageappropriate HIV/AIDS education for young people
that addresses gender norms.
Violence against women (physical, sexual and
emotional), which is experienced by 10 to 60% of
women (ages 15-49 years) worldwide, increases their
vulnerability to HIV.
Forced sex can contribute to HIV transmission due to
tears and lacerations resulting from the use of force.
Women who fear or experience violence lack the
power to ask their partners to use condoms or refuse
unprotected sex. Fear of violence can prevent women
from learning and/or sharing their HIV status and
Programmes can address violence against women by
offering safer sex negotiation and life skills training,
helping women who fear or experience violence to
safely disclose their HIV status, providing
comprehensive medico-legal services to victims of
sexual violence, and working with countries to
develop, strengthen and enforce laws that eliminate
violence against women.
Gender-related barriers in
access to services
Gender-related barriers in access to services
prevent women and men from accessing HIV
prevention, treatment and care.
Women may face barriers due to their lack of access
to and control over resources, child-care
responsibilities, restricted mobility and limited
Socialization of men may mean that they will not
seek HIV services due to a fear of stigma and
discrimination, losing their jobs and of being
perceived as "weak" or "unmanly".
Programmes can improve access to services for
women and men by removing financial barriers in
access to services, bringing services closer to the
community, and addressing HIV-related stigma and
discrimination, including in health care settings.
Women as Caregivers
Women assume the major share of care-giving in
the family, including for those living with and
affected by HIV. This is often unpaid and is based on
the assumption that women "naturally" fill this role.
Programmes can support women in their care-giving
roles by offering community-based care and support,
including by increasing men's involvement.
Marriage also increases the of having HIV.
Lack of education and
Lack of education and economic security affects
millions of women and girls, whose literacy levels
are generally lower than men and boys'.
Many women, especially those living with HIV, lose
their homes, inheritance, possessions, livelihoods
and even their children when their partners die. This
forces many women to adopt survival strategies
(e.g. prostitution) that increase their chances of
contracting and spreading HIV.
Education & Economics
Educating girls makes them more equipped to make
safer sexual decisions.
Programmes can promote economic opportunities
for women (e.g. through microfinance and microcredit, vocational and skills training and other
income generation activities), protect and promote
their inheritance rights, and expand efforts to keep
girls in school.
Anatomy of women
Young girls have an underdeveloped reproductive
system which is so delicate and prone to bruises
hence increased chances of HIV infection.
The anatomy of women i.e. the inner vaginal
membrane have fornices which harbour the virus
hence increases the chances of HIV infection.
Anatomy of women
Menstruation also increases the chances of infection .
During menstruation there is shading of blood from
inflamed endometrium which increases chance of
HIV if there is unprotected sex with an infected
partner during this period.
Many national HIV/AIDS programmes fail to
address underlying gender inequalities. In 2008,
only 52% of countries who reported to the UN
General Assembly included specific, budgeted
support for women-focused HIV/AIDS
HIV/AIDS programmes should :
collect and use sex and age disaggregated data to
monitor and evaluate impact of programmes on
build capacity of key stakeholders to address gender
facilitate meaningful participation of women's
groups, women living with HIV and young people
allocate resources for programme elements that
address gender inequalities.
Culture and Religion
Culture and religion have an influence on sexual
and societal level.
behaviour at both individual
Many men and women publicly endorse the strict moral
norms of their religion and culture but privately behave
One approach of HIV prevention is to encourage people
to follow more closely the precepts of their religion and
Culture & religion
HIV prevention can be achieved by the following
precepts of religion; usually promotes strict sexual
guidelines e.g. Christianity only accepts sex within a
monogamous marriage. While Islam accepts
polygamy, but again only accepts sex within
Culture & religion
• In Africa some traditions tend to support polygamy
and taboos against sex outside marriage, which
differs widely for males and females, and in specific
situations e.g. rites held at puberty in some countries
involve sexual intercourse.
• In Swaziland it is a prestige for a men to have
multiple female partners e.g. king, which would
promote high-risk behaviour.
1. The practice of levirate (inheritance of a wife by the
deceased husband’s brother), despite the cause of
death e.g. AIDS.
