The document discusses the importance of addressing gender equality in Global Fund proposals and responses to HIV, TB, and malaria. It notes that women often have less access to health services and information than men due to social and economic inequalities. It provides examples of how diseases like HIV, malaria, and TB disproportionately impact women. The document advises applicants to involve gender experts and conduct a gender analysis to ensure their proposals address the specific needs of women, men, girls and boys. It also recommends integrating gender-sensitive and transformative interventions that promote human rights and reduce health inequalities.

1. Global Fund Information Note: Addressing Women, Girls and Gender Equality (March 2012) 1
Introduction
The Gender Equality Strategy, endorsed by the Global Fund Board in 2008, reaffirms the Global
Fund’s commitment to addressing gender issues. The strategy encourages activities that address
gender inequalities and strengthen the response for women and girls. The Global Fund
recognizes that men and women1
have unequal access to health services, and that the response
to the three diseases must be made more effective and equitable. Men and women of all ages
should equally be reached by, involved in, and benefit from resources contributed by the Global
Fund.2
The purpose of this document is to describe how applicants can address issues of gender
in their proposals for Global Fund support.
What is gender equality in the context of HIV, TB, and malaria?
Gender differences, both biological (sex) and social, can result in different health risks, health-
seeking behavior, and responses from health systems, often resulting in different health
outcomes. In many contexts, women do not enjoy the same rights, opportunities and access to
services as men. As power is unequally distributed in most societies, women typically have less
access to and control over health information and behavior, care and services, and resources to
protect their health.
Gender is not only a women’s issue because it refers to socially constructed roles and behaviors
that society considers appropriate for men and women. Gender norms affect men’s health, and
can promote risk-taking behavior or neglect of their health, as well as that of their partners and
children. In terms of health care service utilization, men and women seek care differently, while
women usually also bear the burden of caring for infected family members. An adequate health
1
The term men and women used here includes men, women, boys and girls.
2
For more information, please see the following link:
http://www.theglobalfund.org/documents/core/strategies/Core_GenderEquality_Strategy_en/
ADDRESSING WOMEN, GIRLS, AND
GENDER EQUALITY
INFORMATION NOTEADDRESSING WOMEN, GIRLS AND
GENDER EQUALITY
INFORMATION NOTE
This information note has been developed based on normative guidance from and consultation with
technical partners and other key stakeholders. The current version was updated in March 2012 in order
to support Country Coordinating Mechanisms developing funding applications for the Transitional
Funding Mechanism. Although new evidence and normative guidance may have been published since
then, the Global Fund believes that the information contained in this information note is still relevant to
inform countries developing their concept notes during the transition to the new funding model. This
information note will be updated in close coordination with technical partners and other key stakeholders
in order to incorporate new evidence and normative guidance and will be available to countries before
the full implementation of the new funding model.

2. Global Fund Information Note: Addressing Women, Girls and Gender Equality (March 2012) 2
response should address the gender dimensions of specific diseases, and take into consideration
the particular needs and rights of women and men of all ages.
Why is it important to address women, girls, and gender equality?
HIV: Women make up half of all adults living with HIV globally and the majority (60%) of adults
living with HIV in sub-Saharan Africa. Young women consistently have lower comprehensive
knowledge about HIV and AIDS than young men. In some countries young women (15–24 years
old) are three to four times more likely to be infected with HIV than men in the same age group3
.
Besides biological and physiological factors that make women more susceptible to contracting
HIV, harmful gender norms and practices are key drivers of the epidemic. Lack of economic
opportunities, low education levels, and legal, social and political discrimination also influence the
vulnerability of women to HIV. In the hyper-endemic scenarios of southern Africa, HIV is mainly
driven by sexual transmission, often through multiple concurrent partner relationships and age-
disparate sex. In concentrated epidemics, infection is often linked to unsafe paid sex, sharing
contaminated drug injecting equipment, unprotected sex among men who have sex with men
(MSM) and among the sexual partners of those engaging in risk behaviors.
