UNFPA’s mandate and extensive experience in population and development, women’s empowerment and gender equality, and reproductive health and rights, provides a strong basis on which to continue building gender-responsive HIV prevention programmes.

Gender-sensitivity in HIV programming implies explicitly mainstreaming and responding to the different identities, perspectives, barriers and needs that affect girls’ and boys’ and women’s and men’s attitudes and behaviours related to HIV prevention.

Specifically, UNFPA should:

1. Ensure gender-responsive sexual and reproductive health programmes to achieve HIV prevention among young people. Access to gender-sensitive sexuality education (in and out-of-school) and youthfriendly services should be rapidly expanded, including:

• Educational and outreach efforts focused on motivating behavioural change, including by responding to the socio-cultural factors, myths, expectations and double-standards that apply differently to girls and boys which inhibit self-protection from HIV/AIDS. Participatory methodologies with single and mixed-sex groups of young people can encourage self-reflection, discussion and critical analysis about the different pressures and barriers girls and boys face in adopting preventive behaviours. Sexuality, reproductive health and rights, relationship and violence issues should be discussed in relation to STIs/HIV/AIDS and focus on challenging underlying stereotypes or misconceptions.



• Community-based mobilization for creating a supportive environment. Youth peer educators of both sexes can serve as community role models of gender equality and responsible behaviour. Parents, key family relatives, teachers, and other members of the community should be sensitized on the realities of gender, sexual health and HIV issues in youth, with emphasis on developing non-judgemental and open attitudes that will enable them to fulfill their duties in providing an enabling environment for young people. Culturally-sensitive mobilization efforts should enable the empowerment and protection of girls’ rights and needs, while promoting values based on equity and equality between the sexes.



• Condoms (male and female) should be made widely available for sexually active youth of both sexes in places where they can most easily and anonymously access them, such as public vending machines, public places where they gather. (e.g. dance clubs, workplaces, sports), and strategic single- or mixed-sex settings.



• Training for peer educators, health providers and other outreach workers should emphasize gendersensitive interpersonal skills and counseling for young people on open communication, relationship issues, sexual health and sexuality, including on male and female condom use and dual protection for those sexually active.



• Services should safeguard rights to nondiscrimination, confidentiality and privacy, and pay particular attention to the specific challenges each sex may face in negotiating voluntary, safer sexual relations or delaying sexual initiation - including the implications of sexual abuse and violence against girls⁴.

• Public and community-based awareness-raising campaigns on HIV prevention and pregnancy should aim at reaching women, as well as men and the community at large, in order to foster a supportive environment for HIV prevention among pregnant women. Message content should respond to the specific socio-cultural factors and barriers that affect women and men in adopting preventive behaviours, including those related to marital roles and pressures surrounding fertility and virility.



• Health provider training and counseling services should be rooted in an understanding of the identities and potential obstacles specific to women and men regarding HIV prevention and testing, such as social expectations related to motherhood, partner resistance to condom use and testing, risks related to partner abuse or extramarital unprotected relations, and hesitations due to mistrust of health services. Training should emphasize respect for women’s reproductive rights, and should include partner and couple counseling. Services should provide partner counseling for cases where male participation has been identified as beneficial and consented to by the woman, in order to support the woman in negotiating condom use or avoiding unsafe sexual relations.



• Service referrals must be made available for HIV-positive pregnant women and their partners in all cases where HIV testing is offered, in order to ensure access to proper follow up care and treatment, including support groups and other programmes⁵.

• On the demand side, emphasis should be placed on building national capacities to meet female and male user needs and improve their access to preventive methods. For example, issues of condom size may be especially relevant for adolescent boys and costs may be a concern for young people or for users of the female condom. Female condoms should be promoted and introduced in countries through capacity-building and advocacy, as an important empowering option.



• On the supply side, logistics systems should be supported to make preventive reproductive health commodities widely available, including simple diagnostics and treatments for sexually transmitted infections, male and female condoms, emergency contraception (e.g. in the case of condom breakage or improper use and rape), HIV test kits, and safe delivery kits. In emergency and conflict situations, and for refugees and displaced populations, where women are often exposed to large-scale sexual violence and sex for survival, there is a special need to ensure sufficient supplies of these commodities. To expand access, women’s groups and other nongovernmental networks should be included in condom distribution.

In addition, across the broad range of HIV/AIDS programming, UNFPA should ensure that gender concerns and power dynamics are addressed, and consider the following:

• In communication and educational strategies, a thorough understanding of the socio-cultural context surrounding gender roles and gender-specific reasons for health-related decision-making is necessary to tailor messages effectively. Outreach efforts should consider single-sex as well as mixed group strategies focused on gender, reproductive health and rights, and HIV issues;



• At all levels of programming, the active participation of specialized women’s groups should be pursued, as should the participation of people living with HIV/ AIDS;



• To increase access to HIV testing and counseling, service settings should respond to the different needs and concerns of women and men to overcome some of the obstacles they face. For example, market places and other alternate locations can provide women discreet access to HIV counseling and testing during their daily routes. Men-only, weekend or extended service hours may increase male access. Also, the availability of rapid HIV tests may help overcome barriers related to personal misgivings, time availability and freedom of mobility in retrieving test results.



• In advocacy and community mobilization efforts for policies and laws, and for creating a supportive environment for gender-sensitive HIV prevention, community discussions that foster open dialogue and collective understanding about gender and HIV issues offer important opportunities to break harmful stereotypes and develop more positive and equitable values regarding relations between women and men. Policies and laws that protect reproductive health and rights, promote male responsibility, provide for equal education opportunities and equal economic rights for women – including livelihood options, inheritance, banking and property rights – and work to eliminate harmful practices and sexual exploitation of girls and women help ensure the enabling environment needed for the success of HIV prevention efforts.



• In programme monitoring and evaluation, gender-disaggregated data should be collected and analyzed and gender-sensitive indicators developed that can help ascertain programme impact. Quantitative and qualitative indicators should include those related to changes in power relations between women and men, such as: women’s empowerment in sexual and reproductive decision-making; changes in boys’ and men’s attitudes and male responsibility; increased access and use of female and male condoms; and changes in expectations among youth of girls’ and boys’ capacities, shared rights and responsibilities.

Gender roles and relations have a significant influence on the course and the impact of the HIV/AIDS epidemic in every region of the world. Understanding the impact of gender roles and relations on individuals’ and communities’ abilities to protect themselves and effectively cope with the impact of AIDS is crucial for expanding the response to the epidemic.
(UNAIDS Technical Update: Gender and HIV/AIDS, 1998)

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