Report on Gender and HIV&AIDS Think
Tank
Hosted by HEARD
9 December 2008,
Durban
Table of Contents:
1) Introduction and Purpose .............................................................................................. 2
2) General Reflections ...................................................................................................... 3
3) What do we Know? ...................................................................................................... 3
4) Successes ...................................................................................................................... 7
5) Key Challenges, Barriers & Risks .............................................................................. 10
5.1 Challenges and Barriers .................................................................................. 10
5.2 Risks ............................................................................................................... 12
6) Opportunities and Recommendations for working on Gender and HIV&AIDS ....... 14
6.1 Research, Programme and Policy Work on Gender and HIV&AIDS............ 14
6.2 Organisational Culture and the Individual ..................................................... 16
6.3 Bringing a Gender Lens to Existing Work ..................................................... 17
6.4 Broader Good Practice Relevant to this Discussion ....................................... 17
6.5 Added-value from the Workshop ................................................................... 18
6.6 Summary of Successful Programmes: ............................................................ 20
7) In Closing… ............................................................................................................... 20
Appendix 1- Agenda .......................................................................................................... 21
Appendix 2 - List of participants ........................................................................................ 21
Facilitation and report writing: Samantha Willan
Report from HEARD Gender and HIV&AIDS Think Tank, 9 December 2008 1
1) Introduction and Purpose
During the second half of 2008 the Health Economics & HIV/AIDS Research Division
(HEARD) decided to host a Think Tank to focus on gender and HIV&AIDS. HEARD
anticipated that this meeting, attended by a small group of researchers, development
workers and donors in the region, would move the discussion about gender and
HIV&AIDS beyond what we already know on the issue. It aimed to go beyond ‘simplistic
analyses’ of the pandemic, such as: that HIV&AIDS is driven by ‘bad’ men who refuse to
use condoms, and positioning women as ‘victims’ of men. Furthermore, it aimed to
explore why it is that despite the fact that we have recognised that gender inequalities are a
key driver of HIV&AIDS, and vice versa, since the early 1990’s, and despite some very
good work in the area – very little concrete change has occurred.
HEARD is currently interrogating how to expand its own work in relation to HIV&AIDS
and gender, and as such it seemed opportune to hold this discussion with key people in the
field. HEARD hoped the deliberations would inform both its organisational agenda on
research, strategic leadership and capacity building in sub-Saharan Africa, as well as being
thought-provoking for all participants.
The meeting was held on 9 December 2008 and twenty-two people representing research
organisations, local, regional and international NGO’s and donors attended (see appendix
2 for a full list of participants). The following report is a summary of the key points; it is
not a direct minute of the conversation, but rather extracts the highlights of the meeting in
a format that will be useful to HEARD and all participants.
Think Tank Objectives:
Identify successes and challenges in our programmes, policy work and research on
gender and HIV&AIDS in Sub Saharan Africa;
Generate creative, innovative thinking about gender and HIV&AIDS;
Leading to identifying questions and opportunities for HEARD’s work on gender
and HIV&AIDS in Research, Capacity Building and Leadership Support; and
Stimulate your thinking for your own work.
The meeting applied the following understanding of “Gender”:
‘Gender’ refers to the relationships between women and men and the fact that
these are unequal relationships, with women and girls subjugated to men and boys.
‘Gender’ refers to gendered relations, gender norms, norms of masculinity,
femininity and socialisation.
‘Gender’ also refers to sexuality and sexual orientation and the rights and needs
of lesbian, gay, bisexual and transgender people.
A women’s rights perspective informs a ‘gendered analysis’: what are these
rights? Do existing policies adequately recognise them? Are the policies
implemented? Does a women’s rights perspective inform our own work?
Report from HEARD Gender and HIV&AIDS Think Tank, 9 December 2008 2
2) General Reflections
During the day’s deliberations it became evident that there are a number of highly
effective programmes that link gender and HIV&AIDS, and equally that there are many
strong policies (at national, regional and international level) in place that could lead to
women’s empowerment, if implemented effectively. The day also highlighted that there
were many new and innovative research, programmes and policy options around gender
and HIV&AIDS that participants felt were worthwhile pursuing.
The day did not finish with one simple answer as to how best to tackle or work on gender
and HIV&AIDS, nor did it identify one clear gap in our work on this topic. Rather it
pointed to the complexity of HIV&AIDS and gender and the need for continued and
sustained work in this area, it highlighted a number of these areas. Without this, gender
and HIV&AIDS will never be properly integrated or tackled.
3) What do we Know?
The Think Tank began with the facilitator briefly highlighting a few key facts that are
relevant to these discussions. This was not an attempt to present an exhaustive list of key
facts, as all participants already work in the sector and are aware of the realities. Rather it
aimed at raising a few issues to ‘set the scene’ for the day. After the presentation of a few
facts, participants were then asked to briefly note their top concern in relation to gender
and HIV&AIDS. Prof Tim Quinlan, the HEARD Research Director, then spent a few
minutes outlining some key issues about gender and HIV&AIDS that HEARD had
identified in their research.
