Commentary: How to Build a Better National HIV Plan

The evidence is clear: Women who experience social and economic inequities based on gender are at greater risk of contracting HIV. The same is true for men in societies where being a “real man” is equated with having numerous sexual partners. Or where people are marginalized because being gay, lesbian or transgender is viewed as falling outside of what’s considered acceptable.

Challenging gender inequality and changing these types of inequitable norms is now recognized as a key strategy for bringing down the rate of HIV infection among women and men. The good news is that a growing number of international donor organizations such as The Global Fund to Fight AIDS, Tuberculosis and Malaria, are funding programs that use innovative – and at times courageous – strategies to tackle gender-related drivers of HIV. Although such efforts are critical, their sustainability and long-term impact are limited in the absence of supportive national laws, policies and strategic plans.

If the world wants to achieve lasting and continuous decreases in HIV infections, national governments need to step up and civil society advocates need to hold leaders accountable. We need policies and strategies that create an environment in which HIV prevention programs that reduce gender inequities can thrive and expand. Governments need to earmark HIV funding for specific activities, such as preventing violence against women, which is known to exacerbate women’s HIV risk. And, to ensure that policies and strategies result in effective programs, it’s critical that governments collaborate with a variety of civil society players – from local research and implementation organizations to people living with HIV.

It’s a challenging task, but not impossible. Here at ICRW, we developed and tested a process through which any country could build and sustain what we call a “gender-responsive” national HIV prevention strategy. By that I mean creating a plan that acts on evidence regarding how HIV affects women and men differently, promotes equal access to HIV-related information and services as well as strives to deliberately change social norms that create gender-based vulnerability. Gender-responsive HIV strategies also ensure that people who are traditionally discriminated against because of their gender identity receive legal protection and equal access to services.

Our research took place in Uganda and Cambodia because each had national HIV policies that we could study and build upon. Both countries have significantly reduced HIV prevalence. However, the political and socio-cultural environments in each are vastly different. While Uganda is experiencing a generalized HIV epidemic, Cambodia’s is concentrated among high-risk populations, such as sex workers, migrants and injecting drug users.

Although both countries had taken steps to address gender within their national HIV prevention plans, neither had implemented a well-coordinated gender strategy, which was hampering their ability to sustain long term reductions in HIV. This is a typical situation. In too many countries around the world, the mandate to integrate gender into national HIV strategy is carried out as a perfunctory duty by short-term external consultants. The result, as we saw in both Uganda and Cambodia, is the inclusion of general language about gender inequality as a social driver of the epidemic, but few specific, funded strategies or activities to meet women’s and men’s unique HIV prevention and treatment needs. We found that for any country to create a truly gender-responsive national HIV plan, governments, civl society and funders must collaborate in a long-term process: They have to study the issues, review the evidence, carefully plan programs, ensure they are funded and collect data on their impact.

The world has made significant progress in the last 30 years beating back the HIV pandemic. But for many countries, such as Uganda, the rate of decline is stagnating. New and innovative strategies are needed now more than ever. After all, there were still about 34 million people worldwide living with HIV at the end of 2010, while some 2.7 million became infected that year, according to UNAIDS. Preventing new infections requires a committed, multi-faceted approach, one that adopts medical innovations such as male circumcision in tandem with programs that address the gender inequalities that have been at the root of so much HIV transmission for so long.

It’s not too late to accomplish what could have been achieved decades ago — building smarter, more effective national HIV strategies by making gender equity a central goal with specific programmatic strategies, adequate funds and measurable targets.

Related publication: An Action Guide for Gender Equality in National HIV Plans: Catalyzing Change through Evidence-based Advocacy

Katherine Fritz is ICRW’s director of global health research and programs.