2. Initiation rites in parts of Malawi, involve
adolescent girls being secluded for training to be a
wife, the training includes sex with an anonymous
man selected from the community.
The practice of dipo (initiation ceremony into
womanhood in Krobo culture in Ghana involves
initiating sexual activity. Adolescents were usually
targeted but now younger girls are now involved
Polygamy-were use of condoms is not practiced, if
the partner is infected, the other are at high risk of
infection during the window phase.
The practice of dry sex-common in South East,
West and central Africa. Vaginal secretions are seen
as dirty and indicate that the woman’s sexually
aroused which may not be socially acceptable.
iii. The view that the boy friend must use force in a first
sexual encounter with new girlfriend, so that she can
prove to be respectable. This leads to the risk of
tearing and increases chances of infection.
iv. Expectation in parts of Zimbabwe that the woman
uses the same cloth to clean herself and the man after
sex, even if a condom was used.
v. Sex is male pleasure and sex in marriage is for
procreation rather than for enjoyment, men needs a
variety of different partners outside marriage.
First sexual contact (act) with a new partner cannot
cause pregnancy or infection.
The view that wives cannot contact STI from
unfaithful husbands because STIs do not affect
Fears that condoms actually spread HIV, or that they
can become stuck in the vagina.
Culture & Religion
Culture, tradition, beliefs and values are dynamic
and are changing over overtime and can be
influenced in positive ways. Changing does not
mean abolishing a particular practice or custom but
only changing the damaging or harmful elements
while retaining the overall custom, it’s symbolism
and its meaning.
Culture & Religion
• Religious prohibitions against sex education and
• Some powerful religious and faith groups still
oppose sex education despite the evidence in favour
of it. Hence the reason why faith groups need to
decide whether they are more concerned with or to
try to prevent sex that they consider immorale.g.
Catholics. Some churches support condom use e.g.
Culture & Religion
• Although in other studies, Catholics, developed a
concept e.g. Tanzania, Fleet of Hope Three Boats
namely Fidelity, Chastity and Condoms. Therefore a
person chooses which boat to move in, but
condemning those who chose the condom boat.
• The Fleet of Hope is being utilized as a tool for
behaviour change communication in many countries.
Culture and religion
Culture, tradition and beliefs are dynamic and they can
be influenced in positive ways
There is need for sensitive approaches that promote
discussion and involvement to transform some of the
We don’t need to abolish the tradition but merely
change the damaging elements while retaining the
overall custom, its symbolism and its meaning
• The period of development between puberty and
• Development: Process of growth and differentiation.
• About half of the population in developing countries
is aged between 15 and under, and this is the age
group that is beginning to be sexually active. Hence
the reason why access to quality sexual and
reproductive health services information is
• The cultural and religious leaders need to actively
support the youths.
• Peer pressure force the youths to engage in sexual
• Biological, social and economic pressures may
encourage young people to have sex while tradition,
a sense of morality , and religious and family
pressure are likely to discourage girls from engaging
in sex but not necessarily boys.
• Pressures that force young people into sex are:
• Alcohol and other drug consumption that reduces
the will power, judgement and inhibitions.
• Curiosity and hormonal changes (natural).
• Pressures from the friends e.g. be a real men.
• Pressure on girls from boys who refuse to believe
that NO means “NO”.
• Coercion of girls into sex for exchange of gifts,
money, marriage or other benefits. This is usually by
sugar daddies, who maybe teachers, relatives,
friends of the family , members of the
• Urge to rebel against parental rules to establish an
• Media images showing casual sex in glamorous,
• Poverty and pressure on girls to engage in sex to pay
for school fees, food or other needs.
• Fear of seeking sexual release through masturbation.
• Lack of knowledge about non-penetrative sex
• Trafficking in women and girls whereby they are
abducted or promised employment and then sold
into prostitution, less in Sub-Saharan Africa than in
by Verkuhl (1998)
• Approaches of helping young to stay safe.
a) Information and Empowerment
Equip young people with adequate knowledge on
(technical sex education), moral standards(peer
pressure) and materials(pill, condom, STI clinics), to
make sex enjoyable without exposing them to too
much risk. (teach teenagers how to swim or how to
use a boat, while telling them about crocodiles and
bilhazia in the water).
b) Repression and Control
• Create taboos about sexual relationships outside
formal marriage and enforce the taboos using
culture and religion.