The facilitator began by noting a few commonly held assumptions about the relationship
between gender and HIV&AIDS, namely that:
Inequalities between women and men, and women and girls lack of
empowerment, are a significant driver of the pandemic;
HIV&AIDS exacerbates inequalities between women and men, and the dis-
empowered position of women,
Women and girls bear the brunt of the pandemic as they: have increased
vulnerability to infection, carry the burden of care, are frequent victims of
violence, and are increasingly unable to access their socio-political rights to
education, health, economic empowerment etc.
Below is a summary of the key facts that were highlighted:
Women and girls are more vulnerable to infection:
Of the 33 million people living with HIV&AIDS globally, 50% are women, however in
Sub-Saharan Africa 59% of them are women. Indeed, the UNAIDS 2008 Report noted
that: “For the region (Sub-Saharan Africa) as a whole, women are disproportionately
affected in comparison with men, with especially stark differences between the sexes in
HIV prevalence amoung young people (15-24).”1 Furthermore, 45% of new infections are
amoung young people. However, it should be noted that in 14 of 17 African countries,
1
UNAIDS, Status of the Global HIV Epidemic, 2008 Report on the global AIDS epidemic, pp 39
Report from HEARD Gender and HIV&AIDS Think Tank, 9 December 2008 3
with adequate survey data, the percentage of young pregnant women (ages 15-24) who are
living with HIV has declined since 2000-2001.2
HIV prevalence (%) among 15-24 year olds, by sex, selected countries, 2005-2007
Country Girls Boys
Swaziland 23% 6%
South Africa 17% 4%
Zimbabwe 11% 4%
Central African Republic 6% 1%
Uganda 4% 1%
Source: UNAIDS, Status of the Global HIV Epidemic, 2008 Report on the global AIDS epidemic, pp 42
Prevention, Treatment, Care & Support:
More women than men are accessing voluntary, counselling and testing (VCT). In South
Africa a study showed that only 21% of all people accessing VCT were men3.
In terms of treatment access, more women are accessing treatment than men. The UNAIDS
2008 Report hypothesized that this may be due to the fact that women have two entry
points to treatment, either through the prevention of mother to child transmission
(PMTCT) programmes or directly through VCT programmes.
On a positive note, 2007 saw a significant increase in the number of HIV positive women
accessing PMTCT services, increasing from 9% in 2004 to 33% in 2007.4
Finally, research suggests that 90% of care and support occurs in communities and
homes5, and remains overwhelmingly the responsibility of women and girls. Most of this
work remains unrecognised, unremunerated and unsupported. The following two studies
reflect women’s high levels of involvement in care and support: A national evaluation of
home care in South Africa found that 91% of volunteer caregivers were women6.
Another study of 45 primary caregivers in Western Cape settlements found that 43 of
them were women7. Nonetheless, it is important to recognise that despite the reality that
women and girls carry the burden of care, increasingly men and boys are becoming
involved in providing care, albeit still in small numbers.
Mortality Rates:
A recent study in South Africa found that between 1997-2005, all deaths increased by
87%, and they more then tripled for women 20-39 years old, and doubled for males
30-44 years. At least 40% of these deaths were attributable to HIV8.
More widely there has been a significant decline in life expectancy for men and women
across sub-Saharan Africa (see table below).
2
UNAIDS, Status of the Global HIV Epidemic, 2008 Report on the global AIDS epidemic, pp 30
3
Peacock, D et al, 2008, Literature Review on Men, Gender, Health and HIV in South Africa, pp3
4
UNAIDS, Status of the Global HIV Epidemic, 2008 Report on the global AIDS epidemic, pp 124
5
UNAIDS, 2004, 4th Global AIDS Report, p118.
6
CASE, 2005 cited in ActionAid. 2005. Southern African Partnerships Programme (SAPP): Impact of
Home-Based Care on Women and Girls in Southern Africa.
7
Orner, P. (2006). Psychosocial impacts on caregivers of people living with AIDS. AIDS Care, 18, 263-
240.
8
Health-e News, “South Africa still has the biggest HIV epidemic", says UNAIDS. 29/07/08
Report from HEARD Gender and HIV&AIDS Think Tank, 9 December 2008 4
Report from HEARD Gender and HIV&AIDS Think Tank, 9 December 2008 5
Indicators of Mortality
Life Expectancy Life Expectancy Infant mortality
MALES FEMALES per 1000 live
births
Botswana 50.3 50.3 46
Dem. Rep. of Congo 45.3 47.9 113
Mauritius 69.6 76.3 14
Mozambique 41.9 42.5 95
South Africa 48.8 49.6 45
Swaziland 39.6 39.1 70
Tanzania 51.5 53.7 71
Zimbabwe 44.2 42.8 57
Source: UNFPA State of the World Report (2008)
Education and HIV prevalence:
The evidence is increasingly linking higher education levels to lower HIV prevalence for
girls, providing a very strong argument for focusing on increased access to education for
girls as a key HIV prevention strategy. Recent data from 11 African countries clearly
linked higher educational levels with lower HIV prevalence. Furthermore, a recent study
in rural South Africa found that each additional year of educational attainment that young
woman had, reduced their risk of HIV infection by 7%.9
National Policies & Budgets:
The UNAIDS 2008 Report undertook a review of national HIV&AIDS policies to explore
whether they specifically address women and girls, and then went on to analyse whether
funds where then allocated to support these policies. They found the following10:
80% of countries specifically address women as a component of their national HIV
strategy,
83% of countries report having a policy to ensure equal access for women and men
to HIV services,
Only 53% of countries report budget allocations specifically devoted to HIV-
related programmes for women and girls, and
The largest proportions of countries with reported budgets for such efforts are in
Asia (69%) and sub-Saharan Africa (68%).
