GENDER AND SEXUALITY REPORT

Supporting community action on AIDS in developing countries
ApproAches to
gender And sexuAlity:
responding to hiV
Report on the findings of a survey among
Alliance Linking Organisations Acknowledgements
The Alliance is grateful to the many people and
organisations that supported the gender and sexuality
survey. This report was written by Sarah Middleton-Lee,
an independent consultant.
© International HIV/AIDS Alliance 2010
Information contained in this publication may be freely
reproduced, published or otherwise used for non-profit
purposes without permission from the International HIV/AIDS
Alliance (the Alliance). However, the Alliance requests that
they be cited as the source of the information.
Published: February 2011
ISBN: 978-1-905055-84-5
Design: www.janeshepherd.com
cover images
Sex worker in Hyderabad, India.
© Shailaja Jathi
A focus group for sex workers and female
survivors of violence at Ennakhil, a Moroccan
organisation dedicated to helping women
and children. © 2006 Nell Freeman for the
Alliance
KHANA’s Integrated Care and Prevention
Programme focuses on the provision of
home-based care services to people living
with HIV, orphans and vulnerable children and
their families in Cambodia. © Michael Nott for
KHANA and the Alliance
Founders of the Association African Solidarité,
a group offering treatment, home-based care
and support to adults and children living with
HIV, Ouagadougou, Burkina Faso. © Gideon
Mendel for the AllianceAPPROACHES tO GENdER ANd SExuALIty: RESPONdING tO HIV
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CONtENtS
executive summary 3
1. introduction 8
The global context 8
The Alliance context 10
Survey purpose, methods and participants 12
Survey limitations 12
2. Findings 14
What are the most important gender concerns? 14
What is a gender and sexuality approach to HIV? 16
What gender and sexuality work are we doing? 18
What challenges are there in doing gender and sexuality work? 28
Assessing our capacity and future support needs 29
3. conclusions and recommendations 31
Conclusions 31
Recommendations 32
Annexes 34
Annex 1: Examples of gender-transformative approaches 34
Annex 2: Gender and sexuality survey questions 35
Annex 3: Alliance good practice HIV programming standards 36
Annex 4: Key global guidance on gender and sexuality approaches 38
ApproAches to gender And
sexuAlity: responding to hiV APPROACHES tO GENdER ANd SExuALIty: RESPONdING tO HIV
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ACRONyMS
Alliance International HIV/AIDS Alliance
CBO Community-based organisation
GIPA Greater involvement of people living with HIV
Global Fund Global Fund to Fight AIDS, Tuberculosis and Malaria
NGO Non-governmental organisation
SRH Sexual and reproductive health
SRHR Sexual and reproductive health and rights
STI Sexually transmitted infection
UNGASS United Nations General Assembly Special Session on AIDS
COuNtRIES/PARtNERS RESPONdING tO GENdER ANd SExuALIty SuRVEy
Bangladesh HIV/AIDS and STD Alliance Bangladesh (HASAB)
Bolivia Instituto de Desarrollo Humano (IDH)
Burkina Faso Initiative Privée et Communautaire de lutte Contre le SIDA (IPC)
Cambodia Khmer HIV/AIDS NGO Alliance (KHANA)
China International HIV/AIDS Alliance in China (Alliance China)
Côte d’Ivoire Alliance Nationale contre le SIDA en Côte d’Ivoire (ANS-CI)
Haiti Promoteurs Objectif Zerosida (POZ)
India Tamil Nadu Social Service Society (TASSOS); South Indian AIDS Action
Programme (SIAAP); MAMTA Health Institute for Mother and Child (MAMTA);
International HIV/AIDS Alliance India (Alliance India); Network of Maharashtra
People with HIV (NMP+); Humsafar; Palmyrah Workers Development Society
(PWDS); Social Awareness Service Organisation (SASO)
Indonesia Rumah Cemara
Kenya Kenya AIDS NGO Consortium (KANCO)
Lebanon Soins Infirmiers et Développement Communautaire (SIDC-Helem-Liban)
Malaysia Malaysian AIDS Council (MAC)
Mongolia National AIDS Foundation (NAF)
Morocco Association Marocaine de Solidarité et Développement (AMSED)
Latin America
and Caribbean Red Latinoamericana y del Caribe de personas Trans (RedLacTrans)
Nigeria Network on Ethics, Human Rights, Law, HIV/AIDS Prevention, Support and Care
(NELA); Civil Society for HIV/AIDS in Nigeria (CiSHAN)
Senegal Alliance Nationale Contre le SIDA (ANCS)
Uganda International HIV/AIDS Alliance in Uganda (Alliance Uganda)
Ukraine International HIV/AIDS Alliance in Ukraine (Alliance Ukraine)APPROACHES tO GENdER ANd SExuALIty: RESPONdING tO HIV
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Gender and sexuality have long been recognised as key factors
affecting the dynamics of the HIV epidemic. Issues vary across
communities and countries, but power imbalances, harmful social
norms, violence and marginalisation affect women, men, girls,
boys and transgender people across the world, limiting their
ability to prevent HIV infection.
There are a growing number of HIV and broader health initiatives that
not only highlight gender issues, but also aim to change harmful norms
and practices. These are called ‘gender-transformative’ approaches.
However, there are few approaches to achieve gender transformation,
and many organisations within and outside the Alliance have struggled
to overcome the controversies, sensitivities and structural barriers that
impede progress.
In May 2010, we carried out a survey of our national Linking
Organisations to map our current work; assess capacity, challenges
and aspirations around gender and sexuality programming; and better
understand the gender and sexuality context in which our partners
work. Some 28 organisations from 19 countries responded.
executiVe summAryAPPROACHES tO GENdER ANd SExuALIty: RESPONdING tO HIV
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A mother and baby at Mukono Health Centre, Mukono district, uganda. the clinic has a
prevention of mother-to-child transmission programme which is led by one nurse and several
Network Support Agents. © Nell Freeman for the AllianceAPPROACHES tO GENdER ANd SExuALIty: RESPONdING tO HIV
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1. Gender inequality and discrimination, fuelled by socio-cultural issues,
are the most common gender concerns. Other concerns include barriers to
accessing services; lack of gender-responsive programming; lack of attention
to gender-related human rights, stigma and discrimination; lack of political
leadership; lack of supportive legal frameworks; and the need to integrate gender
within organisations.
2. Alliance partners have mixed opinions about how much national
programmes respond to these gender-related challenges – ranging from
partial support to active exclusion. Global Fund support has driven gender-related
action even where national programmes are unsupportive.
3. Many respondents believe a gender and sexuality approach provides
a useful way of understanding HIV work that is based on the roles and
expectations that affect people’s lives, choices and interactions (particularly
in terms of sexual feelings, desires and behaviours). Others think it provides
an insight into the driving forces behind women and men’s differences and
inequalities.
4. Alliance partners are involved in a wide range of work that is relevant to
gender-transformative approaches. 82% of partners are taking actions at an
organisational and programming level, 86% at individual, family and peer level,
and 75% at community and service provider level. Over half (57%) are also
carrying out actions at the policy and society level, with 12 partners (43%) taking
action at all four levels.
5. Key challenges to gender and sexuality work include discriminatory
gender norms and inequality; low male involvement in programming
and interventions; limited access to education for women and girls; poor
understanding or consensus on gender and sexuality; inadequate opportunities to
share good practice; low funding levels; stigma and discrimination; and a lack of
leadership, human resources, capacity and tools on gender and sexuality.
6. Only 25% of respondents feel they have the capacity to apply a gender and
sexuality approach. The remaining 75% have limited capacity. The two most
common capacity barriers are lack of donor funds for relevant initiatives, and lack
of skilled staff and training.
Key findingsAPPROACHES tO GENdER ANd SExuALIty: RESPONdING tO HIV
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The survey confirmed that Alliance partners are focusing significant efforts on gender
and sexuality work. However, the comparatively low number of partners involved
in policy and society-level advocacy means efforts may not always respond to the
wider political and legislative environment. To make gender transformation a reality
they will need to. There are also indications that, in some circumstances, partners
may be less actively engaged in some of the more sensitive or complex aspects of
comprehensive gender-transformative approaches.
On the other hand, while capacity is clearly an issue, there is also an indication that
some partners may be doing, or are already able to do more gender-transformative
work than they think. There can be a false perception that a gender-transformative
approach is a separate and highly specialised area that is distinct from the usual
work of our partners. The survey did confirm that issues of gender and sexuality are
seen to be inextricably linked with human rights.
Individual responses indicate that some partners need greater clarity about what a
gender-transformative approach encompasses – in practice as well as theory.
To improve our work on gender and sexuality in the future, we should:
1. develop a gender strategy for Alliance partners
2. carry out a more specific assessment of the capacity needs of Alliance
partners for gender-transformative approaches, and develop a plan to address
these needs
3. document examples of good practice of gender-transformative approaches
by Alliance partners working in generalised epidemics, concentrated epidemics,
and mixed epidemics
4. ensure that gender transformation is fully integrated and addressed in the
Alliance’s existing and future work on good practice responses to HIV.
conclusions And
recommendAtionsAPPROACHES tO GENdER ANd SExuALIty: RESPONdING tO HIV
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Married man who has sex with men, India © Jenny Mathews/the Alliance/PhotovoiceAPPROACHES tO GENdER ANd SExuALIty: RESPONdING tO HIV
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section 1:
introduction
tHE GLOBAL CONtExt
Why gender and sexuality matter
Gender and sexuality – and their related norms and
practices – have long been recognised as key factors
affecting the dynamics of HIV and the global response
to it.
1
Gender inequalities fuel and exacerbate HIV
epidemics. Although gender issues vary across
communities and countries, power imbalances, harmful
social norms, violence and marginalisation affect both
women, men, girls and boys across the world.
2
They
increase people’s vulnerability and limit their ability to
prevent HIV infection.
3

Half of all people living with HIV are female. However,
in Sub-Saharan Africa, there are three young women
living with HIV for every one young man.
4
And in nearly
every country in the region, the majority of HIV-positive
people are females, especially those aged 15–24.
Meanwhile, in other regions of the world, men are
more likely to be infected with HIV than women, often
within concentrated epidemics that disproportionately
affect key populations, such as men who have sex with
men, transgender people, people who use drugs and
who have transactional sex. In Latin America and the
Caribbean, for example, nearly three times as many
men as women are HIV-positive, with transmission
predominantly among men who have sex with men.
5

However, the real gender picture is often more nuanced
and complex than data indicate. For example, in
some countries in the Caribbean, the majority of those
living with HIV are female. Also, within the generalised
epidemics of many Sub-Saharan Africa countries, men
who have sex with men have a particularly high burden
of HIV infection. But because of homophobia and the
widespread criminalisation of homosexuality, national
responses largely neglect same sex behaviour.
6

Gender inequalities also have an impact on HIV-related
care, treatment and mitigation. For example, while
women and girls assume the bulk of care-giving for
sick family members, there are indications that men
who have sex with men and transgender people are
less likely to access appropriate treatment and support
services than other groups.
7

To have the greatest impact on HIV, it is important that
those in the HIV response take into account the full
range and diversity of gender-related issues that affect
individuals, communities and countries. For example,
many men who have sex with men also have sex with
female partners.
Meanwhile, in Asia, a recent study highlighted that
women are predominantly infected by their husbands
or intimate partners – showing the need to better
understand the complex relationships within some
marriages and long-term partnerships.
8
1. In this report, gender is defined to include men, women, boys, girls, men who have sex with men, women who have sex with women and transgender people.
2. UNAIDS (2010), ‘Report on the Global AIDS Epidemic 2010’.
3. UNAIDS (accessed 22.11.10), Gender, available at: www.who.int/gender/hiv_aids/en/
4. UNAIDS (2010), ‘Report on the Global AIDS Epidemic 2010’, available at: www.unaids.org/documents/20101123_GlobalReport_em.pdf
5. WHO, UNAIDS, UNICEF (2009), ‘Towards Universal Access: Scaling Up Priority HIV/AIDS Interventions in the Health Sector: 2009 Progress Report’.
