Introduction: Increasingly feminised HIV epidemic, with growing infection rates among women and girls in many countries and women continuing to bear the burden of care.
Tackling the global HIV and AIDS catastrophe is a key priority for the International Federation's Global Agenda for 2006-2010. Mobilising the power of humanity to make the difference is at the heart of the International Federation's approach to HIV.
It is a key element in the declaration “Together for Humanity” which was adopted by consensus by all governments and National Red Cross and Red Crescent Societies at the 30th International Conference of the Red Cross and Red Crescent in November 2007.
The IFRC believes that no real dent in the HIV epidemic will be made unless tackling the vulnerability of women and girls is taken seriously and significantly stepped up. The HIV epidemic is becoming increasingly feminised, with growing infection rates among women and girls, and with women continuing to bear the burden of care.
In many of the contexts where we work, the cultural norm is such that caregiving in the context of HIV and AIDS is provided principally, but not exclusively, by women. Many women are widowed before becoming ill themselves and have been involved in providing care to husbands, partners and children. Many daughters and grandmothers care for their parents and adult children. Many grandmothers and aunties care for grandchildren, nieces and nephews.
This remains a great challenge to address, along with how to care for the caregivers.
Secondly, a key driver of the epidemic is gender inequality, which increases the personal and social vulnerability of women and girls.
As such, one of the main obstacles to addressing HIV is women’s relative powerlessness to take their destiny in their own hands.
Women often have fewer rights and resources to call upon. They are frequently forced into early sexual activity, frequently not in a position to protect themselves, not in a position to negotiate safer sex, and may suffer sexual violence and exploitation, including being forced to barter sexual favours for their own survival or that of their families.
This is compounded in many countries by women’s low awareness of rights, lack of economic empowerment and engagement in mainstream economic activities, and limited access to and control of resources.
The IFRC approach: ensure gender equality HIV programming
In this context, the IFRC is attempting to promote and ensure gender equality HIV programming through the harmonizing framework of its Global Red Cross and Red Crescent HIV and AIDS Alliance, working in support of country-based operational alliances (1).
This includes programming based on gender analysis; access and training for women and men; equal participation; addressing gender based violence; collecting, analysing and reporting sex and age disaggregated data, and coordinating actions with partners.
Practically, it focuses on promoting gender awareness, the involvement of men in prevention of mother to child transmission, promoting male volunteers and caregivers in our home based care programmes, supporting equity and access for orphaned and vulnerable girls, and coordination with partners to prevent and address sexual and gender based violence.
Let me now share with you some of the strategies of our RC/RC National Societies that have helped to address gender inequality in HIV prevention and care.
Involving men in HIV prevention and care
In Southern Africa for example, Red Cross Red Crescent National Society home based care programmes enable families and communities to take care of those who are chronically ill at home.
The IFRC has developed eight training modules to prepare National Society volunteers to take a holistic approach to treatment support, which includes HIV prevention, treatment literacy and adherence, nutrition, and psychological support skills.
The predominance of women in personal care giving is a common phenomenon observed in most societies with women being more likely to assume the role as the main caregiver. Community acceptance of men in the caregiver role runs counter to the norm and often drives them away from being active participants.
In order to address the gender imbalance in provision of home based care, National Societies have stepped up recruitment of male care facilitators through community sensitisation meetings and use of practicing male care facilitators as role models.
In the same vein, male involvement in the Prevention of Mother to Child Transmission is also been promoted in Southern Africa. Male involvement and support is essential for uptake and adherence to MTCT interventions.
It is important to ensure that both parents understand their roles and responsibilities in HIV prevention, including knowing their HIV status. In Southern Africa, the IFRC is working closely with UNICEF to develop education campaigns to increase male involvement and uptake of PMTCT services.
Skills-based training (negotiation, leadership) for women, as well as poverty reduction programmes
RC/RC volunteers are often poor. They struggle for food and clean water like the rest of the community. In this context, we have developed our Masambo Fund to support access to treatment for RC/RC staff and volunteers living with HIV. It has been used in some African countries and is a practical example of a way to make it possible for caregivers to continue making their tremendous contribution to society.
In Nigeria, our National Society seeks to promote women empowerment and remedy gender inequality in its health and care activities on HIV through the creation of mother clubs, where women also receive skills-based training.
We find that empowering women through advocacy and the development of negotiation skills is vital if HIV programs are to be sustainable at community levels.
Cambodia HIV prevention work with police
The Cambodian Red Cross police HIV prevention peer education program operating since 1999, has been developed with a strong gender focus, addressing male roles and responsibilities and gender inequalities through peer support and life skills development.
The programme also developed sexual and gender based violence prevention activities within the context of commercial sex work, and has worked with the wives and partners of police. Commmercial sex workers interviewed during evaluations of the programme in 2002, reported a reduction in the number of police clients arriving armed to brothels, less intimidation and less insistence on unprotected sex.
Infection rates amongst police in target provinces has steadily declined during the life of project activities.
Linking HIV/AIDS prevention with action against socio-cultural practices harmful to health
In some African countries and others world-wide, various cultural factors exacerbate the spread of HIV.
These include widow inheritance, practiced as a social safety net in some communities, unsafe male circumcision practices and female genital mutilation.
Linking action against female genital mutilation to raising awareness of HIV, has enabled RC/RC National Societies to reach even the most traditional of communities where attempts to discuss female sexuality would otherwise be rebuffed.
An excellent example here is the 2006 campaign to prevent HIV and female genital mutilation, launched by the Red Cross National Societies of Chad, Cameroon and the Central African Republic, with the help of the Swedish Red Cross and Canadian CIDA.
In Chad, 460 young and female volunteers were trained in peer education skills, and 120 youth were mobilised to educate the community on the detrimental effects of this practice, reaching over 6000 people who gained awareness every month.
Innovative, informal educational activities, such as theatrical productions and the organisation of information and awareness-raising days, proved to be extremely efficient in highly illiterate communities.
220 traditional community chiefs, religious authorities, administrative representatives and opinion leaders were actively involved and trained to plea against female genital mutilation, on the basis of Chadian Law No. 66/PR/2002, on the Promotion of Reproductive Health, which specifies that harmful traditional practices, including female genital mutilation are prohibited.
Conclusion
It is vital that Red Cross/Red Crescent National Societies work closely with Government and non govt actors working on HIV, gender and development to promote gender awareness and equality at different levels.
National Societies have a role to play in community mobilization and promoting gender awareness through RC/RC peer and community education programming, influencing social opinion and attitudes etc.
In Johannesburg last week, at the first annual review of the Global Alliance on HIV in Southern Africa, National Societies discussed strategies to address sexual and gender based violence, promote gender equality and overcome cultural barriers in relation to HIV prevention.
It is clear that there are opportunities for strong action at the community level, also working through traditional power structures. We expect this to be further scaled up through the year and at the next Pan Africa Conference of our National Societies, due later this year.
ENDNOTES
(1) See http://www.ifrc.org/Docs/pubs/health/pochette-hivaids-en.pdf
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