Gender (Updated December 2007)

President George W. Bush's Emergency Plan for AIDS Relief is the largest commitment ever by any nation for an international health initiative dedicated to a single disease-- a five-year, $15 billion, comprehensive approach to combating the disease around the world. U.S. Department of State U.S. Agency for International Development U.S. Department of Defense U.S. Department of Commerce U.S. Department of Labor U.S. Department of Health and Human Services Peace Corps Mailing address: SA-29, 2nd Floor 2201 C Street, NW Washington, DC 20522-2920 www.PEPFAR.gov

Gender  Addressing gender issues is essential to reducing the vulnerability of women and men to HIV infection. Key strategies of the U.S. President’s Emergency Plan for AIDS Relief (Emergency Plan/PEPFAR) aimed at supporting women and girls are incorporated into all PEPFAR program areas and focus on the areas highlighted here.   The Power of Partnerships As of September 30, 2007: In the focus countries, 62% of the individuals on antiretroviral treatment as a result of direct PEPFAR support were women and girls. Increasing gender equity in HIV/AIDS programs and services These programs are designed to provide equitable access to services for both women and men. Specific approaches include: collecting disaggregated data by sex to monitor the number of women and men receiving services; designing treatment service delivery to reduce barriers to women’s access and participation; reaching out to men through prevention of mother-to-child HIV transmission centers and offering them HIV counseling and testing services; and mitigating the burden of care on women and girls by linking treatment and care programs with community efforts that provide resources such as food, support for school expenses, household help, farm labor and child care. Reducing violence and coercion Sexual and other forms of abuse against women and girls fuel the spread of HIV. The practice or threat of sexual violence against women and girls puts them at increased risk of HIV infection by creating situations in which women are unable to voluntarily abstain from sex or negotiate condom use. The Emergency Plan supports the activities of community- and faith-based organizations to change social norms that perpetuate male violence against women, train couples in negotiation and conflict resolution, and strengthen policy and legal frameworks that outlaw gender-based violence. It also supports HIV post exposure prophylaxis in clinical settings for survivors of violence; development of couples HIV counseling; partner notification strategies; health workers’ awareness of and skills to address violence; and links with community and social services that provide protection and care for victims of violence. Addressing male norms and behaviors Practices such as multiple and concurrent sex partners, cross-generational sex, and transactional sex increase vulnerability to HIV infection, particularly among women and girls. To address these issues, the Emergency Plan supports community-based prevention programs and media messages with a focus on positive norms for boys and men; couples HIV counseling and testing as an opportunity to address gender norms and reach men; programs to address alcohol and substance abuse; and special programs with the armed services focusing on responsible male behavior.

Increasing women’s legal protection Many of the practices that increase women’s vulnerability to HIV and limit their capacity to manage its consequences are reinforced by policies, laws and legal practices that institutionalize discrimination against women. The Emergency Plan supports efforts to review, revise and enforce policies that protect victims of sexual violence; support women’s property and inheritance rights; enhance women’s access to legal assistance; and eliminate gender inequalities in civil and criminal codes. Increasing women’s access to income and productive resources The Emergency Plan recognizes that a lack of economic assets increases the vulnerability of women and girls to HIV infection. PEPFAR supports efforts to provide women with economic opportunities to empower them to avoid high-risk behaviors, seek and receive health care services, and care for their families. Such efforts include micro-enterprise and micro-credit activities for HIV-positive women, programs to ensure that girls are given equal opportunity to attend school and vocational training, and skills and management training targeted to offer economic alternatives to prostitution. Additionally, links between Emergency Plan and other U.S. Government-supported education, economic development and microfinance programs are being strengthened.   The Emergency Plan at Work: The following examples illustrate how the Emergency Plan is working in partnership with host nations to address gender issues in HIV/AIDS prevention, treatment and care programs: In Kenya, the Kenya Federation of Women Lawyers provides legal advice to people living with HIV/AIDS concerning rape, sexual assault, and property and inheritance rights.   In Haiti, the Lakay Social Clubs provide HIV/AIDS prevention services for women in prostitution in combination with offering educational opportunities and income-generating alternatives to prostitution. The Lakay project has two main objectives: helping women abandon the sex trade and reducing the incidence of sexually transmitted infections and HIV/AIDS among these women and their clients.   In South Africa, the Men as Partners project tailors behavior change interventions to define masculinity and strength in terms of men taking responsible actions to prevent HIV infection and forced sex. Advertisements and public marches promote men as responsible partners. The program’s comprehensive approach has included: influencing policy and legislation; mobilizing communities; changing organizational practices; fostering coalitions and networks; educating providers; promoting community education; and strengthening individual knowledge and skills so people can decide how to protect themselves.   In Rwanda, Mozambique, Haiti and Kenya, churches, schools and community clubs are working together with a partner organization to encourage abstinence until marriage, fidelity in marriage, and healthy lifestyle choices among youth. These programs are tailored to the specific needs of girls and boys of different ages and circumstances, and include special efforts to reach disenfranchised girls through clubs, activities and small groups. The integrated approach fosters interactive learning and engages influencers of youth to explore and promote positive gender role models.