Asia

The International Center for Research on Women (ICRW) is conducting a study to better understand the barriers Indian women in certain settings encounter when accessing HIV prevention, treatment and support services.

As part of the U.N. Development Programme’s (UNDP) “Universal Access for Women and Girls Now! (UA Now!)” initiative, the ICRW study focuses on female sex workers in Pune, a district in the state of Maharashtra; and the wives of migrant workers in Ganjam, Orissa. Both are vulnerable, high-risk populations in which HIV is very prevalent. And while several studies exist about female sex workers – including by ICRW – none has comprehensively analyzed the barriers women sex workers face in accessing HIV-related services. Meanwhile, there has never been an examination of the vulnerability and risk to HIV among wives of migrant men.

UA Now! aims to improve and expand HIV services for women and girls. The initiative supports countries in developing national action plans that address gaps in efforts to respond to the HIV epidemic and ensures that those responses reflect the specific needs of women and girls.

Along with India, UA Now! also is being implemented in Ethiopia, Kenya, Madagascar, Malawi, Namibia, Rwanda, Zambia, Tanzania and Swaziland. While there are common causes, risk factors and consequences related to women and HIV globally, each country has its own unique structural and cultural implications.

“Women worldwide are disproportionately affected by HIV and continue to have limited access to the services available to them,” said Priya Nanda, UA Now! project director and group director of social and economic development at ICRW’s Asia Regional Office in New Delhi. “What is still not fully understood in India, however, is the range of perceived and actual barriers to HIV prevention, treatment, care and support – particularly for women. We’re working to identify evidence-based, context-specific approaches to effectively address this.”

ICRW will use its research findings to work with India’s National AIDS Control Organisation (NACO) in its creation of an action plan to respond to the epidemic. ICRW also will make recommendations to NACO on how to help women overcome structural, social and cultural barriers to health services. NACO’s targeted intervention strategy primarily addresses high risk groups, which include female sex workers.

“Services should be accessible, affordable and acceptable, and the data on use and access needs to be systematically collected to make the system accountable,” Nanda said. “That’s the only way we can determine whether universal goals are being met.”

By achieving universal access to HIV-related services, countries can gain a significant leg up on broader health and development goals, such as alleviating poverty, reducing maternal mortality rates and creating more equitable societies, according to UNAIDS. UA Now! builds upon U.N. member state commitments to universal access and the Millennium Development Goals promoting gender equality, empowering women and combating HIV and other diseases by 2015.

In India’s case, women make up 39 percent of the approximately 2.9 million people living with HIV. According to NACO data, most women in monogamous relationships are infected by their husbands, but among all women, HIV remains most prevalent among women in sex work. Nanda said that other aspects of women’s risk and vulnerability to HIV are considerably under-researched and unknown.

As part of the UA Now! study, ICRW experts spoke to sex workers and wives of migrant men to understand their experiences when seeking HIV-related services. ICRW also interviewed service providers, government officials and male partners of the women in the study.

Early findings among female sex workers show that:

• Women in sex work report high levels of stigma themselves, making them reluctant to openly seek HIV services.
• They report that service providers do not honor their privacy and don’t keep confidential women’s health information.
• They fear knowing their HIV status, and how that could affect their earning potential.
• While a high proportion of sex workers seek HIV testing services through non-governmental organization clinics, their knowledge of HIV treatment is starkly low.

And early findings among women married to migrant men show that:

• Very few know anything about HIV risk; they trust their husbands.
• Transportation costs to a health provider are prohibitively high, so wives of migrant men are less likely to seek care.
• Few health centers are available in the area, especially with female counselors.
• Families with an HIV-positive person face stigma and discrimination from their extended families and communities.

ICRW’s complete findings are scheduled to be available in March 2011. 

Gillian Gaynair is ICRW’s writer/editor.

The International Center for Research on Women (ICRW) is collaborating with the U.K.-based Cherie Blair Foundation for Women to identify technologies that are helping women entrepreneurs in India overcome barriers unique to them.

The effort builds on ICRW's analysis of how technology can economically strengthen women and comes at a significant time. Donors and private corporations are giving more attention to technology’s role in increasing agricultural productivity, alleviating poverty and addressing other global development matters. The issue of technology also is on the radar of U.S. Secretary of State Hillary Clinton.

On Oct. 7, Clinton announced the launch of the mWomen initiative, a joint project by the Cherie Blair Foundation and the GSMA Development Fund. The effort will promote mobile technologies as tools for international development and women's empowerment.

Clinton said that while mobile technology is not a silver bullet, the spread of cell phones creates new possibilities in the fight against poverty, hunger, corruption and disease. However, for 300 million women in low- and middle-income countries, "the technology is still out of reach...because of an array of economic and social barriers."

