Gendering the fight against Aids

Roger Tatoud
20 August 2006

Two strong messages have emerged from the 16th International Aids Conference in Toronto, Canada. The first is that with drug treatment now being rolled out in developing countries, prevention should return to centre stage in future policies and strategies. The second is that women's lives and status need to be improved and that women need to be given power to prevent HIV infection.

Both messages were embodied in Bill Gates's keynote speech:

"We need to put the power to prevent HIV in the hands of women. This is true whether the woman is a faithful married mother of small children or a sex worker trying to scrape out a living in a slum. No matter where she lives or what she does, a woman should never need her partner's permission to save her own life."

An Eldis report notes that "a decade ago women seemed to be on the periphery of the epidemic, today they are at the epicentre". Of the 38.6 million people living with HIV at the end of 2005, nearly half of them, 17.3 million, were women (Unaids, 2006 Report on the Global Aids Epidemic). And of the 16,000 new infections that occur every day, up to sixty percent are now amongst women (ILO).

Empowering women was a central policy goal of both the International Conference on Population and Development (ICPD) in Cairo in 1994 and the Fourth World Conference on Women (FWCW) in Beijing in 1995. Women's empowerment was emphasised in agreements at the World Summit for Children in 1990, the World Conference on Human Rights in 1993, the World Summit for Social Development in 1995, the World Food Summit in 1996, Habitat II in 1996, and the fifth-year review of ICPD implementation (ICPD+5) in 1999.

That, ten years later, women's empowerment is back on the agenda in the fight against HIV/Aids suggests that it has somehow failed to fulfil its objectives. One explanation for the relative achievements of empowerment strategies might be the failure to recognise that empowering women without disempowering men is like giving a moneybox to the poor in the hope that they will get rich.

Also by Roger Tatoud on openDemocracy:

"Gridlocking Knowledge" (July 2002)

"Genes and ownership: a scientific approach" (November 2002)

" Wealth versus health – the Thai frontier"
(July 2006)

The invisible gender?

Let's not underestimate the importance and success of policies to empower women from the last ten years. In a recent report, ActionAid emphasised how empowering young women through education has contributed to lowering the risk of HIV infection and increased safer sex practice in Africa.

Nowadays, prevention strategies target adolescent girls, to give them access to education and provide them with life skills. But as Mohammad Khairul Alam of the Rainbow Nari O Shishu Kallyan Foundation in Bangladesh observes, "health education programmes which aim to empower women and girls to use condoms often fail adequately to tackle the actual problems because of imbalanced power relations. The desired changes in the behaviour of adolescent girls and boys cannot happen without programmes addressing such issues like how a girl can say no, but also why boys, teachers and other adults should respect the human rights of girls."

Somehow, empowering women requires "disempowering" men. How to do this for the best is open to debate, in light of past experiences and ongoing efforts discussed at the conference.

There are many initiatives and training manuals for empowering women, in particular around reproductive rights, from UNFPA, Unesco, Unifem, FAO, PHDRE ... But few, if any, actually involve men in their approach. This overlooks the reality that in a relationship with a power imbalance, marital or not, it is the man who dictates when to have sex and how.

More appropriate are strategies and policies that bring men and women together, giving both sexes knowledge about HIV/Aids, life skills, leadership skills (since power does not equate to leadership), and showing men that they can confidently share power with women, while showing women that they can assume this power boldly.

In this regard, gender mainstreaming, an approach that puts gender issues at the centre of organisational processes and programmes, might prove successful. Gender mainstreaming undertakes to include gender-related issues during strategy planning and policymaking. Women are not seen or treated as a special group but as one of the various groups concerned with an issue. Strategies are designed for the benefit of all and involve women in the formation process.

There are some advantages to this approach. One is that it does not portray women as powerless, as "women's empowerment" can do. Another is that it avoids opposing one group to another (women to men) and thus reduces the dangers of confrontational dialogue and gender-discriminated workshops and training.

Mainstreaming is a relatively new concept, not restricted to gender-related issues. For instance, the benefits of HIV/Aids mainstreaming were recently evaluated in a report by Unaids, UNDP and the World Bank. Overall, it has had mixed results. In Thailand, the benefits of mainstreaming HIV/Aids in the National Development Plan were evident in terms of improved participation, commitment, coordination, and planning between various ministries and civil society, locally and nationally. The experience and skills acquired through mainstreaming produced faster, more effective responses to the challenges in hand. Where mainstreaming has failed, the report faults not the approach itself, but a lack of understanding, commitment, prioritisation, funding and skills among participants.

Gender mainstreaming is a globally accepted strategy for promoting gender equality in several areas, and training manuals and strategic plans have already been developed to mainstream gender in HIV/Aids initiatives.

To "think" about women and their role in society is already to empower them. It is the first step that leads to power-sharing between men and women, and as such should be at the heart of the responsible and hopefully successful strategies much needed in the fight against HIV and Aids. Undoubtedly gender mainstreaming requires political will and commitment, often in the hands of men. But lest we forget, in France married women were given the right to dispose of their own wage ninety-nine years ago, on 13 July 1907, with the support of men like Tommy Fallot and Léon Richer who saw in women's control of their personal income a protective measure against debauchery and prostitution. Their paternalist logic may be at odds with today's empowerment, but it nevertheless raises hope for modern strategies involving men and women working together to fight HIV/Aids.

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