6. UNAIDS (2010), ‘Report on the Global AIDS Epidemic 2010’, available at: www.unaids.org/documents/20101123_GlobalReport_em.pdf
7. UNAIDS (2009), ‘UNAIDS Action Framework: Universal Access for Men who have Sex with Men and Transgender People’.
8. UNAIDS (2009), ‘HIV Transmission in Intimate Partner Relationships in Asia’.APPROACHES tO GENdER ANd SExuALIty: RESPONdING tO HIV
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9. United Nations General Assembly (2001), ‘Declaration of Commitment on HIV/AIDS’.
10. United Nations General Assembly (2006), ‘Political Declaration on HIV/AIDS’.
11. A worldwide alliance of civil society organisations, networks of women living with HIV, women’s organisations, AIDS service organisations and the United
Nations system, committed to strengthening HIV programming for women and girls. Global Coalition on Women and AIDS (accessed 22.11.10), available at:
www.womenandaids.net/News-and-Media-Centre/Latest-News/UNAIDS-takes-action-to-empower-women-and-girls-to-.aspx.
12. WHO, UNAIDS, UNICEF (2009), ‘Towards Universal Access: Scaling Up Priority HIV/AIDS Interventions in the Health Sector: 2009 Progress Report’.
13. See documents relating to 22nd Meeting of the Programme Coordinating Board April 2008, UNAIDS. Available at: www.unaids.org/en/AboutUNAIDS/
Governance/PCBArchive/22nd_PCB_Meeting_April_2008.asp
14. UNAIDS (2010), ‘UNAIDS Strategy 2011-2015’.
15. UNAIDS (2010), ‘Joint Action for Results: UNAIDS Outcome Framework 2009-11’.
16. UNAIDS (2009), ‘UNAIDS Action Framework: Universal Access for Men who have Sex with Men and Transgender People’.
17. UNAIDS (2010), ‘Agenda for Accelerated Country Action for Women, Girls, Gender Equality and HIV: Operational Plan for the UNAIDS Action Framework:
Addressing Women, Girls, Gender Equality and HIV’.
18. The Global Fund to Fight AIDS, Tuberculosis and Malaria (2009), ‘The Global Fund Gender Equality Strategy’ and ‘The Global Fund Strategy in Relation to
Sexual Orientation and Gender Identities’.
policy responses to gender and sexuality
Gender lies at the heart of many of the political
commitments made by the world’s governments. For
example, the Declaration of Commitment on HIV/AIDS9

and Political Declaration on HIV/AIDS10
acknowledge
the need, within the framework of universal access,
to challenge gender stereotypes, inequalities and
discrimination relating to women, girls and vulnerable
groups. Indicators to assess progress are also included
in the national-level monitoring processes of the
Universal Access framework established by the United
Nations General Assembly Special Session on AIDS
(UNGASS).
Over the years, ‘women and AIDS’ has been the subject
of a number of global initiatives, including the Global
Coalition on Women and Girls launched in 2004.
11

More attention has also been paid to sexual minorities
recently, as more concrete data has become available
to provide an evidence base for how and why groups
such as men who have sex with men, sex workers and
transgender people experience heightened vulnerability
and need to be strategic priorities for support.
12

However, gender – as an umbrella term for policy and
programme approaches – has also been the subject of
intense debate. In particular, there have been tensions
over its definition: whether it should refer solely to
women and girls, or more comprehensively to women,
girls, men and boys, and sexual minorities.
13
Views
on this have been influenced by a variety of factors.
These include the different priorities of generalised
HIV epidemics (where the mode of transmission is
predominantly heterosexual intercourse and females
are often disproportionately affected) and concentrated
HIV epidemics (where the modes of transmission may
be more varied and where key populations are often
disproportionately affected).
Some institutions have explicitly promoted a
comprehensive understanding of, and commitment
to gender. For example, gender equality is one of
the three strategic directions of UNAIDS’ 2011-15
strategy, with goals addressing both women and girls
and sexual minorities.
14
Also, while all of the priorities
advocated in the UNAIDS Outcome Framework 2009-
11 have gender dimensions, two specifically focus on
gender commitments: ‘we can empower men who have
sex with men, sex workers and transgender people
to protect themselves from HIV and to full access
antiretroviral therapy’; and ‘we can meet the HIV needs
of women and girls and can stop sexual and gender-
based violence’.
15
The ‘how to’ of these commitments
is set out in resources including the UNAIDS Action
Framework: Universal Access for Men who have Sex
with Men and Transgender People16
and the Agenda for
Accelerated Country Action for Women, Girls, Gender
Equality and HIV (see Annex 4 for a summary of key
points from both documents).
17
Meanwhile, the Global Fund to Fight AIDS, Tuberculosis
and Malaria (the Global Fund) has developed strategies
on gender (focusing on women and girls) and sexual
orientation and gender identities (focused on sexual
minorities),
18
aiming to achieve a positive bias in its
allocation of funding. Gender has also been central
to the policies of many other international donors.
Agencies with policies or strategies prioritising gender-
related issues – such as the Canadian International
Development Agency, Swedish International
Development Cooperation Agency, UK Department for
International Development and United States Agency
for International Development – often require that
organisations not only articulate their commitment
to gender-sensitivity, but demonstrate how they will
implement it through their work.APPROACHES tO GENdER ANd SExuALIty: RESPONdING tO HIV
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19. Global AIDS Alliance, International HIV/AIDS Alliance, Interact Worldwide, Population Action International, International Planned Parenthood Federation and
Friends of the Global Fund Africa (2010), Make or Break: 2010: A Pivotal Year for Scaling Up RH/HIV Integration and Accelerating Progress Towards MDGs 5 and 6.
20. Please refer to International HIV/AIDS Alliance (2010), ‘Advancing human rights, responding to HIV: Report on the findings of a human rights survey among
Alliance partners’ for more information.
21. International HIV/AIDS Alliance (2010), ‘HIV and Healthy Communities: Strategy 2010-2012’.
10
These donor priorities are informed by the Millennium
Development Goals and wider trends within global
funding and the architecture of health and health
systems. Broadly speaking, the latter presents both
an opportunity and threat to gender-related initiatives.
Increased attention to the linkages between HIV and
sexual and reproductive health and rights (SRHR) is a
critical opportunity to address the full needs of women,
girls and sexual minorities.
19
But broader and more
mainstream national responses to health could threaten
support to and involvement of marginalised groups,
such as men who have sex with men and transgender
people.
Meanwhile, there are also challenges within the legal
context of gender and sexuality-related responses
to HIV. For example, many countries lack adequately
comprehensive laws against gender-based violence,
and in others there are concerns about a wave of new
legislation against homosexuality and sex between
men.
20

programmatic responses to gender and sexuality
There are also a growing number of HIV initiatives that
have built on, and moved beyond earlier ‘women and
girls’, ‘gender mainstreaming’ and ‘gender sensitive’
approaches. These not only highlight gender-related
issues, but actually aim to change harmful norms and
practices. Examples of such ‘gender-transformative’
approaches include the Stepping Stones toolkit
(developed by Strategies for Hope), the Men as Partners
programme (developed by Engenderhealth), Programme
M (developed by Promundo), the One Man Can
campaign (developed by Sonke Gender Justice), and
the Frontiers Prevention Programme (developed by the
International HIV/AIDS Alliance). (See Annex 1 for brief
descriptions of these approaches). While each of these
examples responds to their specific context, they also
share a number of common characteristics (see Box 1).
However, many organisations across the world
have struggled with the very real challenges of
gender and sexuality work, particularly in terms of
achieving transformation. In some contexts, this has
been because of a lack of understanding about the
importance of gender issues, or fear of the associated
controversies and sensitivities. In others, it has been
due to the obstacles that make this kind of approach
hard to put into action. In particular, entrenched
structural barriers (such as cultural norms and legal
restrictions) remain an immense impediment to
progress. There are few quick fixes, with action needing
significant time, skills and creativity.
Furthermore, while the comprehensive definition of
gender promoted by the Alliance and some other
organisations will likely produce greater and more
sustainable results in the longer term, initially it can
make the design and implementation of programmes
more complex and challenging.
tHE ALLIANCE CONtExt
Since its establishment in 1993, there has been a
significant awareness of and commitment to gender
and sexuality issues within the Alliance. However, to
date, the Alliance has not articulated a formal gender
strategy, nor systematically implemented approaches
or standards across its programming. The Alliance’s
international board, donors, and an external evaluation
have all highlighted the need to address this gap.
The Alliance’s strategy for 2010-12 (HIV and Healthy
Communities)
21
provides firm foundations for a
gender and sexuality strategy. It clearly articulates the
need to build on work to date and adopt a gender-
transformative approach (see Box 2 for an Alliance
definition). Gender issues are referred to throughout the
strategy’s three aims and four strategic responses. Of
note, Aim 1 (protect human rights) commits to action
on gender inequality and promotes a comprehensive
gender-transformative approach addressing women,
men, girls and boys, including those perceived to
transgress gender norms, such as men who have
sex with men, women who have sex with women,
sex workers, unmarried sexually active women and
transgender people. Also of note, Strategic Response
1 (scale up integrated programming) outlines different
ways to work on gender equality and the human
rights of sexual minorities within generalised and
concentrated epidemics.APPROACHES tO GENdER ANd SExuALIty: RESPONdING tO HIV
11
gender-transformative programmes:
4 recognise that gender issues are influenced by and relevant to men and boys,
women and girls, and transgender people
4 actively involve and provide constructive roles for all these groups
4 use a comprehensive definition of gender, recognising the full diversity of
identities and practices
4 address a comprehensive range of issues, norms and practices that shape
gender relations and dynamics, and affect people’s health, well-being
and vulnerability. This particularly includes issues that may be sensitive or
controversial, such as gender-based violence and sexual diversity
4 use diverse, creative and context-appropriate methods to engage and mobilise
participants
4 empower communities – enabling participants to identify their own gender
issues, discuss them together, and identify ways to change harmful practices
4 create safe spaces to enable community members to talk openly and freely
4 complement programmatic work with advocacy – or links to advocacy initiatives
– to address structural barriers to gender transformation
4 complement community mobilisation with providing or referring to HIV and
gender services
4 build cross-sectoral action on gender, for example involving community
gatekeepers and decision-makers
4 promote gender transformation within organisations and among people that
provide services and programmes, through training of NGO staff and health
workers.
BOx 1:
gender-transformative
approaches –
characteristics of
good practice
An approach that engages people in changing harmful gender norms, both
of masculinity and femininity, which shape and limit individuals’ autonomy
and capacity, and are key to understanding and addressing HIV risk, vulnerability
and effective HIV prevention. The approach engages men and women separately
and together, according to local circumstance, and addresses violence, coercion
and abuse of all those who are perceived to challenge or transgress gender norms.
It addresses both gender inequality and the specific vulnerabilities of men and
boys such as sexual coercion between men and boys, sex in prison settings and
the legal status of sex between men.”
HIV and Healthy Communities: Strategy 2010-12, International HIV/AIDS Alliance
BOx 2:
definition of a
gender-transformative
approachAPPROACHES tO GENdER ANd SExuALIty: RESPONdING tO HIV
12
22. The Alliance works with nationally based Linking Organisations (that develop and support the capacity of community organisations) and other partners, for
example those that work with specific populations, such as men who have sex with men. In this report, Linking Organisations and other partners are referred to
collectively as ‘partners’.
23. Responses were received from two Alliance partners in Nigeria and nine in India. This is why the number of partners included in the survey is greater than the
number of countries.
24. A total of 30 people from the 28 organisations participated in the survey. However, in this report, percentages are taken from the total number of organisations,
not individuals that participated.
table 1: survey participants
region countries partners
Asia and
Eastern Europe
8 16
Africa 8 9
Latin America
and Caribbean
3 3
total 19 28
SuRVEy PuRPOSE, MEtHOdS ANd
PARtICIPANtS
In May 2010, the Alliance undertook a survey among
its national Linking Organisations and other country
partners.
22
The survey aimed to:
n map current Alliance work, capacity, challenges
and aspirations around gender and sexuality
programming
n better understand the gender and sexuality context
in which partners work.
It included two introductory and 11 open-ended
questions (see Annex 2). Some 28 organisations from
19 countries responded (see Table 1).
23
This report
presents a synthesis of the responses24
and uses the
Alliance’s Good Practice HIV Programming Standards
as a reference point for analysis. It also uses case
studies to highlight partners’ work and provides
observations and recommendations for improving
future action.