• The method leads to little information and even
misinformation.( refusing to teach teenagers how to
swim and use the boat while warning them about
dangers in the water).
• Approach A-Leads to few teenage pregnancies,
abortions, STIs and HIV rates are low e.g. in the
• Approach B-commonly used in the Muslim culture
i.e. control route, where there is female genital
mutilation (FGM). Removal of the external genitals
e.g. clitoris and sewing up the vagina and leaving a
hole for menstruation.
It causes excruciating pain, psychological trauma,
risk of infection from wounds.
Agony repeated when husband has to break open
the scar tissue to have sex and again during child
birth. The later leads to increased maternal mortality
FGM is common in Northern and East Africa and
parts of West Africa.
• Providing information to enable them to make their
• Assisting youths to gain access to education and
• Supporting young people to help themselves and
• Helping young people to reduce gender inequality
all areas but particularly around sexual relationships.
• Ensuring youths have access to youth friendly sexual
and reproductive health services e.g. VCT and use of
• Helping youths to find gainful employment.
• Adolescent sexual health reproduction actually starts
early e.g.in Zimbabwe it starts in primary school.
• Key strategies to empower children and young
people are sex education and life skills development
before they become sexually active.
The aim is to maintain safe behaviour into future,
delaying the start of sexual activity.
UNESCO (1998) and UNAIDS, 1997 states that sex
education combined with life skills development
including a focus on HIV/AIDS /STIs and
reproductive health tends to delay onset of sexual
activity and make young people’s existing sexual
Communication remains the only vaccine against the
spread of HIV because there is no cure for AIDS.
Fight against AIDS remains in the use of
communication to teach people about the disease
and encourage them to change behaviour.
The use of communication techniques and
technologies can positively influence individuals,
populations and organizations in the fight against
Health communication remains the only “vaccine”
against the spread of HIV.
Strategies to provide condoms and promote their use
are compatible with promoting abstinence.
Using condoms is the smallest behaviour change to
make risky sexual behaviour safe.
Any barrier method to prevent infection still carries a
risk e.g. if condom breaks there are chances of
• Consistent condom use reduces the risk of HIV (&
other STIs) transmission .
• Efficiency rate is 99.99%, one in 100,000 can be
expected to break or let viral particles pass.
• Although as a personal strategy against HIV
infection, condom use is not a perfect solution, it
requires people to be highly motivated, always
having them available and of good quality .
There are two types of condoms , male and female.
Both are available on the market, but the female
condom cost more than the male.
Female condoms appear to be highly effective at
preventing infection and pregnancy, being made of
stronger material than the male condoms and
unlikely to tear.
Careful information and behaviour change
campaigns combined with marketing of condoms in
an attractive way can increase condom acceptability.
Condoms need to be associated in public mind with
positive images appropriate to the target group
whether love, sensuality, fun, sexiness, performance,
excitement, safety, trust, care or responsibility.
Barriers to condom use
Availability and accessibility.
Culture and Religion.
Myths and Misconceptions about condoms.
Incompatibility with the need to have children.
Trust and Fidelity in stable relationships.
Ways of reducing HIV &
Fewer sexual partners, Monogamy
The more the sexual partners, the greater the chance
that one or more have HIV. If no body in the
population has many partners, HIV spreads much
more slowly than in the populations where many
men have multiple partners.
“sticking to one faithful partner” or “zero grazing" as
it is called in Uganda if it applies to both partners
equally is a useful message.
Non-penetrative sex and abstinence -:Culture
In some cultures sexual practices involves the men
rubbing his penis between the tightly closed thighs
of his partner until he reaches ejaculation.
Traditional healers, health staff and educators should
encourage this traditional practice where
Masturbation does not involve any penetration and
is essentially safe.
It can be between two people or undertaken alone
for sexual release.
Avoiding any penetrative sexual activity is another
option: Realistically if abstinence is advocated then
masturbation should be encouraged to make
abstinence easier to maintain over time. Nonpenetrative sex is a safe option for HIV discordant