Francoise Ndayishimiye

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Effective Gender and sexual minorities
Programming
Francoise Ndayishimiye
SWA meeting 9-11 October 2009 Hyderabad
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OUTLINE

• KEY GENDER DEFINITIONS.
• WHY FOCUS ON GENDER FOR THE 3 DISEASES?
• WHY GENDER EQUALITY SEXUAL ORIENTATION AND
  GENDER IDENTITY (SOGI) STRATEGY IN THE GF?
• OVERVIEW ON EFFECTIVE GENDER PROGRAMMING
• Followed by Country examples (Bangladesh,
  India, Afghanistan)

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Key Gender Definitions (1)

• GENDER SEX
• Sex refers to the biological characteristics
  which define humans as female or male. Note -
  some people choose to change their sex through
  surgery or are born intersex with a combination
  of male and female genitalia.
• Gender - socially constructed rather than
  biologically determined notions of femininity
  and masculinity

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Key Gender Definitions (2)

• SEXUAL MINORITIES
• Sexual minorities Sexual minorities refer to
  people whose sexual orientation, gender identity,
  and/or consensual adult sexual behaviors do not
  conform to majority norms and values.
• Sexual minorities include gay men and other men
  who have sex with men (MSM), lesbian women and
  other women who have sex with women (WSW), and
  individuals, including heterosexual people, who
  are transsexual, transgender, and intersex, as
  well as female, male, and transgender sex
  workers, all shown to have high rates of HIV
  incidence and prevalence in many countries.

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WHY FOCUS ON GENDER IN PROGRAMMING FOR THE 3
DISEASES?

• Women, men and marginalized sexual minority
  groups are valued differently in society and
  have unequal opportunities.
• Because of sex and gender differences women, men,
  girls, boys and sexual minorities
• - Experience different health risks
• - Engage in different health seeking behavior
• - Have different access to info, prevention and
  care services
• - Receive different responses from health
  systems
• - Experience different health outcomes
• Gender inequalities exist in all societies and
  for all three diseases but are most important in
  relation to HIV/AIDS

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• More Vulnerable
• Less economic and social power
• Stigma discrimination
• Huge social burden

In many communities, the role of the woman as
carer is expanding to also encompass responsibil
ities of provider With no economic power to
cover health expenses.
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Gender and HIV (1)

• Women and girls more vulnerable to HIV because
  of biological vulnerability social
  marginalization and vulnerability economic,
  educational, legal and political discrimination.
• Harmful gender practices and norms submissive
  role of women, cross generational sex,
  gender-based violence, sexual exploitation and
  abuse, marginalization of lesbian, gay, bisexual,
  transgender and intersex communities,
  institutional discrimination of sex workers and
  MSM
• Norms around masculinity and femininity
• ? key drivers of HIV infection
• ? barriers to their access to prevention,
  treatment, care

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Gender and HIV (2)

• Men who have sex with men, transgender and sex
  workers
• Globally prevention services reach fewer than 10
  per cent of men who have sex with men and fewer
  than 20 per cent of sex workers
• Sexual networks - multiple sex partners -
  conducive to the spread of HIV
• Marginalization and criminalization of people
  impacts their ability to negotiate health and
  health services
• Access explicitly or implicitly denied through
  laws, religion, social institutions, and cultural
  traditions

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Gender and Malaria

• Vulnerability to malaria and access to
  treatment is often different for women and men,
  and is influenced by gender roles and issues
• Pregnant women immune deficiency during
  pregnancy
• Men contracting malaria through occupational
  exposure (working in mining or agriculture,
  working at night)
• Inequitable access to health care (men usually
  control family finances)
• Women most often carry the extra burden of caring
  for sick family members

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Gender and Tuberculosis

• Globally, men account for two-thirds (2/3) of
  notified tuberculosis cases (is it less
  notification or real low incidence?)
• However more cases among women are now being
  reported (especially those aged 1524 years).
• This shift highlights the need to target both men
  and women in tuberculosis responses and more
  research on the incidence of TB and gender

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WHY GENDER EQUALITY AND SEXUAL ORIENTATION AND
GENDER IDENTITIES STRATEGIES ?

• Global Fund Board appreciation of a broad view
  of gender two parts - the Gender Equality
  Strategy (approved in November 2008) and the
  Sexual Orientation and Gender Identities (SOGI)
  Strategy (approved in May 2009)
• Ensure increased emphasis on gender and sexual
  minorities issues in Global Fund proposals and
  programming to achieve greater impact in our
  efforts to address the three diseases

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OPPORTUNITIES

• Existing grant (reprogramming where relevant and
  possible)
• New grants or Rolling continuation mechanisms
  (RCC)
• National Strategic Applications (NSA)
• Integration in the disease National Strategic
  Plans

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KEY STEPS FOR EFFECTIVE GENDER PROGRAMMING

• Know your epidemic and understand how gender
  issues can influence epidemics
• Know your target group
• Know Your Response

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Comprehensive Gender Response

• ? Should consider the Context
• Should cover Sensitive and Transformative
  interventions
• Addressing the short-term needs (Interventions
  that address immediate health and welfare and
  specific needs of vulnerable women, girls, men
  and boys, sex workers, MSM, and transgender )
• Addressing the long-term needs (interventions
  that address underlying causes, structural and
  rights-based issues, including harmful norms,
  laws, behaviors and institutional stigma and
  discrimination)
• Costed work plan and indicators for monitoring
  and evaluation!

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Conclusion

• For effectiveness reasons Global fund is
  committed to fund proposals that scale up
  services and interventions that reduce
  gender-related risks and vulnerabilities to
  infection, decrease the burden of disease for
  those most at-risk and marginalized, mitigate the
  impact of the three diseases, and address
  structural inequalities and discrimination to
  improve the effectiveness of the grants at
  country level
• Opportunities existing are
• Existing grant (reprogramming where relevant and
  possible)
• New grants or Rolling continuation mechanisms
  (RCC)
• National Strategic Applications (NSA)
• Integration in the disease National Strategic
  Plans

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Further information

• The Board-approved Gender Equality Strategy and
  Sexual Orientation and Gender Identities Strategy
  are available on the Global Fund website
  http//www.theglobalfund.org/en/publications/other
  
• In addition to following up on these issues with
  your Fund Portfolio Managers and technical
  partners please not that there are also two
  senior advisors in the Secretariat who are
  available to offer further advice on moving
  forward. The Senior Advisor for Gender, Francoise
  Ndayishimiye, can be reached on
  Francoise.Ndayishimiye_at_theglobalfund.org and the
  Senior Advisor for Sexual and Gender Diversity,
  Andy Seale, can be reached on Andy.Seale_at_theglobal
  fund.org

Thanks