Malaria: Gender differences related to malaria are primarily linked to pregnancy, occupational
risks, and care utilization. During pregnancy, women face severe increased risk of malaria, as
well as increased risk of death or adverse birth outcomes. Each year, approximately 50 million
pregnant women are at risk of exposure to malaria4
. However, reports from 22 high-burden
countries in sub-Saharan Africa show that only 55 percent of women attending antenatal clinics
receive the second dose of intermittent preventive treatment in pregnancy (IPTp)5
. Occupational
risks are high for certain men, for example in mines, fields or forests at peak biting times, or from
migration to highly endemic areas for work. Women rising before dawn to perform household
chores may also be exposed to mosquitoes carrying malaria.
Tuberculosis: Tuberculosis (TB) incidence is generally lower among women than men, the
underlying cause for which needs to be determined and addressed. However, TB is among the
top three causes of death among women aged 15-44 years. In 2009, 1.7 million people died from
TB, including 600 000 women. There were 9.4 million new TB cases, of which 3.3 million were
women. The “feminization” of the HIV epidemic has meant a greater burden of TB among
women.6
TB can cause infertility and contributes to other poor reproductive health outcomes
especially for those with HIV. In many settings, women who become ill with TB may be
stigmatized, discriminated against or ostracized by their families and communities. Cultural and
financial barriers may affect or delay care-seeking behavior by women and TB notification rates.
When care is accessed, more women than men adhere to the full course of treatment. As
principal care-givers for infected family members, women will experience the burden of the
disease even when they are not infected. A better understanding of these gender-related
differences in terms of vulnerability and access to treatment and adherence should be addressed
during the planning process and the development of proposals.
Important to know and consider
Gender sensitive7
and/or transformative8
interventions should seek to address immediate and
long-term concerns related to health, social protection and human rights. This includes, for
example, interventions that address the specific needs of vulnerable women, girls, men and boys,
sex workers, prisoners and women using drugs. It also includes the determinants of health such
3
UNAIDS: 2008 Report on the global AIDS epidemic. Geneva: Joint United Nations Programme on HIV/AIDS; 2008.
Epidemiology slides; 2008 [cited 12 April 2010]; [fig 2.04 and 2.10]. Available from:
http://www.unaids.org/en/dataanalysis/epidemiology/2008reportontheglobalaidsepidemic/
4
Global malaria action plan: global burden and coverage today
5
World malaria report 2010.
http://www.who.int/malaria/world_malaria_report_2010/worldmalariareport2010.pdf
6
Tuberculosis Global facts: http://www.who.int/tb/publications/2010/factsheet_tb_2010_rev21feb11.pdf
7
Gender sensitive approach: Recognize and respond to the different needs and constraints of individuals based on their gender
differences to redress existing and immediate inequalities without action on balance of power in gender relations.
8
Gender transformative approach: A longer-term solution that involves building equitable social norms and structures,
transforming gender roles and creating more gender- equitable relationships.

3. Global Fund Information Note: Addressing Women, Girls and Gender Equality (March 2012) 3
as structural and rights-based issues, harmful norms, laws, behaviors and institutional stigma and
discrimination. Through gender sensitive and/or transformative approaches, health inequalities
can be more systematically addressed in order to ensure improved outcomes for the three
diseases. Women and men must work together to achieve gender equality and successful health
outcomes. Integration of interventions for HIV and sexual and reproductive health (SRH) can
improve health outcomes for women by expanding access, improving quality of care, reducing
duplication of resources and reducing HIV-related stigma and discrimination. This may be
operationalized through the integration of SRH interventions in HIV services or the integration of
HIV into SRH services.9
Addressing Women, Girls, and Gender Equality in Global Fund Proposals
Involvement in the Country Coordinating Mechanism (CCM) and in the proposal
development process
A gender analysis of Rounds 8 and 9 proposals shows that CCMs are still dominated by men,
who accounted for more than two-thirds of members in 200910
. Of the CCMs with approved HIV
proposals in Rounds 8 and 9, 78 percent reported having a gender expert among their
membership. However, less than half reported having involved women’s organizations in the
proposal development process. Applicants should work with gender experts, advocates and
potential beneficiaries throughout this process to validate findings and assess potential impact of
policy and programmatic interventions.