9
UNAIDS, Status of the Global HIV Epidemic, 2008 Report on the global AIDS epidemic, pp 69
10
UNAIDS, Status of the Global HIV Epidemic, 2008 Report on the global AIDS epidemic, pp 92
Report from HEARD Gender and HIV&AIDS Think Tank, 9 December 2008 6
4) Successes
The meeting then moved on to reflect on what has worked well in existing gender and
HIV&AIDS work, focusing in particular on the actual “success factors”. The purpose of
this process was firstly, to recognise that when working on this topic many of us feel
committed yet also quite overwhelmed by the magnitude of the challenge, and secondly,
that we often forget to stop and acknowledge our good work. This can have many negative
effects, including: discouraging us and preventing us from building on these successes.
Therefore the meeting spent time identifying success factors, both to celebrate the
successes and also to identify ways to build on them.
It was interesting to note that the group discussions revealed that many people do not
spend much time analysing what makes their programmes work, and how to build on these
successes. furthermore, questions were raised about how to acknowledge research
successes.
Below are the success factors that were identified from existing work on gender and
HIV&AIDS:
Ensuring women’s voices and involvement: women must be meaningfully involved
and drive programmes. Programmes that have found ways to support women’s
agency have been successful. Furthermore, all work should be informed by an
understanding of how women and girls perceive their own disempowerment and
their ‘lived reality’, and must work to change issues identified by these women and
girls.
Recognising that ‘gender’ goes beyond women: successful work acknowledges that
working on ‘gender’ means looking at many types of gendered relations, not only
women and girls. It refers to the relationships between women and men, and
gendered norms e.g. notions of masculinity, femininity, sexual identity and
sexuality. All aspects need to be considered in order to ensure that work
incorporates a comprehensive ‘gender’ analysis.
Using role models and champions: the identification and use of role models and
champions is very powerful. Especially when addressing notions of masculinity
and men’s behaviour. Working with community leaders and popular icons has
shown big successes. However, as individuals often drive these programmes they
can be very hard to replicate.
Working in single sex groups: many programmes have shown successes when men
work with men, or women with women. Participants suggested that it was because
this created a ‘safe space’ for sharing and exploring ideas. For example, many peer
education campaigns show improved success when peer educators are of the same
sex, e.g. men talking to men, and girls talking to girls. Similar successes have been
seen when male caregivers care for men. However, this approach needs to be used
carefully to ensure it is the most appropriate way to work, as their is also evidence
that suggests that working with mixed sex groups brings significant successes as
well.
Ensuring the greater involvement of men and boys: linking to the point above, the
greater involvement of men and boys increases programme successes for a number
Report from HEARD Gender and HIV&AIDS Think Tank, 9 December 2008 7
of reasons. For example, men assisting with providing care assists in decreasing
the burden of HIV&AIDS care on women and girls. Furthermore, some
programmes have taken advantage of the fact that many men in rural communities
tend to work in the fields in the morning and have free time in the afternoons. They
have created programmes that target this time of the day to involve men. A further
effective way to involve men is focusing on their role as fathers, and creating
positive role models of fatherhood. Indeed, the campaign to change ‘Prevention of
mother to child transmission’ (PMTCT) to ‘ prevention of parent to child
transmission’ (PPTCT) is an interesting way to involve men in parenting while
also addressing the stigma and blame mothers face when their babies contract HIV.
Supporting community driven responses: the focus of programmes must be defined
and driven by the communities at grassroots level, and communities must continue
to be meaningfully involved throughout the programme or research. Programmes
designed and/or imposed from above seldom succeed. There must also be strong
involvement of community leaders. To ensure programmes are community driven
development workers or researchers need to spend time building trust with, and
understanding of, the communities involved. A good illustration of this is the
African Women’s Protocol, which was ‘made by Africans, for Africans’.
Multi-pronged responses to basic needs: many successful programmes attributed
their successes to addressing not just a single issue, but rather addressing a number
of basic needs identified by individuals and communities. For example not
addressing only HIV&AIDS or gender empowerment, but linking this response to
needs such as education for all or economic empowerment.
Use a rights-based approach: effective, sustainable responses approach work on
gender and HIV&AIDS from the perspective of women’s rights and human rights.
This rights based approach often shifts the power from the traditionally powerful
to the traditionally powerless.
