The current economic crisis is forcing HIV/AIDS donors to do more with less. Taking on gender inequality in more than a token way to improve efficiency and effectiveness is a no brainer. The current U.S. administration has made women and girls a high priority so PEPFAR has all the political backing it needs, and multi-lateral donors like the Global Fund and the World Bank also have full support from their boards of directors. The powerful combination of budget squeeze and political commitment creates an opportunity for three of the largest HIV/AIDS donors to become the lead "gender bender" in global development; that is, to support development programs that transform the lives of women and girls, and thus the societies in which they live.
When it comes to HIV/AIDS and gender, big donors talk the talk but sometimes stumble when it comes time to walk the walk in the prevention, treatment and care programs that they fund. Despite the billions of global HIV/AIDS dollars invested to help countries around the world to fight the epidemic, women and girls still suffer disproportionately. For every two people that receive antiretroviral drugs five people are newly infected. Most are women and girls, who are now at the center of the epidemic in Sub-Saharan Africa and account for six out of ten people infected with HIV. Females 15-24 are the most vulnerable to infection, with an HIV prevalence rate almost three times as high as that in males in the same age group.
Consider this remark by a project coordinator in Zambia who runs a program that distributes anti-retroviral (ARV) medication to HIV-positive women to prevent mother-to-child transmission:
We have women reporting being abused by their husband for being on ARV treatment, and some have reported hiding ARV treatment just to protect their marriage and secure safety and peace in their homes. Some women stop medication altogether while others refuse to start medication. This happens to women whose spouses refuse to accept their HIV status and blame it on their wives.
How can a program succeed in preventing mother-to-child infection if such gender-based violence, stigma, discrimination, and unequal access to resources -- all aspects of gender inequality -- prevent such women from openly taking the medicine they are given? If interventions emphasize individual sexual and health seeking behaviors, without addressing social, cultural, economic, physical and political factors that affect a person's ability to prevent risk and vulnerability to infection, we will ultimately fail in our battle against HIV.
Of course, HIV/AIDS donors cannot do it all, but a new report from the Center for Global Development and the International Center for Research on Women argues that global HIV/AIDS donors can and must play a key role in this fight. By changing the way they design and implement their programs and working together with country governments and other stakeholders, global HIV/AIDS donors can lead the way to overcoming gender disparities and thus improve our chances of success in the fight against HIV/AIDS.
The new report, Moving Beyond Gender as Usual (full disclosure: I am one of the co-authors), finds that high-level policy commitments to address the risks, vulnerabilities and consequences of HIV/AIDS for women have yet to produce concrete and systematic action on the ground. It offers specific recommendations for how to do better. Some recommendations, such as jointly supporting comprehensive national gender analysis, are designed to foster greater collaboration across donors, country governments and other stakeholders. Others recommendations are donor-specific and focus on such issues as program design, accountability methods, and gender capacity.
There is much that can be done to support women and girls in the response to the global HIV/AIDS epidemic. Now is the right time to finally do it.
Nandini Oomman is the Director of the HIV/AIDS Monitor, a Center for Global Development (CGD) initiative, which tracks the effectiveness of the three main aid responses to the epidemic: the Global Fund, the HIV/AIDS programs of the World Bank, and the U.S. President's Emergency Plan For AIDS Relief (PEPFAR).