Gender

  • Research on key populations leads Botswana to smarter HIV prevention

    At approximately 18 percent, the prevalence of HIV in Botswana’s general population is one of the highest in the world. As a result, national HIV prevention efforts have focused more intensively on the general population than on other populations. Little is known about key populations, such as female sex workers and men who have sex with men, whose behaviors are both stigmatized and illegal in Botswana.

    In 2012, the Botswana Ministry of Health used an integrated behavioral and biological surveillance survey to estimate population sizes and prevalence of HIV and sexually transmitted infections (STIs) among female sex workers and men who have sex with men. The study was historic. For the first time, it showed the HIV and STI burden among these two key populations and raised awareness about how they might have contributed to the generalized HIV epidemic.

    The survey, carried out with technical assistance from FHI 360 through the Preventive Technologies Agreement (funded by the U.S. Agency for International Development), uncovered a population of more than 4,000 female sex workers in the three districts where the survey was conducted. Among these female sex workers, HIV prevalence was 61.9 percent, and the prevalence of gonorrhea and chlamydia were both higher than 10 percent. The female sex workers had a mean of more than seven partners per week, and condom failure, which includes condom breakage and being paid or forced not to use condoms, was common.

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  • Too young to wed: The high price of early marriage

    Today, we celebrate Malala Day, a commemoration of girls’ empowerment and gender equality across all areas of human development. Like Malala Yousafzai, thousands of girls around the globe are dedicated to pursuing their education and choosing their life path yet are prevented from realizing their full potential. For the vast majority of these girls, the greatest barrier to schooling is not the bullets of terrorists — it is the day-to-day economic pressures and the unequal social expectations they face as they enter adolescence and young adulthood. It is a sad reality that in the 21st century, many girls are forced into marriage and starting a family as early as age 14, which brings their educational aspirations to a halt.

    Teenage, Married, and Out of School, a new study by the FHI 360 Education Policy and Data Center, highlights the heavy toll early marriage inflicts on school participation among adolescent girls in nine countries of east and southern Africa. While the universally ratified 1990 African Charter on the Rights and Welfare of the Child (ACRWC), as well as national legislation in all nine countries, protect children against marriage before age 18, early marriage is still visibly present across the region. Some countries, such as Rwanda, have managed to bring this disturbing phenomenon down to a minimum, while marriage at age 14 through age 17 appears to be fairly commonplace in others (Figure 1).

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  • The role of youth sexual and reproductive health in individual and national development

    In honor of this year’s World Population Day, the theme of which is youth engagement and the sustainable development agenda, we are reflecting on youth — our future leaders, parents, entrepreneurs and citizens. Today’s generation of young people is the largest in history: there are 1.8 billion people between the ages of 10 and 24 on the planet. In many countries, more than half of the population is under age 25, creating opportunities for national economic growth but also underscoring the need for greater investment in their health — with consequences that will affect the world’s social, environmental and economic well-being for generations.

    Investment in young people’s sexual and reproductive health in particular ensures that young people are not only protected from HIV and other STIs, but also that they have the number of children they desire, when and if they wish to have them. The ability to control one’s fertility increases individuals’ productive capacity and can lead to a decline in a country’s dependency ratio (number of working citizens compared to nonworking citizens). When the dependency ratio declines in conjunction with adequate investments in youth education and economic opportunity, per capita income can increase — a phenomenon known as the demographic dividend.

    Unfortunately, many young people do not have access to the critical sexual and reproductive health information and services required to stay healthy and avoid unintended pregnancy. Many young women report not wanting to become pregnant, but the level of unmet need for contraception among adolescents is more than twice that of adults. In some regions of the world, the unmet need for contraception among adolescents is as high as 68 percent. Fulfilling the unmet need for contraceptives among adolescents alone could prevent an estimated 7.4 million unintended pregnancies annually.

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  • A call to prioritize gender in development

    The most effective 21st century international development organizations will be those that ask — and come up with workable answers to — the right questions about gender. The right answers are ones that boldly empower women and girls, engage men and boys as partners and don’t shy away from approaches that disrupt business as usual. The organizations that get gender right will be the ones that truly transform lives.

    On June 16, 2014, more than 200 gender experts, funders, policymakers and development organizations will convene for the inaugural Gender 360 Summit in Washington, DC, to explore approaches for empowering women and girls and prioritize gender equality in our work. It is an opportunity for the international development community to examine the roadblocks, reflect on what we are doing well and where we are failing, and push ourselves to do better.

    What have we learned about gender inequalities in different social, cultural and geographic settings? Beyond investing resources, what role can funders and their implementing partners play in elevating the importance of integrating gender considerations into all their work? What are the indicators of success and how do we measure them? These are just a few of the questions that need actionable responses.

    Gender is not just about women and girls. Understanding gender means understanding the differences, in particular the economic, social, political and cultural attributes, constraints and opportunities that are associated with being female and male, and in some places, a third (or other) gender. It also means understanding how the social and economic forces unleashed by modernization (and abetted by development programs) affect women, men, boys and girls and the interactive relationship among them.

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  • Naomi

    What prevents girls in Nigeria from receiving a quality education?

    Girls in Nigeria face many obstacles. These include high school fees, gender inequality and other social pressures that cause them to drop out. Security is a big risk for many girls, especially since the recent kidnappings. Some girls are just too afraid to go to class. The conditions at school can also be a challenge. My class has 50 students and no fan. Some classrooms have no ceiling, no fan and even more students. At certain times of the day, like when the sun is directly overhead, it is too hot for students to even sit in the classroom and impossible for them to concentrate and learn.