SuRVEy LIMItAtIONS
There are a number of limitations to this survey. In
particular, the use of open-ended questions means that
the results provide a brief overview of partners’ work
and issues relating to gender and sexuality, rather than
a systematic, quantitative assessment. For example,
partners were asked to comment on ‘What gender
and sexuality work does your organisation do?’ and
not given a list of types of work from which to select.
Because of this, although a partner may not have
mentioned a type of work, it does not necessarily mean
that they are not carrying it out. Another limitation of
the survey was that about a third of responses (9 of 28)
were from one country (India).
APPROACHES tO GENdER ANd SExuALIty: RESPONdING tO HIV
13
HIV and health discussion group for teenage girls run by Alliance Nationale Contre le SIdA,
Senegal. © 2007 Nell Freeman for the Alliance
teacher Helvina Phiri, distributes text books on sexuality and life skills to her class at Chiwoko
Basic School, one of the schools agreeing to be a pilot centre for including sexuality and life skills
as a regular subject on the academic curriculum, Zambia. © 2006 Nell Freeman for the AllianceAPPROACHES tO GENdER ANd SExuALIty: RESPONdING tO HIV
14
section 2:
findings
WHAt ARE tHE MOSt IMPORtANt GENdER
CONCERNS?
gender and sexuality concerns
Survey respondents were asked to identify the most
important gender and sexuality concerns in their
country; a range of themes emerged.
n Gender inequality and discrimination were the
most commonly cited concerns, fuelled by socio-
cultural issues affecting women, girls and sexual
minorities, such as men who have sex with men,
sex workers and transgender people. The Kenya
AIDS NGO Consortium (KANCO) articulated how
gender issues are culturally constructed through
religious and conservative norms. These leave
women unable to fulfil their rights and drive key
populations underground – making it harder to reach
these priority groups. Rumah Cemara (Indonesia),
Civil Society for HIV/AIDS in Nigeria (CiSHAN) and
the Network of Maharashtra People with HIV (NMP+,
India) also described the challenging impacts of
The social construction of gender determines different paradigms of
masculinity or femininity. There are families and communities in Bolivia that
tolerate, encourage and shape the patterns of machista sexual behaviour, while
women are valued for their passivity, submission and self-marginalisation. Women
do not have access to information about reducing risks and even when informed,
they cannot negotiate condom use. As a result, Bolivia continues to pass on these
standards and values that encourage the transmission of HIV. The inequalities
are closely related to attitudes toward women that translate into subordination,
oppression and exploitation. These attitudes are determined by domestic violence,
humiliation, physical and sexual abuse. Various cultural aspects, myths and
even jokes determine behaviour that conveys a lack of respect for the dignity of
women.”
Instituto de Desarrollo Humano, Bolivia
BOx 3:
gender concerns,
Bolivia
patriarchal societies, while other partners noted
specific socio-cultural issues. For example, Soins
Infirmiers et Développement Communautaire
(SIDC-Helem-Liban, Lebanon) cited gender-based
violence and Palmyrah Workers Development
Society (PWDS, India) cited early marriage and
sexual exploitation.
Other examples of major issues included:
n Barriers to accessing services. International
HIV/AIDS Alliance in Ukraine (Alliance Ukraine)
stated that a wide range of gender-related issues
(such as male dominance, gender-based violence
and women’s low access to information) restrict
women’s uptake of services and commodities.
n Lack of gender-responsive programming. The
Malaysian AIDS Council (MAC) noted the need for
programmes to address the specific gender-related
issues of local HIV epidemics. In Malaysia this is
within a context where women are predominantly
infected through heterosexual intercourse and men
through drug use. This need was echoed by Alliance
Ukraine, which called for responses to address the APPROACHES tO GENdER ANd SExuALIty: RESPONdING tO HIV
15
specific vulnerabilities of women and other groups,
as well as to mainstream a gender-transformative
approach and improve the measurement of gender-
related results. Meanwhile, Association Marocaine
de Solidarité et Développement (AMSED, Morocco)
noted challenges in developing appropriate, rights-
based programming approaches that respond
to stigma and discrimination and gender-based
violence.
n Lack of attention to gender-related human rights,
and action on stigma and discrimination. Partners
such as HIV/AIDS and STD Alliance Bangladesh
(HASAB) emphasised that more efforts are needed
on the ground to promote the rights of key
populations, such as sex workers, men who have
sex with men and transgender people. International
HIV/AIDS Alliance in China (Alliance China) felt that
action is also needed on stigma and discrimination,
which currently drives marginalised groups such as
men who have sex with men underground.
n Lack of political leadership on gender. MAC
(Malaysia) called for stronger national leadership on
gender and sexuality issues.
n Lack of supportive legal frameworks for gender
work. The need for, or lack of, a supportive
legislative environment for gender and sexuality-
related work was noted by partners in countries
as varied as Kenya and Lebanon. Rumah Cemara,
South Indian AIDS Action Programme (SIAAP) and
Initiative Privée et Communautaire de Lutte Contre
le SIDA (IPC, Burkina Faso) highlighted concerns
about legislation against vulnerable groups, such as
sex workers. At the time of completing the survey, a
proposed anti-homosexuality bill was a major issue
for the International HIV/AIDS Alliance in Uganda
(Alliance Uganda).
n The need to integrate gender within organisations.
AMSED identified the need to integrate gender
into all levels of its own organisation, including in
planning, programming and budgeting.
gender issues in national hiV responses
When asked how much national programmes respond
to these gender-related challenges, Alliance partners
again had mixed opinions. Many partners indicated
gender issues were included to some degree
in national HIV responses, in countries including
Cambodia, China, India, Kenya, Malaysia, Mongolia,
Morocco and Nigeria.
For example, in Morocco the National AIDS Strategic
Plan articulates commitment to universal access, with
guiding principles focused on equality, confidentiality,
human rights and combating stigma and discrimination.
In Malaysia the National Strategic Plan on HIV/AIDS
commits to reducing vulnerability among women living
with HIV, female partners of people who use drugs, and
women in the general population.
Two Alliance partners, National AIDS Foundation (NAF,
Mongolia) and Alliance Ukraine, specifically noted how
gender-related action in their country has expanded
through support from the Global Fund. For example,
in Ukraine, while the national strategy on HIV is not
oriented towards gender, Global Fund programmes
have allowed attention to be focused on relevant
Strategies to reverse the HIV epidemic cannot succeed unless continued
political leadership is embraced and women and girls are empowered. The
government must utilise resources to address the needs and realities of women
and girls. These resources must be made available where they are most needed,
in programmes for women and girls affected by HIV and AIDS. There should be
more gender-specific HIV programmes and interventions which take into account
the dual nature of the epidemic in Malaysia, whereupon currently women are
getting infected through heterosexual transmission while men acquire HIV through
injecting drug use … The multifaceted nature of women and HIV requires the
deeper involvement of other ministries and the establishing of wider networks
of multi-sectoral collaboration. Without recognition of this urgency, leadership,
political will and commitment, the situation for women and girls will continue to
deteriorate and the female proportion of the Malaysian epidemic will increase.”
Malaysia AIDS Council, Malaysia
BOx 4:
Viewpoint on
gender and political
leadershipAPPROACHES tO GENdER ANd SExuALIty: RESPONdING tO HIV
16
gender issues. Other partners noted that action on
gender is being incorporated into the roll-out of national
strategies. In China, for example, project management
partners, such as government agencies, increasingly
invite men who have sex with men to participate
in programmes. In Bangladesh, there are national
programmes that support sex workers, men who have
sex with men and transgender people.
Overall, however, many partners qualified their positive
feedback on the national response. For example,
KANCO felt that, although included in Kenya’s national
strategy, attention to gender is inadequate. Similarly,
Alliance Nationale contre le SIDA en Côte d’Ivoire (ANS-
CI) felt that their country “could do more” – a sentiment
reflected by both the Network on Ethics, Human Rights,
Law, HIV/AIDS Prevention, Support and Care (NELA)
and CiSHAN in Nigeria, with the latter calling for a
systematic review of how policies and programmes
could better address gender. MAC noted how a lack of
available and disaggregated data – and the resulting
lack of analysis and evidence on gender and sexuality
– poses a major barrier to a clear understanding of the
complex context in Malaysia and the development of
appropriate programmes to reduce vulnerability.
A range of Alliance partners from India felt that
attention to gender is inadequate within their national
response. Here, programmes tend to be disease-
focused (rather than oriented towards areas such as
empowerment and human rights) and there is an urgent
need for more widespread ‘gender mainstreaming’,
including in programme areas such as women’s and
adolescents’ health.
Another group of Alliance partners, in countries such as
Bolivia and Uganda, were more negative and reported
the exclusion of gender from national HIV responses.
Promoteurs Objectif Zerosida (POZ, Haiti) stated that
gender is only addressed in initiatives by the Ministry
of the Status of Women, while IPC felt that, despite
progress in some programmes, the national response
remains shaped by what is “morally acceptable”, rather
than human rights. RedLacTrans (Latin America and
Caribbean) commented that national programmes are
often centred on the vertical transmission of HIV, while
Rumah Cemara noted the lack of a national programme
directly related to gender equality.
Meanwhile, SIDC-Helem-Liban reported that, although
there are no specific national strategies on the subject,
recognition and respect of gender-related issues is
incorporated into the development of HIV interventions.
WHAt IS A GENdER ANd SExuALIty APPROACH
tO HIV?
A number of themes emerged from answers to the
question: ‘What is meant by a gender and sexuality
approach to HIV?’ A common view – among partners in
countries such as India, Malaysia and Uganda – is that
such an approach provides a way of understanding HIV
work that is based on roles and expectations that affect
people’s lives, choices and interactions (particularly
in terms of sexual feelings, desires and behaviours).
While perhaps related to biological differences, these
roles and expectations are generated and affirmed by
societal, cultural, economic and political factors.
Several partners, such as Alliance Uganda, MAMTA
Health Institute for Mother and Child (MAMTA, India)
and AMSED (Morocco), emphasised that a gender
and sexuality approach provides an insight into the
driving forces behind the differences and inequalities
of males and females within a specific context. In turn,
these forces affect an individual’s vulnerability and risk,
as well as their access to services and ability to fulfil
their human rights. IPC (Burkina Faso) concluded that
gender and sexuality is a complete approach that takes
on board all of the issues that affect HIV.
A gender and sexuality approach to HIV in our work involves improved
coverage of issues linked to gender and sexuality when designing new
policies and programmes to combat HIV. In other words, for stakeholders in the
fight against AIDS it involves placing emphasis on the needs of women and on
minority groups (sexual and social) during planning exercises and when designing
policies.”
Alliance Nationale Contre le SIDA, Senegal
BOx 5:
Viewpoint on gender
and sexuality
approachAPPROACHES tO GENdER ANd SExuALIty: RESPONdING tO HIV
17
Red Latinoamericana y del Caribe de Personas Trans
(RedLacTrans) is a regional network of transgender
people covering 16 countries in Latin America and the
Caribbean. It was set up to disseminate information,
take action and provide a platform for reporting human
rights abuses affecting transgender people.
In 2008, the network’s policy and advocacy work with
heads of government and civil servants working on
health, led to greater representation of transgender
people in regional decision-making forums. It also
influenced policies to raise their visibility and integrate
their priorities into health policy and legal reform. In
Guatemala, RedLacTrans and local organisation Reinas
de la Noche used the media to publicise murders and
disappearances of transgender people and participated
in a national demonstration to stop violence against
women. However, this made the situation worse. As
Johana, Director of RedLacTrans, describes: “As a
result of those actions, there were more attacks, more
threats. I was attacked and someone tried to kill me.”
This illustrated that, when hate and violence originate
in the police force and a public ministry, it is difficult
to protest for justice. Now, transgender organisations
go to the Office of Human Rights to denounce and
publicise hate crimes.
RedLacTrans are also working to gain a hearing before
the Inter-American Court of Human Rights to apply
pressure internationally.
CASE Study 1
NEtWORKING FOR GENdER-tRANSFORMAtIVE AdVOCACy IN LAtIN AMERICA ANd tHE CARIBBEAN
In some cases, definitions reflected different areas
of emphasis. Some partners in Africa (such as NELA
and CISHAN in Nigeria and ANS-CI in Côte d’Ivoire)
spoke almost exclusively of the need to address
women’s rights and access to services (within the
context of epidemics where the most frequent mode
of transmission is heterosexual sex). However, other
partners, such as Alliance China and Rumah Cemara
(Indonesia) – both working within an Asian context
of concentrated epidemics – emphasised that there
is also a need to address issues relating to key
populations, such as men who have sex with men and
sex workers. The need for a comprehensive approach
was cited by Alliance India – where the national context
requires attention to both the increasing feminisation of
the epidemic and heightened prevalence among men
who have sex with men and transgender people.