Building on existing successes, while still being innovative: spending time
identifying , reflecting on, and learning from, successful programmes leads to
work that effectively builds on successes. In other words, through this process
successful programmes can be replicated and scaled-up, rather then constantly
looking for “new ways”. However, successful programmes must also be
innovative, they must harness new energy, ideas and resources; for example there
are innovative ideas and packaging around mass media that could be used more
widely.
Innovative dissemination strategies: research results, programme findings,
evaluations and so forth must be effectively shared with community members and
other development workers. Successful programmes avoid purely extractive work,
and ensure that effective means are found to meaningfully disseminate and
feedback. Using radio, music and popular culture can be an effective way to
disseminate findings and information and start the process of mobilisation.
Long-term programmes: in order to build meaningful community involvement and
sustainable change, programmes and organisations need to have a stable, long-term
presence in communities. This requires long-term predictable funding.
Report from HEARD Gender and HIV&AIDS Think Tank, 9 December 2008 8
Challenge structural barriers: success can be hindered by structural barriers, and
therefore some successful programmes have targeted these for programmatic work
and research. For example, some programmes have identified the police and
judicial system as barriers and have targeted reforming these in order to enable
women and people living with HIV&AIDS to access their rights.
Report from HEARD Gender and HIV&AIDS Think Tank, 9 December 2008 9
5) Key Challenges, Barriers & Risks
The meeting then proceeded to explore challenges, barriers and risks to working on
HIV&AIDS and gender. The purpose of reflecting on these issues was twofold: firstly to
highlight the difficulties, barriers and risks in order to discuss how to overcome them.
Secondly, these challenges often feel overwhelming, yet through a systematic
conversation about how to tackle each challenge they can be broken down into small
manageable challenges that can be tackled.
At the end of the session when participants were reflecting on the challenges and barriers,
a key observation from one participant was that many of the challenges were not new.
And furthermore, many are not specific to gender and HIV&AIDS, but apply across the
development sector. Therefore we noted that the challenge for the Think Tank was to
acknowledge these ongoing challenges, identify how they pertain specifically to gender
and HIV&AIDS, and then spend time identifying ways to mitigate them.
5.1 Challenges and Barriers
Mistakenly believing that “gender” equals women: ‘gender’ is often
misinterpreted as referring only to women, limiting research and programmes. This
misinterpretation leads to a situation where research and programmes fail to
explore all the aspects of ‘gender’, including looking at relationships between men
and women, notions of masculinity and femininity, sexual identity etc.
Women’s sexuality has not been addressed: despite HIV&AIDS being about sex
many programmes and research avoid addressing women’s sexuality, resulting in a
lack of understanding of it, leading to programmes failing to address core issues
such as women’s sexual choices and enjoyment.
Failings of Gender mainstreaming: frequent reference was made to the failures of
gender mainstreaming. The meeting noted that we need to be mindful of these
failures and avoid repeating them (in both gender and HIV&AIDS mainstreaming),
however, there is limited analysis of why gender and HIV&AIDS mainstreaming
fails and how to shift failure into success. The challenge therefore is finding ways
to mainstream gender effectively.
Unequal power relations: unequal power relations between women and men and
between leaders and community members create barriers, and limit meaningful
participation of women and community members. Furthermore, these inequalities
and disempowerment are often imbedded in socio-cultural sensitivities making it
difficult to challenge them and the behaviours stemming from this; examples of
this include the difficulties of tackling gender-based violence and multiple
concurrent partnerships.
Individual behaviours that perpetuate “the norm”: frequently people working on
gender and HIV&AIDS do not “walk the talk” or “practice what they preach”. In
other words through their own behaviour they reinforce ‘gendered norms’ and
women’s disempowerment. In some instances this is through a lack of
understanding of women’s rights, gender equality, socialisation and so on, but it
Report from HEARD Gender and HIV&AIDS Think Tank, 9 December 2008 10
can also be due to a limited commitment to the ideals of equality despite working
in the area.
Mechanistic responses ignore socio-economic inequalities: women’s dis-
empowered position in society present significant challenges, which are
exacerbated by ‘cultural practices’ such as patriarchy. Many HIV&AIDS
responses and programmes are quite mechanistic/technical and ignore the social
and structural realities that they operate in, thereby failing to address these
underlying issues leading to poor outcomes.
Weak policy implementation: even where strong policies exist, implementation
remains poor. There are a number of factors that lead to this including: a socio-
cultural context that makes implementation difficult; limited resources; poorly
conceptualised policies; limited enforcement strategies; and a lack of
accountability.
Lack of community voice in research and programme design and implementation:
these ‘lost voices’ often leads to a mismatch between “western ideals and
language” and community “world views”. This failure results in research and
programmes that exclude community members and leadership, and often leads to
misinterpreting community realities and failing to acknowledge the specificity of
each context that programmes operate in.
Research is often inaccessible & unavailable: often research results are released in
formats that are not user-friendly or meaningful to the communities that
participated or who could benefit from the information. Greater thought needs to
be given to how research and programme outcomes, successes and lessons can be
effectively shared so that communities can benefit from the work.