    Some policies also limit girls. If a girl is pregnant, she cannot return to school after she has her baby. One mistake should not be the end of a girl’s education.

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  • Why adolescents?

    In 2012, young people ages 15 to 24 accounted for an estimated 40 percent of new nonpediatric HIV infections worldwide [UNAIDS World AIDS Day Report 2012]. Furthermore, perinatal HIV transmission is a major cause for HIV infection, and given the success of pediatric antiretroviral therapy (ART), many more infants born with HIV are growing up into adolescents and young adults living with HIV.

    While care and treatment programs for people living with HIV (PLHIV) can be found in every country, there is a gap in provision of ongoing, supportive counseling for adolescents living with HIV (ALHIV). Adolescence is often when young people begin having sex, which increases chances that adolescents living with HIV might pass the infection to partners who are HIV negative. Another concern is that girls living with HIV may become pregnant; if they do not know about or have access to services for preventing mother-to-child transmission, they can pass the infection to their babies. Given that adolescents are a large sub-group of those living with HIV, there is a need for tailored interventions and support systems that address adolescents’ unique vulnerabilities.

    Positive Connections

    To shed light on the specific health and social support needs of ALHIV, FHI 360 — on behalf of USAID’s Interagency Youth Working Group — developed a resource called Positive Connections: Leading Information and Support Groups for Adolescents Living with HIV. This unique guide provides facilitators with background information about the needs of ALHIV, tips for starting an adult-led information and support group, 14 sessions to follow in a group setting and guidance on tracking a program’s progress.

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  • Gender, economics, and ART adherence: What’s the connection?

    In a rural village in central Africa, my colleagues and I stood over a registration book for antenatal care clients with the goal of identifying clinic-level data that could be extracted for a project evaluation. As we made our way through the book, the left sides of the pages were filled with names of women, dates and HIV test results — it was clear that almost all of the women who tested HIV positive received some form of antiretroviral therapy (ART). As my eyes ran to the right across spaces for follow-up records, however, the fields became increasingly emptier, and our team began to discuss the various barriers to services, even a highly effective service like prevention of mother-to-child transmission (PMTCT).

    Access and adherence to the greater continuum of HIV care is influenced by several factors, including community-level gender norms and related behaviors. For example, HIV-positive men may avoid HIV testing and may spend a significant amount of their income attempting to address symptoms of their illness rather than confirming their HIV status. Often, these behaviors are driven by fear that knowledge of a positive HIV test result could compromise their leadership at home and cause family instability. Research has also identified instances when men undermine their wives’ access and adherence to ART, even taking their wives’ medication for themselves. Interestingly, despite such challenges, women are more likely to access and adhere to HIV-related treatment and care than men.

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  • “I will not let you hit your wife!” I yelled. “I work for an organization that is empowering women to end violence in their lives.” Moments earlier, my older brother had joined his wife (my sister-in-law), daughter and me on the balcony of his house. As he ate, he complained that his wife was using the charger for his mobile phone. He grew so angry that he threw his plate of food on the floor and stood up to confront her. He tried to punch her, but I pushed him away.

    This was not the first time I had experienced violence. My former partner and the father of my two children threatened to kill me when I was 24 years old. He physically abused me, treating me like I was his punching bag. He often struck my face so people would know he “owned” me. With all of the bruises, I always felt ashamed to walk in public. My past experience with my former partner made me more sensitive to what was happening in my family.

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  • positive-connections-coverWhy adolescents?

    In 2012, young people ages 15 to 24 accounted for an estimated 40 percent of new nonpediatric HIV infections worldwide [UNAIDS World AIDS Day Report 2012]. Furthermore, perinatal HIV transmission is a major cause for HIV infection, and given the success of pediatric antiretroviral therapy (ART), many more infants born with HIV are growing up into adolescents and young adults living with HIV.

    While care and treatment programs for people living with HIV (PLHIV) can be found in every country, there is a gap in provision of ongoing, supportive counseling for adolescents living with HIV (ALHIV). Adolescence is often when young people begin having sex, which increases chances that adolescents living with HIV might pass the infection to partners who are HIV negative. Another concern is that girls living with HIV may become pregnant; if they do not know about or have access to services for preventing mother-to-child transmission, they can pass the infection to their babies. Given that adolescents are a large sub-group of those living with HIV, there is a need for tailored interventions and support systems that address adolescents’ unique vulnerabilities.

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  • Reducing violence against women and girls in Papua New Guinea

    Yesterday was the International Day for the Elimination of Violence Against Women. In Papua New Guinea, where I work for FHI 360, violence is a serious, widespread problem that affects many women and girls on a daily basis. While exact figures are difficult to obtain, recent estimates show that violence occurs in more than two-thirds of families living in the country.

    FHI 360 is tackling this pervasive problem through a new project. The Komuniti Lukautim Ol Meri Project (KLOM), funded by Australian Aid, supports women and girls who are survivors of violence in Papua New Guinea by providing community services focused on prevention, response and empowerment. The project, which is managed by FHI 360, is being implemented in ten communities in the Sandaun and Western Highlands provinces. Each community has two “mobilizers” who play a pivotal role in helping women and girls who survive violence. For example, when two primary school girls were gang-raped coming home from school in April, the girls’ families reported the incident to the two community mobilizers, who then accompanied the girls to town for medical and legal assistance. FHI 360 works closely with these mobilizers, as well as two provincial hospitals, a faith-based organization and a community-based organization.

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