AIDS Ed 3 5 03 Murphy

Gender and the ABCs: 

Gender and the ABCs Elaine M. Murphy, Ph.D. George Washington University School of Public Health

Sex is biological; gender is cultural: 

Sex is biological; gender is cultural 'Gender norms refer to the societal expectations for male and female behavior and roles, and the relative value of males and females. They…accord different rights [and] create inequality between the sexes in power, autonomy and well-being, typically to the disadvantage of females.' Karen Mason, Gender andamp; Demographic Change: What Do We Know? IUSSP, 1995.

“Since the global response to HIV/AIDS began more than a decade ago, remarkable strides have been made in our understanding of the nature, scope and impact of HIV/AIDS…The most striking development is the recognition of the role that gender plays in fueling the pandemic and influencing its impact.” Gender and HIV/AIDS: Taking Stock of Research and Programmes. UNAIDS Best Practices Collection, 1999: 

'Since the global response to HIV/AIDS began more than a decade ago, remarkable strides have been made in our understanding of the nature, scope and impact of HIV/AIDS… The most striking development is the recognition of the role that gender plays in fueling the pandemic and influencing its impact.' Gender and HIV/AIDS: Taking Stock of Research and Programmes. UNAIDS Best Practices Collection, 1999

More women living with HIV/AIDS than men, end of 2001: 

More women living with HIV/AIDS than men, end of 2001 Source: UNAIDS Country Fact Sheets, 2002

Do the “ABCs” prevent AIDS? (USAID is sponsoring 6-country study on ABCs)Is it just political?Are the ABCs gender-friendly? : 

Do the 'ABCs' prevent AIDS? (USAID is sponsoring 6-country study on ABCs) Is it just political? Are the ABCs gender-friendly? A' is for Abstinence and delay of sexual debut 'B' is for Be faithful or reduce no. of partners 'C' is for Condom use: male andamp; female condoms

Ideally, how might improved gender dynamics fit with ABCs?: 

Ideally, how might improved gender dynamics fit with ABCs? 'A' is for Abstinence and delay of sexual debut Girls/young women feel more confident to delay sexual debut, return to abstinence,* avoid/refuse coerced or unwanted sex, refuse sex w/out condom, negotiate non-penetrative sex. Adolescent and young men re-think 'macho' norms (e.g., manhood=sexual domination), also wait longer to have sex, return to abstinence,* andamp; refuse unwanted sex (e.g., w/out condom). *Abstinence is temporary: eventual marriage is virtually universal

Ideal gender dynamics & ABCs “B” is for Be faithful or reduce no. of partners: 

Ideal gender dynamics andamp; ABCs 'B' is for Be faithful or reduce no. of partners Gender equity: Men now adhere to same standard of fidelity they hold their wives or girlfriends to (who are under threat of being beaten, divorced or abandoned). Other men, re-thinking macho behaviors, reduce no. of partners, are not coercive, and avoid or reduce visits to sex workers. Unmarried women (esp. as they become less financially dependent) are faithful or reduce no. of partners.

Ideal gender dynamics & ABCs “C” is for Condom use—male & female condoms: 

Ideal gender dynamics andamp; ABCs 'C' is for Condom use—male andamp; female condoms Young unmarried women feel confident to negotiate condom use or refuse sex without condoms. Married women whose husbands are unfaithful can refuse sex w/out condom w/out being beaten. Female sex workers can insist on condom use, backed by government policy and brothel owners.

Gender dynamics & ABCs “C” is for Condom use—male & female condoms: 

Gender dynamics andamp; ABCs 'C' is for Condom use—male andamp; female condoms Men agree to -- no longer react violently to -- requests for condom use from wife, steady girlfriend or casual partners. Men agree to or insist on condom use with sex workers. Men also feel free to refuse sex w/out condom.

What do ABC Study Data tell us?: 

What do ABC Study Data tell us? Data support a possible gender role in Uganda, Zambia and Thailand, especially re reduced 'grazing' and higher age of sexual debut. Interestingly, much of this significant behavior change is on the part of men or shared by men. Re traditional indicators of women’s empowerment, however, similar or better 'gender-relevant' trends in the other countries present a puzzle.

Uganda WHO/GPA 1989-1995: both women & men changed: 

Uganda WHO/GPA 1989-1995: both women andamp; men changed Percent of 15-19-yr.-old women ever having sex dropped from 74 to 51%; percent of men of the same age dropped from 68 to 42%. Ugandan women 15-24 reduced premarital sex from 53% to 16%; men 15-24 also reduced premarital sex from 60% to 23%. Ugandan women with 1 or more casual partners dropped from 16 to 6%; while % of men went from 35 to 15%.

But what about traditional “empowerment of women” indicators in Uganda’s HIV decline?: 

But what about traditional 'empowerment of women' indicators in Uganda’s HIV decline? Increase in educational attainment Increase in % of women in labor force Increase in age at marriage Increase in modern FP use; decrease in TFR

Puzzling data: 

Puzzling data Uganda significantly lowered HIV prevalence: currently 5% of population 15-24 HIV+ Zimbabwe continues high prevalence: currently 34% of population 15-24 HIV+ But Zimbabwe women seemingly more advantaged

Uganda (significantly lowered prevalence) vs. Zimbabwe (continued high prevalence) : 

Uganda (significantly lowered prevalence) vs. Zimbabwe (continued high prevalence) Percent of women completing secondary school/higher

Uganda vs. Zimbabwe: 

Uganda vs. Zimbabwe Percent never-married among 15-19 yr.-old women

Uganda vs. Zimbabwe: 

Uganda vs. Zimbabwe Modern family planning use among women andamp; TFR

Uganda vs. Zimbabwe: 

Uganda vs. Zimbabwe Percent of women working

What’s the gender story in Uganda?: 

What’s the gender story in Uganda? Pres. Museveni’s 'non-stop' radio andamp; in-person AIDS messages strongly promoted women’s empowerment. He also… Urged men to be sexually responsible, and encouraged mutual respect between spouses. Placed women in high govt. jobs and Parliament; Established affirmative action at Makerere University

President Museveni of Uganda also:: 

President Museveni of Uganda also: Implemented sex ed w/gender content in schools; Fostered govt. andamp; NGO gender-related AIDS education programs for women, men andamp; youth; Enforced laws vs. sex with minors and proposed mate rape andamp; marital property law; Established macro/micro-credit schemes for women; Involved women significantly in AIDS campaign.

Huge increase in working women in Uganda: Why? What impact?: 

Huge increase in working women in Uganda: Why? What impact? Did Museveni’s empowerment messages and words play a role? Was access to macro- and micro-credit important? Was it partly due to necessity? (60% of women financially responsible for selves and children) Did it empower women to say no to risky sex?

Concluding questions: 

Concluding questions Did significant changes in gender-related behaviors occur in Uganda without waiting for long-term changes in usual indicators of women’s status (except work)? Is Uganda similar to Bangladesh in this way (its Matlab andamp; Extension projects raised FP prevalence w/out waiting for long-term progress in female education, age at marriage andamp; other indicators of SES)? If so, was strong andamp; sustained political leadership the catalyst, accompanied by a myriad of interventions, especially widespread AIDS andamp; gender education and actions to empower women?

Suggested next steps: 

Suggested next steps Foster strong leadership to address gender issues as part of AIDS prevention in other countries. Promote intensive gender-focused interventions -- to empower women via information andamp; income -- to greatly expand programs to reach men -- to educate youth in and out of schools Do complementary qualitative research to better understand gender dimensions of HIV rates, e.g., why higher female ed., age at marriage andamp; FP use did not seem to help women in Zimbabwe.