Some partners included specific issues in their
definitions. NELA (Nigeria) and NAF (Mongolia)
emphasised attention to gender-based violence,
while SIDC-Helem-Liban, (Lebanon) and NMP+ and
MAMTA (both India) emphasised gender inequalities
relating to people living with HIV, especially women.
Alliance China articulated the need to look at specific
issues around men who have sex with men, female sex
workers and women that use drugs, while SIAPP (India)
noted the need to design programmes to address the
specific gender and sexuality issues of transgender
people.
While some partners focused on a more theoretical
definition of gender and sexuality, others, such as
HASAB (Bangladesh) and NAF (Mongolia), articulated
that such an approach must be put into practice
in programme and policy work. AMSED (Morocco)
explained that the approach is about understanding
gender-related inequalities and risks and how they
relate to HIV, and then using that understanding to
design interventions that reduce inequalities and
combat HIV. SASO (India) argued that an understanding
of gender and sexuality is inseparable from an effective
response to HIV.
KANCO (Kenya) saw the approach involving a set of
components, from mainstreaming gender and sexuality
into HIV programming, to making the concerns of both
men and women integral to the design, implementation,
monitoring and evaluation of all programmes.
Some partners indicated the need to move beyond
gender sensitivity towards a gender-transformative
approach. For example, HASAB (Bangladesh) specified
that interventions to address gender inequality must not
only empower women, but also men, by challenging
traditional ideas of masculinity and building gender-
equitable relationships.
KANCO (Kenya), as well as other partners including
NAF and RedLACTrans (see Case study 1), emphasised
that a gender and sexuality approach is also about
policy and advocacy work to address legislative and
policy barriers.APPROACHES tO GENdER ANd SExuALIty: RESPONdING tO HIV
18
WHAt GENdER ANd SExuALIty WORK ARE
WE dOING?
Alliance good practice hiV programming standards
In June 2010, the Alliance released its Good
Practice HIV Programming Standards to guide the
design, implementation and evaluation of Alliance
programmes25
(see Annex 3 for further details). The
standards relate to seven programme areas:
26

1. human rights and greater involvement of people
living with HIV (GIPA)
2. research, evaluation and documentation
3. HIV prevention
4. integration of sexual and reproductive health, HIV
and rights
5. HIV and tuberculosis
6. HIV programming for children
7. HIV and drug use.
Each programme area includes a number of agreed
standards, which are measurable and evidence-based
benchmarks’ of quality. For each standard, there is
a description of what it means and what evidence
supports it, alongside suggested implementation
actions, markers of progress and a list of relevant
resources and research.
The standards provide a framework for examining the
extent to which the Alliance’s gender-related work
correlates with good practice and, in turn, identifying
what support might be need to enable organisations
to fulfil these standards. The following section focuses
on standard 3.9, which explicitly addresses a gender-
transformative approach, while also briefly reviewing
examples of other relevant standards.
Alliance good practice standard on gender-
transformative approaches
In this report, to enable a broad exploration of gender-
transformative approaches, standard 3.9 is interpreted
to address HIV prevention and care, support and
treatment. Responses to the survey question: ‘What
gender and sexuality work does your organisation do?’,
are mapped against the four groups of implementation
actions described for 3.9 in the programming standards
(see Table 2).
25. The Alliance was a lead organisation in the development of the ‘Code of Good Practice for NGOs Responding to HIV’ (2004) and has endorsed the code. The
programming standards reflect the Alliance’s commitment to implementing the code.
26. Treatment and care standards are being developed and will be incorporated at a later date.
programme area good practice
standard
3. hiV prevention 3.9 our organisation uses a
gender-transformative
approach to hiV prevention
organisational and programming level actions
(implementation actions group 1)
82% of the 28 partners indicated that they are carrying out
one or more of the organisational and programming level
implementation actions for standard 3.9 (as listed in table 2).
These include actions to integrate gender analysis
into organisational planning, programming and
assessments; collect and analyse gender disaggregated
data; assess and build organisational capacity in
gender; and incorporate a gender-transformative
approach into existing and future HIV programmes.
A number of partners indicated that their organisational
strategies have been informed through some type
of gender analysis. CiSHAN (Nigeria) uses such an
analysis to explore differences in sex-disaggregated
information, so that its policies, programmes and
projects identify and meet the different needs of men
and women. For AMSED (Morocco), integrating a
gender approach was one of the key recommendations
of a knowledge, attitudes and practices study on
illiterate girls and women, sexually transmitted
infections (STIs) and HIV prevention. This led to
AMSED’s programmatic focus on illiterate girls and
women and sex workers. Meanwhile, MAC (Malaysia)
based its strategy on the government’s National
Strategic Plan for HIV, informed by the national
epidemiology and context, and characterised by strong
gender inequity. MAC focuses on supporting women
living with HIV, the female partners of people who use
drugs, and women in the general population.
IPC (Burkina Faso) has used information on the
country’s epidemiological situation to explore issues of
vulnerability and identify the strategic direction for its
programming – the integration of gender and SRHR.
The IPC’s values and principles promote equal rights
for all and are central to its planning and implementation APPROACHES tO GENdER ANd SExuALIty: RESPONdING tO HIV
19
table 2: percentage of Alliance partners reporting at least one implementation action relevant to using a
gender-transformative approach
groups of implementation actions for Alliance good practice hiV programming standard 3.9:
‘our organisation uses a gender-transformative approach to hiV prevention’
% of
partners
implementation actions group 1: organisational and programming level actions
> Integrate gender analysis into the planning and programming cycle of the organisation and incorporate gender-related issues
into participatory community assessments.
> Collect and analyse programme-related data and indicators disaggregated by sex, age and other equity parameters. Embed
them in the organisational monitoring and evaluation system.
> Assess and build the organisational capacity needed to understand and address links between gender inequalities and HIV.
> Incorporate a gender-transformative approach into existing and future HIV prevention programmes.
82%
implementation actions group 2: individual, family and peer level actions
> Engage people of all gender identities, separately and together (including those living with HIV), in HIV prevention
programmes; improve the quality of relations between them and integrate gender into behaviour change communication
interventions and materials.
> Provide people of any gender identity who are especially vulnerable or at risk of HIV/violence with safe, supportive and non-
judgmental spaces (or refer them to such spaces).
> Strengthen mechanisms for documenting, reporting and responding to gender-based violence and other rights abuses.
> Empower people of all gender identities to have more control over sexual decision-making and risk reduction, by building
their skills and providing them with, or referring them to livelihood support services that address socio-economic inequalities.
> take a family-centred approach and work with families to create a home environment that helps change gender and social
norms (men as caregivers, for example). this can be done through behaviour change communication, skills-building, and
livelihood interventions that empower families (particularly women) to access financial and other resources.
> Change group norms through educational activities and increase peer support for positive gender norms.
86%
implementation actions group 3: community and service provider level actions
> Engage community leaders in educational activities, campaigns and the media to challenge harmful gender norms.
> Mobilise communities through outreach, information, education and participatory interventions.
> Make local environments safer in cooperation with local communities.
> train and sensitise health care workers, police, prison and other key service staff to provide services that are non-
discriminatory and sensitive to of the needs of people of all gender identities.
> Provide people with, or refer them to health, social, legal and other services that are inclusive of people of any gender identity
or sexual orientation.
75%
implementation actions group 4: policy and society level actions
Advocate for:
> Equitable access to HIV and HIV-related/integrated services for people of any gender identity or sexual orientation.
> Protection against gender-based violence, coercion and abuse, especially for those perceived to challenge or transgress
gender and sexuality norms.
> Change policies, laws or customs that limit the power and autonomy of women, that prescribe traditional or limiting
definitions of masculinity, femininity and other gender identities, and that affect property and inheritance rights and access
to education.
> Find allies (such as human rights organisations, women’s organisations and community networks, among others) and build
their capacity to make links between HIV, human rights and gender.
> Prioritise needs in situations of conflict, war and displacement.
> Ensure that gender-transformative interventions reflect the diversity of gender identity and sexual orientation and address
their specific and changing needs. For example, promote critical thinking about gender identity and adolescents’ roles
through information, education, special events, and campaigns; engage men in maternal and child health, prevention of
mother-to-child HIV transmission, and violence prevention strategies; make women part of male circumcision programmes.
> Pay special attention to people most at risk of HIV infection, such as discordant couples, families and individuals affected by
HIV, adults and young people in concurrent and inter-generational sexual relations, and transgender women.
57%APPROACHES tO GENdER ANd SExuALIty: RESPONdING tO HIV
20
processes, as well as its approach to monitoring and
evaluation. Similarly, Alliance Nationale Contre le SIDA
(ANCS, Senegal) responded to its national context –
characterised by the feminisation of the epidemic and
heightened prevalence among key populations – by
developing a dual strategy that addresses women and
sexual minorities, particularly men who have sex with
men and sex workers. Examples of ANCS’ strategies to
address gender-related issues within these populations
include: mobilisation and sensitisation; reduction of
stigma and discrimination; promotion of prevention of
mother-to-child transmission services; distribution of
male and female condoms; increased access to HIV
testing and counselling; and group discussions.
Alliance partners have also supported non-
governmental organisations (NGOs) and community-
based organisations (CBOs) to base their work on an
analysis of their gender environment. For example,
Alliance China supported a group of men who have
sex with men in Kaiyuan City, Yunnan, to include issues
about gender and sexuality in a participatory community
assessment. This was followed up by involving the men
in the design and implementation of the project, with
intensive mentoring about programming approaches.
Similarly, some other partners indicated that they
have collected and analysed data and indicators
disaggregated by sex, age and other equity factors.
KANCO (Kenya) carried out an audit of the level of
gender mainstreaming among its member organisations,
alongside a baseline study of HIV-related gender
and human rights-related violations in communities.
The findings of both were critical to defining the
organisation’s programmes and advocacy.
Some partners also specified steps that they have taken
to assess and build their own organisational capacity
on gender. For Alliance Ukraine, these have included
observing gender equity in recruitment processes;
providing training for staff; keeping staff up-to-date on
gender issues; doing research into gender and sexuality;
re-programming, with the support of the United Nations
Development Programme and Open Society Institute;
and developing gender-sensitive targeted information
materials (on women and girls and men and boys).
AMSED (Morocco) has also provided its staff with
training on gender and sexuality, focused on stigma and
discrimination, as has NMP+ (India).
A large number of partners – such as Alliance Uganda,
IPC (Burkina Faso) and KANCO (Kenya) – noted that
they provide capacity building on gender for the NGOs
and CBOs that they support. Specific examples include:
n RedLacTrans provides workshops for transgender
people addressing issues such as gender identity
n SIAAP (India) integrates detailed information on
gender and sexuality into training on areas such as
counselling for NGOs and CBOs working with sex
workers and gay and bisexual men
n AMSED (Morocco) provides capacity building on
issues relating to HIV prevention and violence for
projects with sex workers
n Alliance Ukraine combines gender-related training
with the provision of information and materials to
partners.
The capacity building work of SIDC-Helem-Liban
(Lebanon) has included: training groups of young
people on gender, sexuality and HIV; integrating gender
into education and prevention work; and building the
capacity of women living with HIV to care for themselves.
MAMTA (India) – which has gender, sexuality and human
rights as cross-cutting issues within its programme –
complements its capacity building of NGOs and CBOs
by developing materials and manuals (such as on
sexuality education and gender training); creating a pool
of national and international resources; and facilitating
a network of 134 NGOs across seven Indian states
focusing on young people and sexual and reproductive
health (SRH). Meanwhile, Alliance China has, since 2005,
funded a programme to support HIV-positive women.
This combines capacity building with involvement in
project design, implementation and management.