Integration of interventions addressing women, girls, and gender equality in Global Fund
proposals
Both the TRP review of Round 10 proposals and a gender analysis of Rounds 8-10 proposals
suggest that there is a need for countries to improve the integration of gender equality in
proposals. The gender analysis of Rounds 8 and 9 shows that 64 percent of approved HIV
proposals have interventions specifically targeting women, but only 13 percent included
interventions to address harmful gender norms and only 7 percent involved stigma reduction.
Interventions for Prevention of Mother to Child Transmission (PMTCT) often gave little
consideration for the long-term treatment of mothers or the participation of men. In Round 10,
only 24 HIV proposals included interventions to address gender-based violence and from those
only one recommended proposal included a comprehensive package to address gender based
violence. Similarly among 39 Round 10 HIV proposals that included PMTCT, only one-third
involved interventions supporting ART for mothers and their adherence to treatment.
Key steps in incorporating a gender-sensitive approach include:
(a) Epidemiological and behavioral data description and analysis:
Before starting to write a proposal, applicants should conduct an analysis based on the
epidemiological and behavioral data in their country in order to understand the context of the
epidemic and its best response. Applicants should look at gender as one aspect in understanding
how well affected groups are able to access the services they need. Assessing the needs from an
equity perspective can draw on a range of quantitative and qualitative data collection methods.
The equity assessment aims to encourage better use of existing data to inform and improve
proposals submitted to the Global Fund. A detailed information note on “Matching resources to
need: opportunities to promote equity” is also available.
Applicants are requested to provide data disaggregated by sex and age in the epidemiological
background of the proposal, and also in the indicators for planned outcomes over the proposal
term, where relevant. In addition to incidence, prevalence and epidemiological trends, variables
describing geographic and socio-economic factors are important. Cultural trends and sociological
differences that drive the epidemic can shape what will or will not be effective in the response.
Data could include:
9
http://www.who.int/reproductive-health/hiv/index.html
10
An Analysis of Gender-Related Activities in Global Fund Approved HIV Proposals from Rounds 8 and 9, Global Fund,
December 2010.

4. Global Fund Information Note: Addressing Women, Girls and Gender Equality (March 2012) 4
 The magnitude of the epidemic (by sex, age, subgroups, region)
 Epidemic trends: past, current and projected character and potential
 Differences between how women and men in different population groups are affected
 Where the last 1,000 infections occurred (by age, sex, sub-population, socio-economic, and
geographic location) to help define the most vulnerable groups
 Transmission dynamics (modes and sources) that give rise to most new infections
 Extent to which the major responses, including national strategic priorities, investments and
interventions, match the major drivers of infection
 Extent to which major interventions reflect proven approaches and global best practices
For more information consult: “Know your epidemic and your response” as an additional
resource.
(b) Conduct a gender analysis of the epidemiological and behavioral data to describe and
analyze needs, challenges, gaps, and opportunities to reach men and women, boys and girls.
This analysis should describe the extent of marginalization and vulnerabilities of key populations
including: people who inject drugs; MSM; transgender people; sex workers (female, male and
transgender); and women who have sex with women. It is important to note that these are not
homogeneous groups, and they are further divided along age, class, caste, religious, ethnic and
socio-economic lines. A gender analysis should utilize both quantitative and qualitative data
collection methods. Cultural trends and sociological differences that drive the epidemic can shape
what will or will not be effective in the response. The epidemiological and behavioral data
available in the country should lead into a gap analysis to identity areas of gender related gaps
or weaknesses and opportunities to reach men and women, boys and girls with attention to those
who might have been previously excluded. Areas of weaknesses may include gender related
inequality in accessing services, or structural barriers that are resulting in failure to address the
specific needs of a particular group. If the analysis shows that the program does not address
inequities, there is a need to redefine policy and program implications of the gender/gap analysis.
The following table can be used to guide gender-responsive strategies in proposals:
Aspects
related to HIV,
TB, or malaria
For women, girls, men, boys, sex workers (female, male, transgender),
people who inject drugs (female and male), MSM, and other vulnerable or
marginalized groups
Vulnerability  What differences exist in the health risks?