Human Rights versus “Epi thinking” and Human Rights versus National and/or
Customary Laws: there is often a tension between a human rights based approach
and an approach driven by epidemiological thinking which focuses on ‘reducing
the prevalence level’, which on occasion might involve denying basic rights in the
interest of ‘public good’. Compulsory testing is a good example of this.
Furthermore, many national and customary laws do not enshrine all basic human
rights. There is a further tension between rights based and morality based
approaches, where women’s rights may be denied on the grounds of ‘correct moral
behaviour’.
Lack of resources and poor management: the lack of resources applies to both
financial and human resources. However, it was noted that frequently there is more
human capacity then is acknowledged, and the challenge lies in identifying ways to
‘tap into’ existing human resources. Smaller organisations find it even harder to
access these resources.
Donor control and conditions: in many cases donors hold power because they
have the resources, leading to donors shaping the programme and/or research
agenda rather then these being informed by community voices. Furthermore, many
donors are reluctant to fund pilot or baseline programmes aimed at establishing
community needs. Additionally, donor funds are often unpredictable and linked to
Report from HEARD Gender and HIV&AIDS Think Tank, 9 December 2008 11
short-term programmes and research that may not be sustainable, this is
exacerbated by recent trends whereby donor funds are dwindling in the
HIV&AIDS and gender sectors.
Inappropriate Monitoring & Evaluation: often the M&E frameworks are very
quantitatively focused, and do not value qualitative data. Ignoring the qualitative
data makes it difficult to understand and value many of the programmes working
with a broader social change focus such as women’s empowerment and changing
relations between women and men.
Lack of integration with sexual reproductive health and rights (SRHR): many
within the HIV&AIDS and SRHR sector have failed to work together effectively
and this has meant that many opportunities for integrating work has been lost, for
example the greater integration of reproductive health and HIV&AIDS education
may assist in addressing stigma and improving prevention strategies.
Lack of coordinated approaches between, and competition amoung, NGO’s and
CBOs: lessons and knowledge are often not shared and coordination is weak
between many NGO’s and CBO’s. This is driven largely by a sense of “turf war”
over ideas and funds.
Lack of political will: at local, national and international level there is a very little
political will to address gender inequalities, gender norms and women’s
disempowerment, which are recognised as key drivers of the pandemic. This lack
of political will presents significant barriers to policy implementation, accessing
funds and effective programme work.
Lack of sex disaggregated data: many research and implementation programmes
fail to collect data by sex, making analysis specific to women and men’s realities
impossible. And in many cases even where such data exists many programmes and
researchers fail to analyse it fully and usefully.
5.2 Risks
The meeting then moved on to spend some time looking at risks, in order to ensure that
any potential risks were identified, so that they could be mitigated.
Below are the risks that were identified, namely:
That the global trend is increasingly moving towards a focus on treatment and
ignoring key issues such as: sexuality and the structural drivers of gender
inequalities and HIV&AIDS.
That in our attempts to integrate gender into HIV&AIDS work we might follow a
very narrow definition of gender and loose the broader context of ‘gender’ that is
found, for example in the work on sexual reproductive health & rights.
That programmes and research might integrate the language of gender into their
work, but with limited understanding of the concepts. For example, a limited
understanding of patriarchy and masculinity will lead programmes to assume that
training alone will ‘change men’s behaviours’.
Report from HEARD Gender and HIV&AIDS Think Tank, 9 December 2008 12
That ideas will be imposed from above – especially as many people find working
on gender quite daunting - and the community experiences and voices will be lost.
That we will repeat the mistakes made in gender mainstreaming.
That programmes and research disrespect and disregard local community identities
and culture.
That there is not enough acknowledgement that integrating gender into
HIV&AIDS work means tackling many social and structural issues and such
change needs to be gradual in order to be sustainable.
Report from HEARD Gender and HIV&AIDS Think Tank, 9 December 2008 13
6) Opportunities and Recommendations for working on Gender and
HIV&AIDS
The final session of the Think Tank focused on innovative, creative thinking. Participants
were urged to reflect on the successes, challenges and risks identified earlier and use these
to reflect on the ‘Big Question’, namely “ having said all that we have said, what are
the solutions?”
This was the longest session, and possibly the most important discussion of the day as
participants were encouraged to identify new and innovative responses to gender and
HIV&AIDS.
The recommendations emerging from these discussions have been grouped into 5
categories namely: research, programme and policy work on gender and HIV&AIDS;
organisational culture; bringing a gender lens to existing work; broader good practice that
is relevant to this discussion and added-value from the workshop.
6.1 Research, Programme and Policy Work on Gender and HIV&AIDS
Research opportunities:
Women’s experiences of sex and sexuality: more research is needed that explores
women’s lived experiences of sex and sexuality. This research needs to move
beyond narrow epidemiological, medical and behavioural approaches to women
and their vulnerability to infection. For example, it could explore multiple
concurrent partnerships, sexuality, and sexual enjoyment, from women’s
perspectives. There is also a need to develop more positive messages about
women’s experiences of sex.