Finally, although the Alliance survey did not specifically
ask respondents to define or describe a gender-
transformative approach, there were indications of
relevant strategies being used. For example, through
support from the Global Fund, NAF (Mongolia) supports
prevention programmes for key populations, such as
sex workers, men who have sex with men, mobile
populations, miners and people who use drugs. Through
capacity building and training, it covers a range of issues
from sexual orientation to safer sex and reproductive
health. Similarly, Instituto de Desarrollo Humano
(IDH, Bolivia) incorporates gender and sexuality in its
prevention programming, for example working with
parents to raise their understanding about issues of
sexuality. For IDH – as for the Khmer HIV/AIDS
NGO Alliance (KHANA) in Cambodia (see Case
study 2) – organisational commitment to gender and
transformative approaches has led to the development
of comprehensive organisational strategies and policies.CASE Study 2
APPROACHES tO GENdER ANd SExuALIty: RESPONdING tO HIV
21
In 2010, KHANA – the largest national HIV NGO
in Cambodia, supporting approximately 70 local
organisations – developed a gender, sexuality
and diversity strategy. This was based on a rapid
assessment commissioned by the senior management
team to identify gender-related gaps and issues in
programming, institutional culture and organisational
practice. The assessment took a broad approach to
gender, addressing the range of socially constructed
roles and relationships, personality traits, attitudes,
behaviours, values, powers and influence that society
ascribes to women and men.
The gender strategy commits KHANA to organisational
policy, planning and programmes that will:
> be informed by comprehensive gender and sexuality
analysis and data disaggregated by sex, age and
other relevant diversity factors
> mainstream gender and sexuality into every stage of
planning, implementation, monitoring and evaluation
> ensure sufficient funding and technical resources
are available to build gender and sexuality
mainstreaming capacity and change attitudes to
gender equality and human rights within KHANA and
its implementing partners
> promote gender equality and human rights for all
> promote diversity and the meaningful involvement
of people living with and affected by HIV within
KHANA, its implementing partners and the national
response to HIV
> actively address homophobia, sexual discrimination,
harassment and inequality within the organisation
through a code of conduct, awareness-raising and
accountability systems
> address systemic practices that create barriers to
reducing the vulnerability of women and girls to
HIV, including gender-based violence and sexual
exploitation and abuse
> actively involve men and boys as allies in promoting
gender equality and meeting the practical and
strategic gender needs of women
> engage and coordinate with partners, governments,
funders and civil society organisations to promote
and support effective, creative ways to promote
gender equality
> monitor, evaluate and institutionalise organisational
learning on mainstreaming gender into community-
based HIV programmes
> ensure budgeting, recruitment, training,
management, and decision-making systems support
women’s rights and gender equality.
The strategy focuses on both internal and external
actions, based on four objectives.
1. Creating an enabling internal environment that
promotes diversity and equality of opportunity
regardless of gender, sexuality or HIV status and
supports staff to contribute fully. Key activities
include: having family-friendly workplace policies;
increasing KHANA’s ability to recruit and promote
female staff; awareness-raising, leadership and role
modelling from the senior management team on
diversity and equality of opportunity; and addressing
gender norms that discourage women from applying
for promotion.
2. Integrating gender analysis and mainstreaming
throughout the programming cycle, i.e. during
needs assessment and planning, contracting
and technical support to implementing partners,
service delivery and monitoring and evaluation.
Key activities include: raising awareness of gender
inequality and its impact on HIV vulnerability;
building capacity for gender and sexuality
mainstreaming; addressing gender and sexuality
norms and inequality in HIV prevention programming;
and generating and disseminating the information
needed to support gender mainstreaming.
3. Advocacy to promote, protect and realise the
rights of women, men, transgender people and
children to prevent and mitigate the gender-
based vulnerabilities to and impacts of HIV.
Key activities include: advocacy within KHANA
and implementing partners; and advocacy around
national programming and policy.
4. Empowering people living with or affected by
HIV, and most at risk populations, to minimise
their vulnerability to HIV infection and mitigate
the gender-based impacts of HIV. Key activities
include: working with other organisations that have
empowerment programmes and expertise; and
providing people with the knowledge, skills and
opportunities they need to empower themselves.
The gender strategy includes an indicative work plan,
with key actions accompanied by short, medium
and long-term indicators. The strategy also fed into
KHANA’s annual replanning process. The draft strategy
was presented to the KHANA board of directors in April
2010 and informally endorsed.
dEVELOPING AN ORGANISAtIONAL StRAtEGy ON GENdER, SExuALIty ANd dIVERSIty IN CAMBOdIAAPPROACHES tO GENdER ANd SExuALIty: RESPONdING tO HIV
22
individual, family and peer level actions
(implementation actions group 2)
86% of partners indicated that they are carrying out one or
more of the individual, family and peer level implementation
actions for standard 3.9 (as listed in table 2).
These include actions such as engaging people of all
gender identities in programmes; providing people
with safe spaces; documenting or responding to
gender-based violence and other human rights abuses;
empowering people to have control over their sexual
decision-making and risk reduction; taking a family-
centred approach to changing gender norms; and
changing group norms through educational activities
and peer support.
The survey confirmed that Alliance partners support
gender and sexuality-related work among a range of
different types of communities (see Box 6). Examples
of relevant actions include those of AMSED (Morocco)
which builds the capacity of sex workers to negotiate
condom use, alongside HIV prevention awareness-
raising among their clients. MAC (Malaysia) is targeting
its efforts to empower women in the general population,
women living with HIV, and female partners of people
who use drugs. It combines providing shelters with
outreach, workshops, awareness-raising and peer
support (see Case study 3).
A small number of partners, including TASSOS (India),
described efforts to address issues of gender-based
violence. Meanwhile, educational activities were cited
by Hamsafar (India) which organises workshops on
sexuality in schools and colleges. Rumah Cemara
Among the 28 Alliance partners responding to the survey, 82% work with sex
workers, 79% with men who have sex with men, 39% with people who use drugs
and 36% with transgender people. Other groups include: women living with HIV;
children living with HIV; orphans and vulnerable children; illiterate girls and women;
women in the general population; school children; female partners of people who
use drugs; street children; clients of sex workers; young people; students; ex-
drug users; prisoners; people with disabilities; teachers; parents; rural youth; and
migrant workers.
BOx 6:
communities we
work with
(Indonesia) described its peer support approach
among different types of people living with HIV in
West Java, including men who have sex with men,
transgender people, women, sex workers and people
who use drugs. The work involves providing information
and condoms, as well as increasing access to services,
such as treatment of STIs and voluntary counselling
and testing. A meeting of the peer support group for
people living with HIV is held every three months. The
work has helped to achieve unity among different
groups in the region and to support people living with
HIV to work with the AIDS Commission and be involved
in programmes. Meanwhile, peer support relating to
gender was also cited by NMP+ (India).
Through its targeted prevention programmes, ANS-
CI (Côte d’Ivoire) enables women to better discuss
and negotiate condom use during transactional sex.
The voluntary counselling and testing centres that it
supports also collaborate with youth centres, which
carry out activities related to gender and sexuality.
NELA (Nigeria) provided an illustration of what its
gender-related work means for an individual woman.
Their work includes attention to economic support,
women’s empowerment and information on HIV, STIs
and family planning. They described how a client had
been maltreated by her husband and was referred
to a NELA clinic from the nearby primary health care
centre. Both the woman and her husband were given
counselling, but he continued to neglect her and
refused to give support. NELA helped the woman set
up an income generating project which enabled her to
feed herself and her baby. On seeing his wife healthy
and doing well, the husband apologised to her.APPROACHES tO GENdER ANd SExuALIty: RESPONdING tO HIV
23
CASE Study 3
MAC recognises that gender inequality in Malaysia
affects the vulnerability of women who are in the
general population, living with HIV and the partners
of drug users, in both similar and different ways.
Deeply entrenched beliefs and expectations around
the social roles and behaviours of women and girls
prevent them from accessing adequate education,
services and support. Women living with HIV and the
female partners of drug users face increased stigma
as their status is seen as outside accepted gender
norms. MAC’s work focuses on empowering women
in these groups through a range of activities, such as
outreach programmes, community sensitisation events,
workshops, drop-in clinics, peer support programmes
and the provision of shelters.
The outreach programmes that MAC and its partners
implement revolve around SRH education. Some of the
activities, in partnership with the Ministry of Women,
take the form of community sensitisation events and
workshops that seek to raise awareness around gender
inequality and discrimination, and to provide focused
training on SRH. These initiatives are targeted at entire
communities and try to involve men as well as women
and to increase their awareness of gender-related
issues. Since 2006, MAC has also conducted capacity
building workshops specifically with women living
with HIV. These ‘training of trainers’ workshops give
the participants the skills to ‘cascade’ the information
to other women living with HIV. As a result, a number
of women living with HIV who participated in the
workshops are now working on the ground with MAC or
with their implementing partners.
With their partners, MAC also supports four residential
shelters that accommodate specific groups of
vulnerable women. Two shelters provide temporary
accommodation for women living with HIV and their
children, with referrals primarily from hospitals. Shelter
staff use a family-centred approach, combining onsite
educational activities with outreach to the friends
and families of the women to facilitate their eventual
reintegration into the community. A third shelter caters
to female partners of drug users, while the fourth
provides accommodation and services for sex workers
and homeless women living with HIV. MAC advises each
of these shelters to work with families and communities
so that the women can eventually move out of the
centre and pursue livelihoods in their own communities.
Some of the shelters also operate drop-in clinics for
women living with HIV and the female partners of drug
users, providing educational information and support.
Finally, MAC also operates hospital-based peer support
programmes for men and women living with HIV. These
rely on hospital referrals and primarily focus on psycho-
social support and adherence to antiretroviral treatment.
In particular, MAC sees an opportunity here for
integrating the peer support programmes with outreach
activities. They are currently targeting advocacy efforts
to get government support for a home-based care
programme that would enable workers to combine
treatment and care for individuals living with HIV with
sensitisation activities with their families. MAC believes
that this approach can play a key role in reducing
stigma and spreading awareness.
Although MAC has witnessed successful results in each
of its different programmes and activities, it has also
identified new opportunities for broadening the scope
of its gender sensitive work. In particular, MAC sees
the potential of applying a family-centred approach
to programming with drug users, to draw in the
partners of those community members and encourage
protection. They argue that this requires an ideological
shift from considering only the health aspects of drug
use to considering the gender-related aspects of
the relationships of drug users and focusing on the
empowerment of their partners. Accordingly, MAC has
begun to target national advocacy efforts in this area.
SuPPORtING ANd EMPOWERING VuLNERABLE WOMEN IN MALAySIAAPPROACHES tO GENdER ANd SExuALIty: RESPONdING tO HIV
24
community and service provider level actions
(implementation actions group 3)
75% of partners indicated that they are carrying out one or
more community and service provider level implementation
action for standard 3.9 (as listed in table 2).
These cover gender-related actions such as mobilising
communities through outreach; training health care
personnel and other stakeholders; engaging community
leaders; and providing people with social and legal
services.
TASSOS (India) has promoted a gender policy at the
state level and disseminated a translated version to
all its partners. It carries out workshops and training
for health workers in Tamil Nadu and Pondicherry.
CASE Study 4
IDH sees gender as an issue that cuts across all its
work, and has developed internal gender programming
standards. The organisation recognises that gender
inequality is a structural driver of HIV transmission in
Bolivia, where the firmly rooted culture of machismo
fuels issues like gender-based violence and excessive
alcohol consumption.
IDH’s extensive work in this area involves a gender
analysis of machismo and the socio-economic
and cultural status of women. It also examines the
consequences of excessive alcohol consumption and
its impact on families, children, wives, sexual relations,
disease and violence. Since 2010, IDH has included
the theme of gender and sexuality in its prevention
programme, recognising that sexuality is a necessary
starting point for a better understanding of HIV.
However, IDH understands that inequality also impacts
on access to HIV treatment and care and, as a result,
has trained over a thousand health care workers in
urban and rural settings on gender issues.
IDH has also led training sessions with schools,
universities, the police and the military. Facilitators
usually use one of two main methods: film screenings
(to stimulate reflection and discussion among
participants); or forum theatre (to enable participants to
explore how gender, alcohol and HIV issues influence
their own lives).
Surveys administered before and after interventions
have indicated positive changes in knowledge about
HIV, gender and high risk behaviours related to alcohol
and violence. The surveys have also shown a greater
awareness of, and ability to critique machismo, among
the participants.