 How do these differ in timing, severity, prevention, and treatment?
 What are the implications for health service delivery?
 Do young girls have the same information, power and tools to protect
themselves against HIV infection compared to young boys of same age?
Access  Does availability of and access to health services differ? Can women have
resources to seek for health services where they are sick?
 What structural constraints affect access to health and health-related
resources (i.e. legal policies, social stigma, provider assumptions,
community norms, religious/cultural proscriptions, cost, time)?
 How are men reached by RH/HIV prevention and services
 Do women living with HIV have access to contraception? Do women living
with HIV have access to accurate information on their contraceptive
options?

5. Global Fund Information Note: Addressing Women, Girls and Gender Equality (March 2012) 5
Service quality  Are services integrated for ease of access by key populations 11
(voluntary
counseling and testing (VCT)/HIV and TB/sexual transmitted infections
(STI) and sexual and reproductive health)?
 Does gender-based stereotyping affect use of health services? Do men
have friendly services where they want to be informed on about their own
sexual and reproductive health?
 Do health providers act as barriers or facilitators to service uptake? What
is the level of stigma towards women and young women living with HIV by
health providers?
Empowerment  Do key populations have opportunities to have a voice in their health
care?
 Are women able to access health care without male supervision?
 Are women and girls able to negotiate terms of sexual relations?
 How does gender affect health care within the family/community?
 What limits service-related mobility, autonomy and decision-making (i.e.
violence and coercion, economic resources, inheritance laws, human
rights)?
(c) Include interventions in response to gaps identified: if the analysis (whether through the
matrix above or some other methodology) shows that the program does not address gender and
especially does not address specific issues of women and girls, there is a need to redefine the
current priorities and change the planned approach for more equitable and efficient health
outcomes.
Planned Interventions should then take into account the analysis of gender related weaknesses
and gaps. The proposal should include activities that are targeted to and designed to improve
health outcomes for most at risk women and girls (including interventions within and beyond the
health sector), and the most at risk and or most affected population in response to the gap
analysis described above. It should specify which activities and which populations. Applicants
should think about how to incorporate gender into the Service Delivery Areas (SDAs) of the
proposal. This will include:
 Developing gender-specific objectives together within overall objectives
 Designing interventions with budget and targets to reach groups of men and women
according to their specific needs
 Including input, process, output, outcome, impact indicators that will help to follow up and
measure the planned interventions and their impact
Examples of how to incorporate activities to address gender inequalities in interventions:
It is important to pay attention to possible gender sensitive and transformative approaches in
SDAs or interventions, whenever appropriate. Any interventions should be based on country
context and evidence of local effectiveness. Below are some examples:
Behavioral Change Communication SDA: The methodology used for behavioral change can
emphasize the importance of partner reduction for both men and women, including through
strategies such as support to enhanced couple-communication, focus group discussions with
women and men on changing patterns of sexual behavior, and strategies to promote positive
models of masculinity.
Behavior change communication and community-based interventions can be effectively used to
change harmful gender norms and practices and unequal gender relationships and discrimination
11
Definition of key populations: Depending on the country context, the following groups may require explicit attention: women
and girls; MSM; transgender persons; people who inject drugs; people who abuse alcohol; male and female sex workers and
their clients; prisoners; refugees and migrants; people living with HIV; young people; vulnerable children and orphans; and
populations of humanitarian concern.

6. Global Fund Information Note: Addressing Women, Girls and Gender Equality (March 2012) 6
against women and girls. They could include: working with men and boys or with traditional and
religious leaders to promote gender equitable norms and attitudes; training, community-based
education, peer and partner discussions; community discussion focused on traditional laws and
customs that may require that women get permission from husbands/fathers prior to seeking
health-care. Mass media campaigns concerning gender equality may also be part of
comprehensive and integrated interventions to increase HIV protective behaviors.
Condom use programs SDA: Both male and female condoms should be promoted.
Interventions can include: training of providers and counselors to be able to promote female
condoms; providing greater availability and access to female condoms; education and training
regarding their use as an additional option to male-controlled condoms.