Why have we failed on gender? researchers could explore why most HIV&AIDS
work in Sub-Saharan Africa has failed to effectively tackle gender, what are the
blocks and challenges? For example Treatment Action Campaign (TAC) is a
recognised success story around HIV&AIDS, and while it has attempted to tackle
gender it still faces many challenges in doing this. Research could analyse these
challenges, and also identify what has lead to the successes they have experienced
in tackling gender.
‘Points of transition in life’ and sex: research could identify the ‘points of
transition in life’ when women engage in sex, for example when they move from
single sex high schools to university or from rural to urban settings. Research
could explore what ‘cultural resources’ could be accessed to empower and educate
women at these key points of transition in their sexuality and even in their role as
parents.
Home-based care needs to be done differently: research needs to identify improved
ways to deliver home-based care in a way that will change its current exploitative
nature. Home-based care needs to move from an approach that utilises “a cheap
pair of hands” to one that supports meaningful participation of caregivers and links
this to broader social change, both for women and men. This research will then
need to inform policy and programme reviews.
Report from HEARD Gender and HIV&AIDS Think Tank, 9 December 2008 14
Sexual Reproductive Health and Rights (SRHR): further research is needed to
explore the links between HIV&AIDS and SRHR. While the links seem obvious
and there is increasing cooperation between the two sectors, they only began
working together in the last few years, and more research is needed to identify how
to effectively integrate the two areas at programme, service delivery and policy
level.
Social mobilisation: support research exploring ‘social mobilisation’ within the
HIV&AIDS and gender sector11. The research should focus on what ‘social
mobilisation’ means in the context of gender and HIV&AIDS, and how this could
shape programme work to improve effectiveness.
Beyond the heterosexual epidemic: more research is needed to understand the
broader epidemic in Sub-Saharan Africa. There is insufficient research exploring
the epidemic amoung the lesbian, gay, bisexual and transgender community. The
research should also explore the feedback loop from these marginalised
communities back into heterosexual communities.
Gender mainstreaming: researchers need to undertake a comprehensive review of
lessons learnt from gender mainstreaming. Frequent references are made to the fact
that it failed, yet not enough is understood about why it failed and the lessons that
can be learned from this. These lessons can then be used to inform effective
integration of HIV&AIDS into gender and vice versa, the lessons should also
inform HIV&AIDS mainstreaming.
Policy opportunities:
Greater integration of policies: there is a need to review all relevant policies to see
if they are adequately integrating gender and HIV&AIDS. This means identifying
all policies (national, regional and international) that pertain to gender and
HIV&AIDS, but also policies that impact on gender and HIV&AIDS, such as
policies on land rights, education etc. This interrogation, through an HIV&AIDS
and gender lens, should identify any gaps, where policy reform is required; or
opportunities where policies could be used to leverage for change.
Implementation challenges: policy implementation is generally poor, therefore
even where strong policies exist, these seldom translate to meaningful change on
the ground. Work is needed to identify the gaps between policies and
implementation, identify why this occurs and recommend ways to change this.
This should involve extensive lobbying of policy makers at all levels, in all related
fields.
Interrogate the South African National AIDS Strategy (NSP): in light of the calls
for policy reviews above, it would be prudent to begin with reviewing the NSP to
ensure it adequately addresses gender issues. Such a review could become a useful
platform for mobilising the South African HIV&AIDS sector to consider gender
more effectively, and as an illustration of how gender should be integrated into
HIV&AIDS policies.
11
For the purposes of this meeting report we are taking social mobilisation to mean: creating conditions
conducive to starting and sustaining positive change around gender and HIV&AIDS at individual, community
and national level.
Report from HEARD Gender and HIV&AIDS Think Tank, 9 December 2008 15
Long-term, predictable funds and revised evaluation techniques: donors need to be
lobbied to recognise that implementing women’s rights and equality requires broad
based social transformation which is a slow process. Therefore funds for
programmes on gender and HIV&AIDS must be long term and predictable in order
to ensure sustainable change. Furthermore, donors need to move away form
onerous quantitative data evaluations to enable more meaningful qualitative data to
be used – it is through such data that the richness of successes and change are
captured.
Programme opportunities:
Explore and implement programmes that combine technical/behavioural and
structural interventions: In the field of HIV prevention, there is growing
recognition that in the absence of addressing structural factors, technical and
behavioral interventions alone have limited ability to reduce new infections. In
response to this, many have argued for ‘combined interventions’. These bring
together interventions at the technical/clinical, behavioral and structural levels to
act at multiple levels to reduce risk. An example would include bringing together
technical or behavioral interventions such as counseling and testing or gender
empowerment training, with interventions such as microfinance that address
economic underdevelopment. The structural component has the potential to
address immediate needs, and provides an entry point for sustained contact with a
population that is rarely afforded access to public health interventions.