Implementing gender work can be challenging in
Bolivia, especially considering the degree to which
machismo, alcohol and violence are normalised in its
society. IDH has learned that it must challenge these
issues in a sensitive manner. This is particularly the
case when addressing aspects of machismo present
in indigenous culture, as criticising any aspect of
indigenous culture is politically sensitive. IDH has also
learned that there are already many organisations
engaging with women on gender issues; so it has
decided to focus its work on issues of masculinity and
engaging men for social change.
AddRESSING NEGAtIVE GENdER NORMS tHROuGH tRAINING ANd OutREACH IN BOLIVIA
SIAAP (India) has empowered female sex workers
and gay and bisexual men by building community
organisations to address gender and sexuality-related
stigma and discrimination. Alongside a range of training
programmes addressing issues of gender and sexuality,
it provides support for sex workers when they are
arrested, including legal help.
A strong example of a comprehensive approach to
community and service provider level actions was
shown by IDH (Bolivia), which has addressed issues of
gender in a challenging socio-cultural environment (see
Case study 4). APPROACHES tO GENdER ANd SExuALIty: RESPONdING tO HIV
25
policy and society level actions (implementation
actions group 4)
57% of the 28 partners indicated that they are carrying out
one or more of the policy and society level implementation
actions for standard 3.9 (as listed in table 2).
CASE Study 5
KANCO is one of Kenya’s leading HIV organisations,
with a membership of 960 community groups, faith-
based organisations and NGOs. Gender is an important
component KANCO’s programmes and policy work. In
recent years its gender programmes have included a
community gender development project which trained
women and girls, and some men and boys, on gender,
HIV and human rights issues; and a capacity building
programme for its member organisations on gender
mainstreaming and gender-based violence.
To complement its programmatic work, KANCO has
also been a member of various national policy and
coordination bodies, advocating for the development
and implementation of gender-related policies.
For example, it contributed to the National Gender
Taskforce through participation in the Joint AIDS
Programme review meeting and other forums during
the review of the National Strategy on AIDS. Kenya’s
new strategy includes gender-disaggregated indicators,
priorities, targets and budgets.
KANCO is also working to ensure that gender
is mainstreamed in the country’s laws. KANCO
contributed to the development of the HIV Laws Act,
ensuring that, when the act is violated, a tribunal is held
in which two of the seven members must be women.
KANCO is currently working to amend aspects of the
Law of Succession Act (which determines how property
moves from one person to another) to ensure it is
more gender sensitive. KANCO was also involved in
establishing provisions within the national constitution
that state that some committees cannot be held without
a certain percentage of women.
Despite recent gender-sensitive changes to Kenyan
law, implementation remains a major challenge.
Cultural practices, such as wife inheritance and the
disinheritance of widowed women (which leaves women
impoverished and vulnerable to high risk behaviours
like unprotected transactional sex work) persist,
contributing to the spread of HIV.
Another challenge is the deeply engrained nature of
gender inequality in Kenyan society, particularly in rural
areas. While women often emerge from gender training
workshops feeling empowered and more aware of their
rights, many find it difficult to actually challenge gender
inequality in their daily lives. From this experience,
KANCO has learned that more programmes need to
incorporate male role models to work with other men to
change harmful gender norms.
SHAPING tHE NAtIONAL HIV StRAtEGy IN KENyA
These actions focus on different types of advocacy
around a gender-transformative approach, for example
in relation to equity; gender-based violence, coercion
and abuse; and policies, laws and customs that limit
the autonomy of women. Actions also focus on finding
allies and building movements on gender; prioritising
needs in conflict situations; ensuring interventions
reflect the full diversity of gender and sexual orientation;
and paying special attention to people most at risk of
HIV infection.
In some contexts, for example, Alliance partners have
mobilised civil society organisations to collaborate and
explore issues on gender and sexuality and identify
common messages. RedLacTrans organised a meeting
on gender and sexuality that brought together 16
organisations representing diverse sexual identities in
Nicaragua; and NAF (Mongolia) has provided a civil
society voice in the policy and legislative environment
on issues that affects people living with HIV, sex
workers and men who have sex with men.
KANCO (Kenya) has actively participated in a range
of national advocacy initiatives, from being a member
of the national gender task force to promoting the
development and implementation of gender-related
policies (see Case study 5). APPROACHES tO GENdER ANd SExuALIty: RESPONdING tO HIV
26
MAMTA (India) supported the National AIDS Control
Organisation to form an expert committee to review
the curriculum of the national adolescence education
programme, and revise its content to ensure a broader
perspective of SRHR, including gender and sexuality
issues. As well as government bodies, the committee
included representatives of research and training
institutions, teachers and parent-teacher associations.
The revised 16-hour curriculum has now been rolled out
by the government across the country.
A number of partners responding to the Alliance
gender and sexuality survey are implementing the
South Asia Action Project (HASAB in Bangladesh
and Alliance India, MAMTA and SASO in India). This
project is a community mobilisation and advocacy
initiative designed to support the SRHR of vulnerable
adolescents and young people in the region. The
project strengthens youth groups and networks and
advocates for young people’s participation in SRHR
programming and policy processes. It increases the
access of young people from vulnerable communities
to comprehensive SRHR education and services.
Alongside promoting youth-friendly services, the
advocacy work aims to address harmful cultural and
gender norms and build knowledge and life-skills
among young people, particularly young men who have
sex with other men and young people using drugs.
other gender and sexuality-related Alliance good
practice standards
In addition to standard 3.9, a number of other Good
Practice HIV Programming Standards have direct
relevance to the gender and sexuality-related work of
Alliance partners. These standards are set out below,
along with a brief snapshot of work being done in these
areas from responses to the survey.
programme area good practice
standards
1. human rights and the
greater involvement of
people living with hiV
(gipA)
1.4 our programmes are designed
to build the capacity of both
rights holders and duty bearers
to claim their rights and to
promote, protect and respect
the rights of others
1.7 our organisation is committed
to the effective implementation
of the gipA principle
throughout all areas of our
organisation
HASAB (Bangladesh) indicated that their project
‘Promoting Rights of Extreme Socially Excluded People’
responds to standard 1.4. The project supports sex
workers to protect and promote their rights, reduce
stigma and discrimination and increase their condom
negotiation skills. It involves the provision of regular
training for sex workers to build their skills to take
collective action and make their voices heard. Mina (a
sex worker based at Maymenshing Brothel and involved
in the project) reported how her clients had always
refused to use condoms. After training on human
rights and HIV by a self-help group of sex workers,
she gained the skills, knowledge and confidence to
negotiate condom use. Mina and other members of the
group now all try to negotiate condom use with clients.
HASAB supports another project with the clients of
sex workers, and overall about 80% of the clients of
Maymenshing Brothel now use condoms.
Survey responses also indicated that many Alliance
partners are addressing gender within their support to
people living with HIV, and through their efforts to put
the principle of the greater involvement of people living
with HIV (GIPA) into practice (standard 1.7). Of particular
note, SIDC-Helem-Liban (Lebanon) reports that it
involves HIV-positive women in HIV prevention and
education activities, alongside building their capacity
to take care of themselves. The work has involved
supporting a workshop for 20 women living with HIV in
the Middle East and North Africa region, which focused
on the specific needs of women, including sexuality.
programme area good practice
standards
4. integration
of sexual and
reproductive health,
hiV and rights
4.9 our organisation works with
others to promote and/or
implement programmes that
address gender and sexuality as
an integral component of the srh
and hiV response
4.10 our organisation promotes and/
or provides interventions to
address gender-based and sexual
violence and abuse in its hiV and
srh responses
4.11 our organisation has a policy and
programme to address stigma
and discrimination, which act as
a barrier to protective behaviours,
support and access to srh and
hiV prevention and treatmentCASE Study 6
APPROACHES tO GENdER ANd SExuALIty: RESPONdING tO HIV
27
As described earlier, the answers to the question ‘What
gender and sexuality work does your organisation do?’
indicated that many Alliance partners do apply some
type and degree of gender and sexuality approach to
their programming, based upon a broad definition that
includes issues not only related to HIV, but wider areas
such as SRH (standard 4.9). There were also indications
of attention to gender-based and sexual violence
and abuse (standard 4.10), for example by AMSED
(Morocco) whose work with sex workers involves
building their capacity to address key issues, including
violence and HIV prevention, that affect their lives.
In relation to standard 4.11, survey responses confirmed
that action on stigma and discrimination is critical to
the Alliance’s approach to gender-related programming.
In answer to the question ‘Do you do any stigma and
discrimination work?’, 25 out of the 28 partners (89%)
said yes. Examples of their work include supporting
NGOs/CBOs through grants for relevant programmes;
supporting stigma and discrimination audits; and
providing training and ‘training of trainers’ to participants
such as health workers, people living with HIV, sex
workers, community leaders and religious leaders.
For some partners, tackling stigma and discrimination
involves a range of strategies. KHANA (Cambodia)
supports community counselling, community awareness,
event organising, forums, media work, meetings and
workshops. Similarly, the comprehensive approach
of KANCO (Kenya) includes sensitising its members,
supporting stigma audits, disseminating GIPA guidelines
and the civil society code of conduct, advocacy on the
eradication of HIV-related stigma and discrimination,
and the development of supportive workplace policies.
Addressing stigma is also central to the work of ANCS
(Senegal). One aspect of this is training trainers among
people living with HIV, men who have sex with men, sex
workers and other community actors.
In many cases, partners’ work on stigma and
discrimination has involved awareness-raising and
advocacy among a wide range of stakeholders and
community ‘gatekeepers’. For example, while TASSOS
(India) has targeted medical students and young people,
HASAB (Bangladesh) has carried out dialogue with
the media, health service providers, law enforcement
agencies, religious leaders, elected leaders, young
people, teachers, advocates, house owners, shop
keepers, rickshaw pullers, truck drivers, members of
the elite, employers, government stakeholders, NGOs
and human rights groups. IPC (Burkina Faso) and
CISHAN (Nigeria) are among a number of partners
that have carried out national advocacy on stigma and
discrimination, calling on their governments to pass
anti-discrimination legislation.
In India, female sex workers experience violence from
criminals, partners, pimps, madams and the police. This
restricts their ability to negotiate the use of condoms
or access health services, which in turn reduces the
likelihood of them adopting safer health behaviours and
increases their vulnerability to HIV.
To address this, the Bill and Melinda Gates Foundation’s
Avahan project – of which Alliance India is a partner
–builds the capacity of organisations and, especially
female sex workers themselves, to increase their
protection from violence and sensitise perpetrators. The
project believes that an individual is less likely to take
action against violence than groups of women working
together. As such, it helps female sex workers to form
support groups. The project’s key approaches are
advocacy training for female sex workers, developing
crisis response teams (involving sex workers and
non-NGO partners) and raising community awareness
on the rights of female sex workers. The project has
also worked with senior officials in the police force to
influence officers’ behaviour, reinforced by a media
campaign to ‘name and shame’.
Although the response to the project has been positive,
it is difficult to assess how much this advocacy has
reduced the levels of violence – as reporting by sex
workers is low (due to loyalty or fear of reprisals). The
project has called for more emphasis on protection,
based on the idea that women who are less intimidated
by the threat of violence are more able to avoid it. In
the state of Manipur, women claimed that the biggest
contribution to reducing violence was the opening of a
night shelter that allowed them to hide from criminals
and the police and get advice on protection options.
In Andhra Pradesh, women said that confidence was
the greatest form of protection. Female sex workers
who were trained as outreach workers reported almost
eliminated violence from their lives, as they were better
able to stand up for themselves.
AddRESSING VIOLENCE AGAINSt FEMALE SEx WORKERS IN INdIAAPPROACHES tO GENdER ANd SExuALIty: RESPONdING tO HIV
28
Partners’ efforts have often involved targeted
interventions. For example, Alliance China is supporting
groups of people living with HIV to do an anti-stigma
programme and produce a publication sharing their
experiences; and Alliance India is supporting a crisis
response team for men who have sex with men, female
sex workers and transgender people (see Case study
6). Alliance Ukraine has conducted advocacy training
for NGOs that are working with drug users and sex
workers.
programme area good practice
standards
7. hiV and drug use 7.6 our programmes targeting
people who use drugs are
gender-sensitive, and include
interventions for the sexual
partners of people who use
drugs
Partners from Malaysia, India and Ukraine reported
that their work to support drug users and their
partners addresses gender-related issues. MAC
(Malaysia) empowers the female partners of drug
users through outreach, workshops, awareness-raising
and peer support. SASO (India) has changed from an
organisation focused on men who use drugs to one that
includes women drug users, as well as partners and
children of drug users. Alliance Ukraine has supported
research into gender-sensitive approaches to HIV
prevention and harm reduction interventions among
drug users, with recommendations about how to
develop these approaches in future programming.