Post-exposure prophylaxis (PEP) SDA: Addressing gender based violence (sexual, physical,
and psychological) can include comprehensive post-rape prophylaxis services with prophylactic
treatment of HIV infection, emergency contraception, trauma counseling, legal services and social
support; education of police as services providers; awareness raising for families to fight against
stigma for rape survivors.
Prevention of mother-to-child transmission of HIV (PMTCT) SDA: Programs can include
strategies to increase male involvement, couples counseling, offering reproductive choices to
women living with HIV and comprehensive treatment, care and support for mothers and families.
Addressing stigma and discrimination in families and among service providers and communities
should be also part of the strategies that will be used to increase uptake and use of PMTCT
services.
The description of PMTCT interventions should make clear how linkages between HIV, family
planning and sexual and reproductive health (SRH) will be strengthened. The linkage or
integration of these services should consider specific needs of men, women and young people
and women and young girls living with HIV. Given the low interest of men in sexual and
reproductive health, more effort could be made to promote use of these services by men.
Care and support with specific interventions targeting sex workers SDA: A comprehensive
prevention program that includes components such as peer education, medical services, and
support groups, can be effective in enabling sex workers to adopt safer sex practices. Policies
that involve sex workers, brothel owners and clients and law enforcement officials in the
development and implementation of condom use can also increase condom use.
Care and support with interventions addressing socio-economic determinants SDA:
Supportive interventions can include: increased employment opportunities, microfinance,
vocational and skills training or small-scale income-generating activities to reduce behavior that
increases HIV risk taking particularly among women and young girls. Other interventions such as
training men to provide voluntary home care assistance can relieve the burden of home care for
women. This intervention could include also providing life skills training for women, girls and sex
workers to negotiate safer sex and to protect and promote sexual, reproductive and other rights. It
could also include implementing strategies to keep girls in school and to make schools safe for
them.
For more information, applicants are encouraged to consult the document:
www.whatworksforwomen.org
Community Systems Strengthening SDA: Community based organizations including women’s
organizations have a great role to play in effective implementation of most of the above activities.
However, these organizations often lack the resources they need to be effective partners in
national HIV responses. Funding activities that strengthen community responses are key to
improving outcomes. In addition to services and programs, applicants are also encouraged to
focus on system weaknesses within organizations promoting gender equality and especially
within women’s organizations and apply for resources for community systems strengthening. This
may include managerial capacity building and monitoring and evaluation support. Further
information is included in the information note on Community systems strengthening investments
to support responses to AIDS, TB and malaria, available on the Global Fund's website.

7. Global Fund Information Note: Addressing Women, Girls and Gender Equality (March 2012) 7
Any proposed activities should be clearly budgeted for and reflected in the budget and work plan.
The activities integrated in the proposal should have corresponding indicators for measurement
and monitoring assigned to them. In the performance framework, key outcomes and impact
indicators should be disaggregated by sex and age where relevant (considering UNGASS,
national M&E system and the context of the epidemic/disease in the country).
(d) Integrate gender into monitoring and evaluation
Gender-sensitive monitoring and evaluation (M&E) requires a mix of input, output, outcome and
impact indicators that reveal the extent to which an activity has addressed the different needs of
women and men. Practical steps to improve the existing M&E system should include: (i)
development of a management information system that incorporates both first and second
generation surveillance data; (ii) inclusion of data disaggregated by sex and age at minimum and
ideally by other stratifiers; and (iii) ongoing operational research to collect data on key affected
populations. The choice of appropriate gender-sensitive indicators varies according to project
goals, the state of the epidemic, the level of understanding on how gender issues affect the spread
of the disease and access to treatment, care and support, and the availability of both quantitative
and qualitative sex-disaggregated data.
The Global Fund recognizes that many countries may not be able to generate useful and reliable
strategic information for decision making through their M&E system. The Global Fund
recommends that applicants invest 5-10% of program budgets in M&E to address gaps and
weaknesses identified in the system. This budget may be used, for instance, to strengthen
collection of disaggregated data, or introduce it, enhance analytical capacity to interpret data or to
fill the information gaps with qualitative and/or quantitative studies.
e) Guidance and technical assistance
A vast range of programmatic resources and guidance is available from technical partners (such
as WHO, UNAIDS, UNICEF, UNFPA, UNDP) and civil society organizations to help applicants to
select interventions and design programs that address the specific needs of women and girls
and inequities in relation to the epidemiological and country context. These partners also provide
technical assistance for proposal development. Some examples are listed above.
