Africa

In 1994, Rwanda experienced a genocide that left 1 million dead and 3 million as refugees. Further, militia youth and military men used mass rape and sexual and gender-based violence (GBV) as weapons of war, leaving tens of thousands of women infected with HIV.

When the genocide ended, many of these women were left with nothing — their husbands and children had been killed, their homes taken or burned, their communities torn apart, and their health compromised. Access to medical care and counseling was nearly non-existent immediately after the war. Some women who had had families, homes and perhaps jobs just months before the war, slept on the street, while others found abandoned housing. These women were left to pick up the pieces, care for surviving children, and cope with the psychological trauma of loss and violence entirely on their own. Their bodies had been violated, and they felt alone in the world, which, they later said, had destroyed their spirits.

Soon after the genocide ended, seven women survivors came together in the capital of Kigali to share their experiences of violence and loss, and to provide each other with the emotional support they so badly needed. This eventually evolved into the Polyclinic of Hope Care and Treatment Project which helps Rwandan women cope with the combined after-effects of the genocide.  

Although HIV prevalence in Rwanda is low compared to many countries in sub-Saharan Africa, the rate among women is about 30 percent higher than that of men. And even though the genocide ended nearly two decades ago, gender-based violence is still dangerously common, with 31 percent of women reporting having experienced it since the age of 15.

The Polyclinic of Hope umbrella program provides a diversified package for women and their children, from vocational training and shelter in a newly constructed community called the Village of Hope, to post-conflict counseling and a range of HIV and AIDS treatment services. Read the full case study, "Rebuilding Hope: Polyclinic of Hope Care and Treatment Project," to learn more about the program and the women survivors it is helping.

Previous case study: "Women First in Mozambique"

In Zambezia Province's remote villages—often hours from urban areas down bumpy dirt roads—women toil in their homes and gardens just as they might have done hundreds of years ago. Strict male and female roles keep women digging on the land by day, cleaning and cooking by night, and supervising their children in between chores. They have little free time, little access to the outside world—even the radio is a rare treat—and basic household products are many miles away in the nearest trading center. They also have little help. Men are responsible for earning income for the family, but in an area with few employment opportunities, many cope through excessive drinking and risky sex. As women try to protect themselves from illness and manage their households, they do not have the money, time or information to make even small changes to improve their lives.

This stark reality has presented unique challenges in rural swathes of Mozambique where there are few opportunities, economic or otherwise, for women. Yet in a country where 85 babies are infected with the virus by their mothers every day and 22 percent of women between the ages of 20 and 24 are living with HIV; as compared to 7 percent of men the same age; it is critical that effective interventions are put into place.

The Women First program has sought to combine HIV prevention education with income generating projects to ensure that a maximum number of women are reached. Women participants are supplied with basic household products like soap, cooking oil, sugar and candles which they sell door-to-door, "Avon Lady" style, in their own and nearby villages. In exchange, not only do they earn an income, but they also receive critical information about protecting themselves against infection. 

Read the full case study to find out how this innovative program has employed creativity, resiliency and targeted gender approaches in the fight against HIV and AIDS in Mozambique.

Nearly two decades ago, ICRW’s research and advocacy efforts helped put HIV and gender on the map, playing a pivotal role in raising global awareness of the unique vulnerabilities to HIV infection that women and girls face. Since then, the international community has come to universally accept this wisdom. Continued research has drilled deep to expose the social and economic roots that make women and men susceptible to the disease in different ways.  

So today – 20 years later – what is happening on the ground?  Have public health and development experts successfully converted this knowledge into improving real programs in villages and towns where HIV rates are high?  

ICRW’s Director of Global Health, Katherine Fritz, was part of a team that spent the past few years investigating 31 programs across sub-Saharan Africa in an attempt to find out.   

The initiative was spearheaded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), which recognizes the many links between gender and the continuing global AIDS epidemic. Carried out by USAID’s HIV/AIDS arm, AIDSTAR-One, with the help of leading researchers like Fritz, the result is a comprehensive compendium of HIV prevention, treatment, care and support programs that are integrating multiple gender strategies into their work in Africa.  

Researchers found that innovative programs that adapt to the needs of the communities they work in – such as those that combine HIV prevention or education with income generating projects for women in poor rural areas – were the most successful. Others that proved effective approached and worked with men and women differently, in order to best reach both genders. Programs that integrated efforts to decrease gender-based violence, which is linked to the spread of HIV infection, also showed progress.

Complementing the compendium is a series of five descriptive case studies that zoom in closer on the programs and the people they help. The co-authors – including Fritz and ICRW Research Associate Zayid Douglas – look at diverse populations from female fish sellers in Kenya and genocide survivors in Rwanda to truck drivers in bustling Zambian border towns and door-to-door saleswomen in rural Mozambique.

Read our case studies:

Rebuilding Hope in Rwanda: Polyclinic of Hope Care and Treatment

Earning Their Way to Healthier Lives: Women First in Mozambique

Risky Business Made Safer: HIV Prevention in Zambia's Border Towns

Allowing Men to Care: Fatherhood Project in South Africa

Jennifer Abrahamson is ICRW's senior director of public and media relations.