"We're called to close the mobile gender gap because of our commitment to fairness and because of our commitment to progress," Clinton said. "Investing in women's progress is the most direct and effective way to invest in progress economically and socially."

For ICRW and the Cherie Blair Foundation, their shared research is examining how information and communication technologies (ICT), such as mobile phones, can enable women to conquer barriers that otherwise might limit their business efforts, possibly even preclude them altogether. The research is focused in India because of that nation’s rapidly developing economy, where cell phone users number second to those in China and where there is high interest in entrepreneurial ventures.

However, “access to and use of technologies in India vary widely by gender, location and other factors,” said Anjala Kanesathasan, a senior public health specialist at ICRW. “We want to better understand the emerging trends in this area and how women entrepreneurs are using technology, as well as the barriers that inhibit their access to it. All of this will help us identify the factors that need to be in place for women entrepreneurs to thrive economically.”

Gillian Gaynair is ICRW’s writer/editor.

Photos © David Synder/ICRW

Prachi and older brother Dhiraj say they get along much better since participating in a school-based ICRW program that works with boys and girls to promote gender equality.

Prachi Chavan, 12, and her 14-year-old brother Dhiraj, in their home in Ghatla, a slum community in eastern Mumbai.

MUMBAI, India – It's "hobby day" at Govandi Station Municipal School in Ghatla, a slum community in an eastern Mumbai suburb. The school's entrance is a field of dirt, where boys playfully try to tip a cow in one corner and where women and children nearby pick through trash heaped in bins.

Even though it's vacation time, the school remains open to students for a few hours each morning. Kids like 12-year-old Prachi Chavan and her 14-year-old brother, Dhiraj, come here to play dodge ball, cricket and other games. It's only 8:30 a.m. and boys and girls – along with some teachers and the Chavan children's father – gather in a concrete space in the back of the school.

Prachi grabs a cricket bat and takes her place in the imaginary cricket field. She bends at her waist, raises the bat and smiles wide, releasing deep dimples in both cheeks.

Pow! Prachi strikes the ball. "Ground shot!" her dad cries out as others scurry to scoop up the ball.

Later, it's Dhiraj's turn. His little sister cheers him on. After a few more swings from Dhiraj and others, Prachi calls out "Dada! Dada! Chalna!" Brother, brother, let's go!

Dhiraj Chavan gears up to bat during a school yard cricket game.

A couple of years ago, Prachi and Dhiraj never would have played together. Nor did she call him "Dada" in public. Dhiraj told her not to; it wasn't cool to associate with his sister. And they didn't talk much at home. But that and much more has changed since the two participated in the International Center for Research on Women's (ICRW) Gender Equity Movement in Schools (GEMS) program.

GEMS begins in the sixth grade and works for two years with boys and girls in 45 Mumbai-area public schools. The program also takes place in Kota and Goa.

The effort champions equal relationships between girls and boys, dissects social norms that tend to define men's and women's roles in India, and addresses different forms of violence and how to intervene. GEMS students, who are between 12 and 14, also learn how and why their bodies change during puberty. And they talk about what makes for healthy relationships as well as how to prevent HIV.

They're all serious topics. But they're tackled in a fun way, though extra-curricular activities, role-playing and games lead by adult facilitators from the Committee of Resource Organizations for Literacy (CORO) and Tata Institute of Social Sciences (TISS), ICRW's local partners in the program.

Innovative approach

The GEMS Diary is a colorful, interactive workbook that teaches students about social norms, qualities of a healthy friendship and how to stop violence.

It's an unconventional approach in a deliberately-chosen setting – the school system.

"In a deeply gender-divided society like India, girls and boys are segregated from early on in their lives. Schools validate this by limiting how and where boys and girls interact," says Pranita Achyut, an ICRW specialist in poverty, gender and HIV/AIDS who oversees the implementation of GEMS. "This kind of segregation only stands to limit boys' and girls' understanding of each other. We think it's critical to challenge these practices within the school system, where children learn to socialize."

Key to this has been facilitators' effort to create an environment of trust and acceptance within the classroom.

"It's highly unusual for discussions with children at school to touch on their life experiences, but GEMS gives them a safe place to raise even the most intimate questions," Pallavi Palav, CORO's project coordinator for GEMS. "And it has been like opening a floodgate. Girls and boys challenge each other and ask questions they've never discussed in the presence of teachers or other authority figures."

GEMS gives students a safe place to raise even the most intimate questions.

ICRW is already seeing results. Before starting the project in 2008, ICRW, CORO and TISS surveyed some 2,800 students on their attitudes about violence as well as the roles of men and women, among other topics. A follow-up survey this year shows that many students' support of traditional gender roles – such as the notion that women shouldn't work – shifted during the course of the program, particularly among girls.