‘Translating’ research and evidence into programme good practice: more work is
needed on how to take evidence gathered through research back to communities to
ensure that programme responses change to reflect the new evidence and good
practice. An important element of this lies in ensuring that communities are
involved in, and drives the research from the beginning. Equally important is
building commitment amoung development practitioners to spend more time
exploring good practice and keeping abreast of new research, and using this to
inform their work.
Review indicators: lobby for and develop more indicators that ‘unpack’ the
gendered impact of programmes. For example, indicators that: desegregate data by
sex, review budgets through a gender lens and identify women’s involvement and
leadership in programmes. And in addition, indicators should be developed at
multiple levels, including the regional level (SADC) and the local level.
Women’s voices and leadership: all programmes need to ensure that they include
women’s ‘lived experiences’ and ‘voices’ throughout the programme, from
planning through to implementation and evaluation. It is also crucial to ensure that
women’s leadership is a core value of programmes, and where women leadership
is weak, capacity-building programmes should be put in place to build it.
6.2 Organisational Culture and the Individual
Build capacity, and commitment, of staff: individuals need skills on two levels.
Firstly, they need a strong understanding of gender and HIV&AIDS in order to be
able to interrogate their own behaviour, and to explore if they operate in a ‘gender
Report from HEARD Gender and HIV&AIDS Think Tank, 9 December 2008 16
sensitive’ manner in the workplace. Secondly, they need sufficient understanding
of gender to be able to approach every programme and research study with a
‘gender lens’. An audit should be undertaken within organisations to identify if
there is a need to build capacity in these issues, and the necessary training
programme then implemented.
Leadership: strong female leadership needs to be built in the sector. Furthermore,
existing leaders (both male and female) need to be challenged to behave
appropriately and to become role models, for instance all leaders should: test
regularly, practice responsible sex and behave in a manner that respects and
empowers women and girls.
Workplace policies: all organisations need to have comprehensive workplace
policies on both HV&AIDS and women’s rights. Where organisations already
have such policies they should be reviewed to ensure they adequately address the
links between gender and HIV&AIDS.
6.3 Bringing a Gender Lens to Existing Work
Organisational review of existing work: all existing HIV&AIDS research and
programme work should be reviewed to see if it is adequately considering gender;
and where it is not, to make recommendations about how to effectively integrate
gender into the work.
Review all existing data: existing data and information needs to be re-interrogated
to establish whether there is information in our programmes and research that is
not being used effectively. Such a review should identify what data researchers
already have that could be used to provide insight and knowledge on the gendered
impacts of the epidemic. There is likely to be a wealth of existing data that has not
been interrogated through a ‘gender lens’.
Build organisational understanding of gender and HIV&AIDS: this relates to the
point under “organisational culture”, namely that a ‘gender lens’ can only be
applied once researchers and development workers have the knowledge and skills
to undertake gendered analyses and research. Therefore organisations need to
invest in building staff understanding and commitment on ‘gender’.
Improve existing good HIV&AIDS work by applying a gender lens: there is a lot of
very strong HIV&AIDS work which would become even more cutting edge if it
included a gender analysis. Therefore it would be pertinent to look at successful
HIV&AIDS programmes and see how they can be enhanced through a gender
analysis.
6.4 Broader Good Practice Relevant to this Discussion
This section highlights a number of issues that were raised as generic good practice for
development work, but which are particularly important when considering gender and
HIV&AIDS.
Report from HEARD Gender and HIV&AIDS Think Tank, 9 December 2008 17
Women’s voices and leadership: as already noted above women must be involved
from the beginning of all research and programmes, their voices and experiences
must inform all work and their concerns must be directly addressed. In addition,
women leaders must be included in strategic leadership and management positions.
And where appropriate, programmes must include components to build women’s
leadership in the sector, in order to ensure strong ‘women’s voices’.
Identify, lobby and/or build leadership concerned about gender and HIV&AIDS:
strong leaders are needed to provide leadership and show the importance of
integrating gender and HIV&AIDS work. Existing leadership may need to be
lobbied to build their understanding of, and commitment to, the issue, they may
then need to be provided with support to make meaningful changes. And finally
new leadership, especially amoung women and people living with HIV&AIDS,
may need to be built in this sector.
More networking and synergies leading to improved feedback between research
and programmes: there needs to be an increase in the networks and synergies
between research and programmes and also between researchers themselves and
development practioners themselves. They need to share their findings, challenges
and successes in an open manner, as a sector we should avoid competition of ideas,
knowledge and learning.
Improved accessibility of research: more effective ways need to be found to make
research accessible to all role players who could benefit from it, namely: women,
people living with HIV&AIDS, community members and government.
Meaningfully involve communities: research and programme work must
meaningfully involve community members, especially women, in all aspects of
work to ensure it is driven by the needs and priorities of the community.
Furthermore, research findings and programme outputs must be packaged in an
accessible manner to ensure that the community can use them.
Build capacity of government officials: more work needs to be undertaken with
government officials to build their commitment to, and understanding of, gender
and HIV&AIDS. This may be slow in many cases but it will bear fruit eventually
as it begins to build capacity and commitment and breaks down inertia.