WHAt CHALLENGES ARE tHERE IN dOING
GENdER ANd SExuALIty WORK?
Responses to the Alliance survey confirmed that
partners face a significant number of challenges to their
work on gender and sexuality. These include:
n Gender norms and inequality. MAC noted, for
example, that despite progress in empowerment,
women in Malaysia remain vulnerable to HIV for a
range of biological, economic and cultural reasons
that place them in subservient roles in relationships.
Girls and young women are expected to be sexually
naïve, so have little access to information and
services, and are at greater risk of sexual coercion
and violence. All the while the dynamics of the
national epidemic are also changing. Previously
it was characterised by transmission among
men through drug use; now, although the overall
proportion of women living with HIV remains low, the
number of new cases among females is increasingly
dramatically. CiSHAN (Nigeria) also commented how
there is a relationship between poverty, women’s
lower social status, gender-based violence and HIV.
This results in a “downward spiral of more infection
and more poverty”. Similarly, HASAB (Bangladesh)
described how the challenges of gender and
sexuality reflect the whole socio-economic and
political status of women. Here, discussion about
sexuality is not culturally acceptable and a woman’s
role is to be passive, with men taking decisions
about where and how sex will occur (among other
things).
Gender inequality and discrimination against women
were also cited as challenges by partners in Bolivia,
Cambodia, India, Kenya, Lebanon, Morocco, Nigeria
and Uganda. AMSED noted that cultural issues in
Morocco affect women in the general population
and women from key populations, and that this
translates into lack of access to services.
n Low male involvement in programming and
interventions. NELA (Nigeria) noted that men are
often reluctant to get involved in programmes, even
at the level of getting tested for HIV or accessing
care and support in a timely manner. IDH (Bolivia)
noted that a holistic approach is required for
interventions – one that actively involves both men
and women.
n Limited access to education (formal and informal)
for women and girls. This challenge was cited by
NELA (Nigeria) and Humsafar and NMP+ (both India).
n Poor understanding or consensus on gender and
sexuality. SIAAP (India) expressed concern that key
national stakeholders and policymakers view gender
and sexuality issues from a public health, rather than
a rights, perspective. TASSOS (also India) felt that
organisations have different understandings about
what gender and sexuality mean.
n Lack of national platforms and opportunities to
share good practice. Partners in India (SIAPP),
Nigeria (CiSHAN) and Senegal (ANCS) noted the lack
of opportunities for different types of stakeholders
to share their gender and sexuality experiences and
practices. SIAPP was concerned that there is no
platform for community members to engage with
law enforcement agencies, government officials and
policymakers on an ongoing basis. ANCS highlighted
the lack of a mechanism to facilitate exchange APPROACHES tO GENdER ANd SExuALIty: RESPONdING tO HIV
29
between those working in the HIV response and in
the field of gender and sexuality.
n Lack of national policy and leadership on gender
and sexuality. Partners in countries such as Senegal
(ANCS), Kenya (KANCO) and Burkina Faso (IPC)
were concerned about the poor integration of gender
and sexuality into national policies, structures and
technical guidance.
n Lack of human resources, capacity and tools
on gender and sexuality. This lack of resources
among national stakeholders, Linking Organisations
and implementing NGOs and CBOs was cited as a
challenge by AMSED (Morocco), CiSHAN (Nigeria),
KHANA (Cambodia), IPC (Burkina Faso), MAMTA
and Alliance India (both India), POZ (Haiti) and
RedLacTrans (Nicaragua). A number of specific
concerns were also expressed. These included
that too few tools are available in Spanish and
successful experiences are not well documented
(RedLACTrans); that there is little choice of tools
(modules, toolkits, and so on) to carry out sessions
(ANCS); and that there is a need for more tools and
support materials on programming and advocacy
work (IPC).
n Limited ‘how to’ for programming gender and
sexuality. AMSED (Morocco) cited challenges
around building the negotiation skills of women,
and promoting human rights to combat violence
against women, stigma and discrimination. IDH
(Bolivia) noted that, while knowledge about gender
and sexuality has increased, more work is needed
to change attitudes. Alliance Ukraine cited the
challenge of finding appropriate ways of working with
female drug users and addressing violence against
drug users and sex workers.
n Low funding levels for gender and sexuality
initiatives. Funding was identified as a challenge
in Bolivia (IDH), Burkina Faso (IPC), Mongolia
(NAF), Nigeria (CiSHAN) and Senegal (ANCS). NAF
(Mongolia) highlighted the challenge of scaling up
gender and sexuality work when resources for work
with marginalised communities are already limited.
n Stigma and discrimination. This remains a
significant barrier to the work of many Alliance
partners. Some of the areas being addressed include
stigma and discrimination against men who have sex
with men (Alliance China), self-stigma among people
living with HIV (NMP+, India), and the double stigma
of people affected by HIV and members of key
populations (Rumah Cemara, Indonesia).
ASSESSING OuR CAPACIty ANd FutuRE
SuPPORt NEEdS
The two most commonly cited capacity barriers were lack
of donor funds for relevant initiatives and lack of skilled
staff and training (in gender and sexuality, and related
areas such as human rights).
When asked about the capacity needed to apply a
gender and sexuality approach, responses cited an
extensive and varied list. The most common need,
articulated by partners such as KANCO and ANCS,
was for training and capacity building to understand the
theory and, more importantly, practice of gender and
sexuality approaches (both for their own staff and the
NGOs/CBOs that they support). In some cases, such
as ANC-CI and ANCS, technical support was requested
for general approaches to integrating gender, including
human rights. In others, it was requested for specific
areas, such sex work (MAC) and other key populations
(Alliance Ukraine).
Another common need, expressed by partners such
as KHANA and MAC, was for a gender analysis to
collect, analyse and publish gender-disaggregated data,
combined with social research to increase understanding
about how such data connects to HIV-related
vulnerabilities and risk.
MAC, alongside other partners from Morocco, Senegal
and Nigeria, identified capacity gaps in gender-related
advocacy work to revise national laws and policies, and
engage relevant stakeholders such as policymakers,
law enforcement officials and the judiciary. Other gaps
in capacity included leadership; resource mobilisation;
technical guidelines and tools (such as simplified
planning guides); focal points or ‘desks’ for gender
and sexuality; ways of involving community leaders;
culturally-specific approaches to gender and sexuality;
and gender-sensitive indicators.
Other needs partners identified included: gender
programme design and management; up-to-date
information (including gender-disaggregated data and
analysis, materials, manuals and tools); examples
of good practice; opportunities to publish and share
experiences; commodities (such as condoms, lubricants
and contraceptives); and networking (with partners at
regional and international levels, and local organisations).
only 25% of responding partners said they have the
capacity that they need to apply a gender and sexuality
approach. the remaining 75% said they have limited
capacity. Just over half (54%) have a focal person that
deals with gender and sexuality. APPROACHES tO GENdER ANd SExuALIty: RESPONdING tO HIV
30 30
N’deye Coumba Gaye, President of the Sex Workers Association, dakar, Senegal. © 2007 Nell
Freeman for Alliance
Jaqueline Anchundia Paladines from the Organisation of Sex Workers of Esmeraldas doing outreach work
in a local park, Ecuador. © 2006 Marcela Nievas for the AllianceAPPROACHES tO GENdER ANd SExuALIty: RESPONdING tO HIV
31
section 3:
reflections And
future Actions
CONCLuSIONS
n Action at all levels on gender and sexuality
The survey confirmed that Alliance partners are
focusing significant efforts on gender and sexuality.
Assessed against the Alliance’s own Good Practice
Standard for a gender-transformative approach,
a high proportion of partners are taking actions at
an organisational and programming level (82%),
at individual, family and peer level (86%), and at
community and service provider level (75%). Over
half (57%) are also carrying out actions at the policy
and society level. Twelve partners (43%) are taking
action at all four levels.
The results of the survey show that the work
of partners is broadly in line with the Alliance’s
standards for this area, with the strategies promoted
by agencies setting global norms (see Annex 4),
and with the good practice of other organisations
(see Box 1 and Annex 1). However, as noted in
the Introduction to this report, the survey has a
number of limitations. While giving an indication of
the work being undertaken, the responses provide
little systematic detail or analysis of exactly what
approaches they have taken, and how work is
being done. As such, it is not possible to assess the
quality, effectiveness or impact of work.
n gender-transformative or gender sensitive
approaches?
It is challenging to assess the extent to which
Alliance partners are carrying out approaches
that are gender-transformative (as defined in HIV
and Healthy Communities: Strategy for 2010-12,
see Box 2) as opposed to gender ‘sensitive’ or
‘responsive’. Many partners confirmed that they
work with women or sexual minorities – 79%
with men who have sex with men and 36% with
transgender people, for example. However, there
was little detail about whether the community-level
actions by NGOs and CBOs involve working within
such groups and, critically, bringing groups together
to actually change gender norms and address
issues of inequality. Also, the comparatively low
number of partners involved in policy and society-
level advocacy could mean that efforts do not
always respond to the wider political and legislative
environment; to make gender transformation a reality
they will need to.
The survey also provided some indications that, in
some circumstances, partners may be less actively
engaged in some of the more sensitive or complex
aspects of comprehensive gender-transformative
approaches. For example, relatively few partners
noted efforts to address gender-based violence or to
involve heterosexual men and boys.
n clarity on theoretical and practical approaches
Partners were asked what they understood by a
gender and sexuality approach. Taken together,
their responses reflect a good understanding, with
particularly clear and passionate explanations
of how gender and sexuality impact on people’s
vulnerability, and why they are critical to action on
HIV. However, individual responses indicate that
some partners need greater clarity about what such
an approach encompasses – especially in practice,
rather than theory.
n perceptions of capacity
A gender-transformative approach involves
consciously and systematically addressing APPROACHES tO GENdER ANd SExuALIty: RESPONdING tO HIV
32
gender-related issues at all levels, including within
the design, implementation, management and
monitoring and evaluation of programmes and
policies. However, 75% of responding partners state
they only have limited capacity to carry out such
work – with gaps in skills and expertise, technical
resources, and funding. While respecting the views
of these partners, some may actually underestimate
their existing capacity for gender and sexuality-
related approaches. They may be doing, or already
able to do, more gender-transformative work than
they think. There can be a perception that a gender-
transformative approach is a separate and highly
specialised area that is distinct from the usual
work of Alliance partners. This perception can be
exacerbated by some of the academic terminology
associated with the subject.
n gender, sexuality and human rights
Finally, the survey also confirms that issues of
gender and sexuality are inextricably linked with
human rights. This reiterates the findings of a
similar 2010 survey of Alliance partners, focused on
human rights.
27
This identified issues around gender
inequality and discrimination, and criminalisation
of sexual minorities as top human rights issues.
It demonstrated that many partners view gender
issues as integral to the definition of a human rights-
based approach.
RECOMMENdAtIONS
Based on the findings of the survey and the
conclusions drawn, a number of recommendations are
set out below for the Alliance to improve its work on
gender and sexuality.
1. develop a gender strategy for Alliance
partners that:
n responds to HIV and Healthy Communities:
Strategy for 2010-12 and the Good Practice HIV
Programming Standards
n confirms a common understanding of a gender-
transformative approach and of terms such as
gender and sexuality
n promotes a comprehensive approach to a gender-
transformative approach that is rights-based and
includes attention to sensitive issues (such as
gender-based violence)
n clearly articulates and promotes what such an
approach means in practice, with examples of
relevant strategies, activities and indicators
n addresses how such an approach can be measured
n is informed both by the national, regional and global
experiences of the Alliance itself and international
good practice and policy dialogue, including on the
wider health Millennium Development Goals.
2. carry out a more specific assessment of the
capacity needs of Alliance partners for gender-
transformative approaches. develop a plan to
address these needs by:
n maximising existing resources by the Alliance and
others, such as gender analysis tools and guides on
gender mainstreaming
n ensuring that the Alliance’s Technical Support Hubs
can provide high quality capacity building, based
on a common understanding of, and technical
strategies for a gender-transformative approach
n mobilising and supporting Alliance partners to
develop their own gender strategies
n building capacity of Linking Organisations to include
gender-transformative approaches into proposal
development and resource mobilisation activities.
