Integrating Multiple Gender Strategies to Improve HIV and AIDS Interventions: A Compendium of Programs in Africa

This compendium of HIV/AIDS programmes in sub-Saharan Africa is designed to illustrate the many programmatic approaches to integrating multiple gender strategies to mitigate women’s and men’s vulnerability to infection. Its premise is that gender strongly influences how HIV spreads and how people respond to the epidemic and that using multiple approaches in HIV/AIDS programming is more effective than single strategies.

Featured programmes address at least two of the following gender strategies:

1. reducing violence and sexual coercion;
   
2. addressing male norms and behaviours;
   
3. increasing women’s legal protection; and
   
4. increasing women’s access to income and productive resources.
   

The compendium describes each of the 31 selected programmes, and synthesises trends and findings to provide initial insights on using multiple gender strategies in HIV programming, including how strategies are employed together, where gaps exist, and what lessons and experiences are common across programmes. In the second phase of the project, the International Center for Research on Women (ICRW) research team will conduct four to six case studies of the programmes described in the compendium.

The findings include:

• "Community involvement is vital to programs that address multiple gender strategies because these approaches often require changing interconnected and sensitive gender norms. National policy and government involvement also are important to sustaining and scaling up combined approaches.
• Of the four gender strategies:
  

1. Reducing gender-based violence was the most common.
2. Increasing women’s legal protection was the least common.
   
3. Programs often addressed male norms and behaviors in combination with gender-based violence efforts, successfully engaging men with innovative approaches.
   
4. Strategies to increase women’s income were combined with other strategies to sustain women’s capacity to address a range of issues in their lives, including violence and HIV.
   

• Most programs lack rigorous data collection and evaluation, often because implementers do not have sufficient resources or technical capacity. Though all the programs featured here are gender-focused or have strong gender components, few collect findings related to gender outcomes."

The following are among the elements described in the findings:

Integrating multiple gender strategies can include: individualised counselling, group workshops, live theatre, television and radio serial drama, community mobilisation, peer education, mentorship, income generation, and clinical services, among others. Programmes can include large, medium , and small efforts such as: expand markets for health products; use campaigns to address male norms and reproductive health issues; provide grants to women involved in transactional sex and sex work; access health and other information through education materials and outreach activities; support women starting small businesses; teach skills to improve household food security; reach uniformed services personnel and their families through behavioural change communication, HIV counselling and testing, palliative care, and peer education; and provide an intensive curriculum on HIV prevention, sexual and reproductive health, and sexuality and life skills to adolescent girls.

Gender strategies can be part of programme design and/or implementation. They are often found to reinforce other programme goals. For example, a South African programme that initially set out to address male norms and HIV risk behaviours among young men in soccer clubs found itself drawn into discussions of how to prevent violence against women because the young men participants themselves identified violence against women as an issue interlinked with the men’s efforts to reduce HIV risk and reinforce positive male behaviour. Micro-finance programmes found a need to address gender violence using, for example, interactive drama that helped women learn how to defuse potential conflicts, and offering self-defence and family law classes.

Because treatment programmes are less likely to address gender strategies than prevention programmes, the document suggests the following: “Opportunities for integrating gender strategies into treatment programs may include ensuring that treatment is facilitated in ways that consider women’s concerns, such as childcare, privacy and time constraints, as well as supporting women’s adherence by teaching skills to safely navigate disclosure with intimate partners and other family members. Treatment programs could also take steps to address men’s specific needs, including expanding access to treatment by providing services at times and locations that are convenient and welcoming for men, offering outreach activities to raise men’s awareness about the benefits of treatment, and promoting men’s involvement in PMTCT [Preventing Mother-to-Child Transmission] activities."

One indication of potential sustainability was measured by the extent to which community members were involved in the design, implementation, and resourcing of their programmes. Models for involving community members varied widely - from community advisory boards to mentors to participant selection by community churches, schools, and governments. Male involvement was sought using various approaches including community mobilisation, sensitisation workshops, and peer education. Recommended strategies include viewing men's potential to positively influence gender norms in communities as an asset, for example, recruiting and training a group of mentor fathers. Supportive national policy and government involvement are additional keys to sustainability and scalability. For example, Ethiopia Radio Serial Dramas to Prevent HIV/AIDS were created because the government of Ethiopia put out a request for a radio-based media strategy.

Various gender strategies contribute to reducing HIV risk. Referrals to health, social welfare, or justice services; provision of temporary safe havens, as well as psychological, medical and legal services; offering sexual assault victims post-exposure prophylaxis (PEP); and education of religious leaders, teachers, the police, and community health workers about sexual violence responses are among the strategies found in the programmes reviewed. Promoting dialogue around gender-based violence through theatre, murals, and community conversations, sometimes with survivors of abuse performing to promote community discussion of violence, gender power relations, and HIV, are among communication-based options, as are peer empowerment workshops. Fatherhood and male norms initiatives involve men in group workshops and dialogues. Addressing legal literacy for women is a strategy less developed in the programmes reviewed. It can be a part of care and support services, such as the inclusion of will-writing and helping parents understand how to legally protect their loved ones’ land rights. In Nigeria, Protection Committees address issues of violence and inheritance matters as well as advocate for access to social services and the rights of women and children.

Recommendations include:

1. Community buy-in, involvement, and leadership in programme design and implementation should be part of efforts to change gender norms.
2. Increasing the involvement of men - especially young men - in gender-based programming should remain a high priority.
3. Funders and programme designers should provide implementers adequate flexibility to adapt programming based on new findings about gender because important connections between gender constraints are sometimes identified during programme implementation.
4. Programmes should combine gender strategies to address the specific gender constraints experienced by programme audiences.