Results also show that students were better able to recognize different forms of violence after they participated in GEMS.

"Overall, findings suggest that programs like GEMS can play a vital role in changing deeply-rooted social norms within India's rapidly changing society," Achyut says. "The findings also suggest that schools are perhaps the most appropriate places to intervene for a lasting impact."

However, experts say there still are many students whose views about boys' and girls' roles in society haven't altered since they became involved in GEMS. "Learning to be sensitive to the issues GEMS challenges children to think about isn't easy; it's a journey," Achyut says. "It's a big issue, and what we're doing may not be a complete answer, but it may well be the first step."

ICRW will release its complete findings in early 2011. In the 2010-11 academic year, ICRW and its local partners will focus on institutionalizing GEMS by involving teachers on a deeper level and, in some areas, the community, too. In two of these communities, ICRW also will aim to engage fathers of girls on issues related to their daughters' confidence and opportunities.

A family benefits

Dipti Chavan, Prachi and Dhiraj's mother, says her children are more responsible and respectful since being a part of the GEMS program.

For GEMS students such as Prachi, what most resonated with her were discussions about relationships – why it's important to be respectful, understanding and to share feelings. She credits the program with bettering her relationship with her brother – they now talk to each other and play together. She says she talks to him about how much he's changed and asks him why. Dhiraj tells her they have to live out what they're learning through GEMS.

"We're much closer," she says of her brother. "I wish that this relationship remains always like this…I really feel so free from all the restrictions."

On this day, Prachi's mother begins preparing small plates of poha, a traditional breakfast dish of flattened rice, potatoes and spices when everyone returns from the school playground. As she dishes up the meal, Dipti says that her children are more proactive, responsible and respectful since participating in GEMS.

"We are shocked to see the change," she says. "I don't have to reinstruct these two kids. They're doing on their own."

Now, Dhiraj helps Prachi with household chores. They study together. And they've learned how to negotiate the things that once caused them to bump heads – like how to share TV time.

But for Prachi, a more subtle change seems to have occurred: She's found her voice.

Since participating in GEMS, Prachi Chavan now believes girls can do anything boys can, including pursue an education and work outside the home.

"I used to think that only boys can study, they can grow. They get the respect," Prachi says as she sits on the floor, legs crossed. "There's nothing for girls; they have to be home and take care of household chores."

But through GEMS, Prachi explains that she realized her outlook was based solely on the relationships between women and men she sees in society. She's discovered that doesn't necessarily have to be her reality.

"It's a girl's right to get an education. She can do anything boys can do," Prachi says. "She can get an education, get a good job, work outside and take care of her parents. Why should girls be restricted only to household work?"

Prachi's tone is emphatic. Confident.

As she listens, Dipti's eyes pool with tears. It's the first time she's ever heard her daughter speak like this.

She smiles.

Gillian Gaynair is ICRW's writer/editor.

The top United States diplomat on women’s issues recently visited the International Center for Research on Women’s (ICRW) Asia Regional Office in New Delhi, India, to identify successful efforts that move societies to better value its girls. Such an approach is central to creating a more equitable, healthy world for girls and women, U.S. Ambassador-at-Large for Global Women’s Issues Melanne Verveer said.

She added that issues such as child marriage, feticide and violence against women are, at their root, about how girls are viewed by society. “How do we get the breakthrough,” Verveer said, “to bolster the value of the girl?”

The ambassador’s time in India was part of a week-long, multi-country September tour, in which she stopped at ICRW to learn more about its work on the ground, particularly efforts to change social norms that influence behaviors among adolescent girls and boys. ICRW senior staff and Ravi Verma, who directs the Asia Regional Office, spoke with Verveer about ICRW’s innovative programs that involve boys, such as the sports-based Parivartan program, and about potential solutions to delay marriage for young women.

During the two-hour visit, Verveer also learned more about how ICRW approaches its work. She said it’s one of the few organizations that measures and evaluates programs to ensure that they’re effective and sustainable, and praised ICRW’s collaboration with grassroots organizations, corporations and national governments.

The ambassador’s visit to India comes at a time when the U.S. and India have committed to partner in areas of common interest, such as technology and food security, as outlined in the ongoing U.S.-India Strategic Dialogue. ICRW President Sarah Degnan Kambou said she will stay in close touch with the Office on Global Women’s Issues to ensure that the needs of women and girls are integrated in all U.S. development efforts.

Roxanne Stachowski is ICRW’s external relations associate.

Melanne Verveer, U.S. Ambassador-at-Large for Global Women's Issues, visits staff in ICRW's Asia Regional Office in New Delhi, India.