Resources and links to tools and guidance
(a) Gender and Health
 What is "gender mainstreaming"?
http://www.who.int/gender/mainstreaming/en/
 Women and health: today's evidence tomorrow's agenda.
http://whqlibdoc.who.int/publications/2009/9789241563857_eng.pdf
 Engaging men and boys in changing gender-based inequity in health: Evidence from program
interventions
http://www.who.int/gender/documents/Engaging_men_boys.pdf
 Involving Men in Promoting Gender Equality and Women’s Reproductive Health
http://www.unfpa.org/gender/men.htm
(b) HIV and AIDS
 WHO tool for integrating gender into HIV programs, 2008
http://www.who.int/gender/documents/gender_hiv_guidelines_en.pdf
 UNAIDS action framework on women, girls, gender equality and HIV, 2009
http://data.unaids.org/pub/Report/2009/jc1794_action_framework_gender_equality_en.pdf
UNAIDS Agenda for Accelerated Country Action for Women, Girls, Gender Equality and HIV
http://www.unaids.org/en/media/unaids/contentassets/dataimport/pub/report/2010/jc1825_com
munity_brief_en.pdf
 UNAIDS action framework on universal access for MSM and transgender people, 2009
http://data.unaids.org/pub/Report/2009/jc1720_action_framework_msm_en.pdf

8. Global Fund Information Note: Addressing Women, Girls and Gender Equality (March 2012) 8
 UNAIDS guidance note on HIV and sex work, 2009
http://data.unaids.org/pub/BaseDocument/2009/jc1696_guidance_note_hiv_and_sexwork_en.p
df
 Fact sheet: Gender and HIV/AIDS
http://www.who.int/gender/documents/en/HIV_AIDS.pdf
 Women and HIV/AIDS- links and publications
http://www.who.int/gender/hiv_aids/en/
 Linkages between sexual and reproductive health (SRH) and HIV
http://www.who.int/reproductive-health/hiv/index.html
 Gender-based violence
http://www.who.int/topics/gender_based_violence/en/
 Example of Indicators for Programs to Address Violence Against Women and Girls
http://www.cpc.unc.edu/measure/news/indicators-for-programs-to-address-violence-against-
women-and-girls
 UNIFEM Gender and HIV/AIDS Portal
http://www.genderandaids.org/
 The Gender Dimensions of the HIV/AIDS Epidemic
http://www.unfpa.org/gender/aids.htm
 The Global Coalition on Women and AIDS
http://womenandaids.unaids.org
 Exploring the role of economic empowerment in HIV prevention
http://journals.lww.com/aidsonline/Fulltext/2008/12004/Exploring_the_role_of_economic_empo
werment_in_HIV.6.aspx?WT.mc_id=HPxADx20100319xMP
 Rapid Assessment Tool for sexual and reproductive health and HIV linkages
http://data.unaids.org/pub/Manual/2009/2009_rapid_assesment_brochure_en.pdf
 A Practical Guide to Implementing Reproductive Health and HIV/AIDS into Grant Proposals to
the Global Fund
http://www.populationaction.org/Publications/Reports/A_Practical_Guide_to_Integrating_Repr
oductive_Health_HIV-AIDS/Summary.shtml
 Gender Mainstreaming in HIV/AIDS; Taking a Multisectoral Approach
http://www.thecommonwealth.org/shared_asp_files/uploadedfiles/%7B735AB75B-7A3A-4FC0-
BC39-A342BB570D7B%7D_HIV%20AIDS%20gender%20manual.pdf
(c) Gender and Malaria
 A Guide to Gender and Malaria Resources:
http://www.rollbackmalaria.org/docs/advocacy/gm_guide-en.pdf
(d) Gender and Tuberculosis
 Gender in Tuberculosis Research: http://www.who.int/gender/documents/TBlast2.pdf