6.5 Added-value from the Workshop
This section briefly captures a few of the additional benefits of the workshop.
Creating a community of practice: many participants expressed a desire to
establish a ‘community of practice’ to keep the discussions and enthusiasm from
the day alive. Initial suggestions were that the e-mail group be used to share ideas,
successes, overcome challenges and keep the ‘energy of the day’ alive.
Networking opportunities: the Think Tank provided an opportunity for many
practitioners and researchers to meet people from the field. Such networking is
Report from HEARD Gender and HIV&AIDS Think Tank, 9 December 2008 18
crucial for building a cadre of researchers and practitioners who are leading voices
on gender and HV&AIDS.
Re-invigorating passion about gender and HIV&AIDS: many participants reported
that the Think Tank was useful in terms of reinvigorating their commitment to
issues around women’s rights, gender and HIV&AIDS.
Report from HEARD Gender and HIV&AIDS Think Tank, 9 December 2008 19
6.6 Summary of Successful Programmes:
Below is a list of a few successful programmes that participants highlighted, it is not an
exhaustive list, but rather a snapshot of a few successful programmes that participants
thought it might be useful to learn from.
Gays & Lesbians of Zimbabwe
Gender AIDS Forum (Women and Leadership Programme) (South Africa)
Cape Mental Health (people with intellectual disabilities) (South Africa)
Valley Trust (Women’s programme) (South Africa)
Swaziland Organisation of People living with HIV&AIDS
Africare Zimbabwe (involving men in care)
Sonke Gender Justice (South Africa)
Targeted AIDS interventions (KZN) (South Africa)
Pop Council (involving youth in care)
Grassroots Women (Kenya)
Treatment Action Campaign (South Africa)
SASO (Kenya)
FARAJA (Tanzania)
Intervention with Microfinance for AIDS and Gender Equity (IMAGE) (South
Africa)
7) In Closing…
HEARD, and the facilitator, would like to thank all the participants who gave of their time
so generously, and who engaged so enthusiastically throughout the day, we could not have
done it without you. The Think Tank was a great success because each and every
participant was committed to actively engaging in a high level of debate and discussion –
we thank you! And thank you for the very positive feedback that we have received from a
number of participants.
To those who were unable to attend, we hope this record of the meeting goes some way to
sharing the days deliberations with you. And finally, thank you to those who assisted in
compiling the report.
Report from HEARD Gender and HIV&AIDS Think Tank, 9 December 2008 20
Appendix 1- Agenda
8:00 Welcome, introductions, objectives and process
What do we know?
Successes to date
10:45 Tea
11:15 What are the Challenges?
What could we do differently?
1:00 Lunch
2:00 What could we do differently? Continued…
Recommendations
4:00 Closure
Appendix 2 - List of participants
Name Organisation e-mail address
Olagoke Akintola School Of Psychology, UKZN akintolao@ukzn.ac.za
Alice Banze Oxfam GB abanze@oxfam.org.uk
Marisa Casale HEARD casale@ukzn.ac.za
Paul Dover Swedish/Norwegian Regional HIV/AIDS paul.dover@foreign.ministry
Team for Africa .se
Jennifer Gatsi Namibia, International Community of nwhn@yahoo.com
Mallet Women Living Positively (ICW) & namibia@icw.org
Namibia Women’s Health Network
Andrew Gibbs HEARD gibbs@ukzn.ac.za
Jill Hanass- HEARD hanasshj@ukzn.ac.za
Hancock
Geoff Jobson HEARD jobsong@ukzn.ac.za
Rose Jolly Queens University jollyr@queensu.ca
Kevin Kelly CADRE kk@cadre.org.za
Mzi Lwana Reproductive Health & HIV Research Unit mlwana@rhru.co.za
(Wits)
Mpume Mbatha Project Empower mpume@projectempower.or
g.za
Alphonse SADC, HIV&AIDS Unit, SADC Secretariat amulumba@sadc.imt
Mulumba
Vailet IDASA vmukotsanjera@idasa.org.za
Mukotsanjera veemko@yahoo.co.uk
Rob Morrell UKZN morrell@ukzn.ac.za
Collet Ngwane Centre for the Study of Violence & cngwane@csvr.org.za
Reconciliation (CSVR), Gender Based
Violence Programme
Nkosinathi HEARD Ngcobo14@ukzn.ac.za
Ngcobo
Paul Pronyk Image Study, School of Public Health, pronyk@agincourt.co.za
WITS and LSHTM
Tim Quinlan HEARD quinlant@ukzn.ac.za
Anita Sandstrom Southern African AIDS trust (SAT) sandstrom@satregional.org
Vicci Tallis Open Society Initiative for Southern Africa, viccit@osisa.org
OSISA
Laura Washington Project Empower laura@projectempower.org.z
Report from HEARD Gender and HIV&AIDS Think Tank, 9 December 2008 21
a
Samantha Willan Facilitator Samantha.Willan@gmail.co
m
Report from HEARD Gender and HIV&AIDS Think Tank, 9 December 2008 22