3. document examples of good practice of gender-
transformative approaches by Alliance partners
working in generalised epidemics, concentrated
epidemics, and mixed epidemics. In particular,
use the Alliance’s comparative advantage as
an organisation with extensive experience of
community mobilisation and support with groups
most affected by HIV, to articulate the complexity
and necessity of transformative approaches at the
community level.
4. ensure that gender transformation is fully
integrated and addressed in the Alliance’s
existing and future work on good practice
responses to hiV. Examples include: surveys
among Alliance partners on other thematic areas;
good practice guides; the Alliance’s accreditation
process; and monitoring and evaluation of HIV and
Healthy Communities: Strategy 2010-12.
27. ‘Advancing Human Rights, Responding to HIV: Report on the Findings of a Human Rights Survey among Alliance Partners’, International HIV/AIDS Alliance,
September 2010.APPROACHES tO GENdER ANd SExuALIty: RESPONdING tO HIV
33
drop-in centre for men who have sex with men, Battambang, Cambodia
© Eugenie dolgberg for the AllianceAdVANCING HuMAN RIGHtS: RESPONdING tO HIV
34
Annex 1:
exAmples of gender-
trAnsformAtiVe ApproAches
Stepping Stones was developed by Strategies for
Hope and ActionAid in 1995 and has been used
throughout the world. It is a training package on
gender, HIV, communication, relationship skills and
life-skills. It covers many aspects of people’s lives,
including why people behave in the ways they do, how
gender, generation and other issues influence this,
and ways in which people can change their behaviour.
Stepping Stones uses a series of 14 sessions among
individual or combined peer groups. These use a
participatory approach through discussions and
activities based on the participants’ own experiences
and using methods such as role play and drawing.
Strategies for Hope (1995), Stepping Stones: A Training
Package in HIV/AIDS, Communication and Relationship
Skills.
Men as Partners was started by EngenderHealth in
1996 and has been implemented in over 15 countries
in Africa, Asia, Latin America and the USA. The
programme works with men to play constructive roles
in promoting gender equity and health in families and
communities. Its approaches include: interactive, skills-
building workshops that confront harmful stereotypes
of what it means to be a man; training health care
professionals in providing male-friendly services;
leading local and national public education campaigns;
and building national and international advocacy
networks to create a global movement.
Engenderhealth (accessed 6.1.11), Men as Partners,
available at: www.engenderhealth.org/our-work/gender/
men-as-partners.php
Promundo is a Brazilian NGO set up in 1997 to
promote gender equality and end violence against
women, children and youth. Its combines research
and advocacy with programmes to promote positive
changes in gender norms and behaviours among
individuals, families and communities. For example,
Programme M (‘M’ being for Mulheres and Mujeres –
‘women’ in Portuguese and Spanish) seeks to promote
the health and empowerment of young women through
critical reflections about gender, rights and health.
It consists of educational workshops, community
campaigns and innovative evaluation instruments
to assess impact on young women’s gender-related
attitudes and perceived self-efficacy in interpersonal
relationships. The curriculum was field-tested in Brazil,
Jamaica, Mexico and Nicaragua and has been adapted
for India and Tanzania.
Promundo (accessed 6.1.11), Programmes, available at:
www.promundo.org.br/en/activities/programs
The Sonke Gender Justice project started in 2006
and works across Africa to strengthen government, civil
society and citizen capacity to support men and boys
to take action. The One Man Can campaign supports
men and boys to end domestic and sexual violence
and promote healthy, equitable relationships that men
and women can enjoy. It promotes the idea that each
person has a role to play and can create a better, more
equitable and just world. It encourages men to work
together with other men and women to take action.
The campaign includes an action kit (with music and
fact sheets) and suggests action ideas for men – for
example supporting a survivor or challenging other men
to take action.
Sonke Gender Justice (accessed 6.1.11), One
Man Can, available at: www.genderjustice.org.za/
onemancan/?php MyAdmin=l06quHmc2HyKa50XHUS
FkShStJ8
The Frontiers Prevention Project by the International
HIV/AIDS Alliance India included a focused prevention
programme in Andhra Pradesh, targeting key
populations and reaching over 22,000 female sex
workers and 12,000 men who have sex with men.
The programme’s gender-transformative approach
combined multiple strategies including participatory
site assessments; promoting networks to provide
mutual support; training leaders; building capacity to
address structural determinants of inequality (including
gender-based violence); advocacy on policymaking;
outreach to gatekeepers; providing safe spaces; and
strengthening the capacity of NGOs.
International HIV/AIDS Alliance India (2006), Focused
Prevention in Andhra Pradesh.35
AdVANCING HuMAN RIGHtS: RESPONdING tO HIV
Annex 2:
gender And sexuAlity
surVey Questions
introduction
1. Linking Organisation/partner
2. Is there a focal person that deals with gender and sexuality within your
organisation?
3. What do you understand by a gender and sexuality approach to HIV?
4. What gender and sexuality work does your organisation do? (Please
include programming, policy, capacity building work in your response)
5. Do you have a good case study of successful work you could share?
6. What are the challenges you face doing gender and sexuality work?
capacity
7. What capacity do you think is needed to apply a gender and sexuality
approach to programming?
8. Do you feel that your organisation has that capacity?
9. What type of support in the area of gender and sexuality do you need?
national context
10. What are the most important gender and sexuality issues in your country
with regard to HIV at the moment?
11. Do national programmes respond to the most important issues?
12. Are you doing work with the following groups? (please tick all that apply)
13. Do you do any stigma and discrimination work?
14. Which key population(s) in your country has their human rights most
frequently violated?APPROACHES tO GENdER ANd SExuALIty: RESPONdING tO HIV
36
WHAt ARE tHE ALLIANCE’S GOOd PRACtICE HIV PROGRAMMING
StANdARdS?
n These programming standards define the Alliance approach to HIV programming.
They set out what our beneficiaries can expect from our HIV programmes and our
research.
n Programme standards define good practice in various technical areas, and are
based on evidence, and on Alliance experience and values.
n The standards refer to tools that define good practice for specific intervention
types, or that assist in implementing the standard. They do not define reach
and scope. Targets for reach and scope are set by people closer to the specific
programmes, according to local epidemiology and context.
n These standards are aspirational. Where our programming is not meeting them, it
will highlight our quality improvement priorities, and help with identifying technical
support needs.
n These standards are not yet complete. We are currently working on treatment and
care standards which will be incorporated into the final standards document.
n These standards refer to a range of themes and topics. They are only to be
applied to work currently undertaken. For example, if a Linking Organisation is
not developing work on drug use and HIV, then the HIV and drug use standards
do not apply. Some of the standards are cross-cutting and will be relevant for the
whole Alliance, such as those on the human rights and GIPA.
WHy dEVELOP PROGRAMMING StANdARdS?
n To define and promote good practice in community-based HIV programming.
Definitions of good practice and quality are based on evidence and programme
learning, and are shaped by the Alliance’s values.
n To support assessment and evaluation of programme quality.
n To influence programme design.
n To build an evidence base for quality programming.
n To shape the provision of technical support provided through the Alliance’s
Technical Support Hubs.
Annex 3:
AlliAnce good prActice hiV
progrAmming stAndArdsAPPROACHES tO GENdER ANd SExuALIty: RESPONdING tO HIV
37
WHO IS INVOLVEd?
n Alliance Linking Organisations and their implementing partners (community- and
faith-based organisations), and the Alliance’s Technical Support Hubs, their users
and beneficiaries, will use programming standards to design, implement and
evaluate HIV programmes.
n Users or beneficiaries of Alliance services and programmes can use programming
standards to understand what our programmes are for, and to help evaluate
Alliance programmes.
n Alliance programme officers and programme managers will use programming
standards to assess, design and evaluate programmes (using a self-assessment
tool).
n Alliance resource mobilisation staff will use programming standards to develop
high quality proposals.
n Funders of Alliance programmes have an interest in programming standards.
Alliance standards illustrate that our programmes are shaped by a culture of
quality and good practice, are informed by evidence, and are monitored and
evaluated according to a set of standards.
n Other civil society organisations are interested in quality standards for their
community level programmes. Alliance programming standards can influence and
guide good programming in other civil society organisations.
ARE WE MEEtING tHE StANdARdS?
We have developed a self-assessment tool which Alliance organisations can use to:
1. objectively appraise and describe the current status of an organisation and its
programmes in relation to Alliance good practice quality programming standards
2. enable organisations to identify and agree on a plan for continuous development
of good practice programming (including building capacity and delivering
technical support)
3. report on the quality of our programming. AdVANCING HuMAN RIGHtS: RESPONdING tO HIV
38
Annex 4:
Key gloBAl guidAnce on gender
And sexuAlity ApproAches
1. Agenda for Accelerated country Action for
Women, girls, gender equality and hiV: operational
plan for the unAids Action Framework: Addressing
Women, girls, gender equality and hiV, unAids
(2010)
principles: Human rights-based approach;
participation; evidence-informed and ethical responses;
partnership; engaging men and boys; and strong and
courageous leadership.
issue 1: Knowing, understanding and responding to
the particular and various effects of the HIV epidemic
on women and girls
recommendation: Jointly generate better evidence
and increased understanding of the specific needs
of women and girls in the context of HIV and ensure
prioritised and tailored national AIDS responses that
protect and promote the rights of women and girls
(knowing your epidemic and response).
results:
n Quantitative and qualitative evidence on the specific
needs, risks of and impacts on women and girls
in the context of HIV exists through a process of
comprehensive and participatory data collection,
including on male and female differentials in the
epidemic, and better inform the implementation of
effective policies and programmes that promote and
protect the rights and meet the needs of women and
girls.
n Harmonised gender equality indicators are used
to better capture the socio-cultural, economic and
epidemiological factors contributing to women’s and
girls’ risk of and vulnerability to HIV.
n Evidence-informed policies, programmes and
resource allocations that respond to the needs of
women and girls are in place at the country level.
issue 2: Translating political commitment into scaled
up action to address the rights and needs of women
and girls in the context of HIV
recommendation: Reinforce the translation of political
commitments into scaled-up action and resources for
policies and programmes that address the rights and
needs of women and girls in the context of HIV, with the
support of all relevant partners, at the global, national
and community levels.
results:
n Stronger accountability from governments to move
from equality to results, for more effective AIDS
responses.
n All forms of violence against women and girls are
recognised as violations of human rights and are
addressed in the context of HIV.
n Women and girls have universal access to integrated
multi-sectoral services for HIV, tuberculosis and
sexual and reproductive health and harm reduction,
including services addressing violence against
women.
n Strengthened HIV prevention efforts for women and
girls through the protection and promotion of human
rights and increased gender equality.
issue 3: An enabling environment for the fulfilment
of women’s and girls’ human rights and their
empowerment, in the context of HIV
recommendation: Champion leadership for
an enabling environment that promotes and
protects women’s and girls’ human rights and their
empowerment, in the context of HIV, through increased
advocacy and capacity and increased resources.
results:
n Women and girls empowered to drive transformation
of social norms and power dynamics, with the APPROACHES tO GENdER ANd SExuALIty: RESPONdING tO HIV
39
engagement of men and boys working for gender
equality, in the context of HIV.
n Strong, bold and diverse leadership for women, girls
and gender equality for strengthened HIV responses.
n Increased financial resources for women, girls and
gender equality in the context of HIV.
n Gender-responsive UNAIDS.
2. unAids Action Framework: universal Access
for Men who have sex with Men and transgender
people, unAids (2009)
The Action Framework focuses on three objectives:
1. improve the human rights situation for men who
have sex with men and transgender people—the
cornerstone to an effective response to HIV
2. strengthen and promote the evidence base on men
who have sex with men, transgender people and HIV
3. strengthen capacity and promote partnerships to
ensure broader and better responses for men who
have sex with men, transgender people and HIV.
Within a comprehensive package of measures to
address HIV-related issues among men who have
sex with men and transgender people, the need for a
conducive legal, policy and social environment requires:
n the promotion and guarantee of the human rights
of men who have sex with men and transgender
people, including protection from discrimination
and the removal of legal barriers to accessing
appropriate HIV-related prevention, treatment, care
and support services for them, such as laws that
criminalise sex between males
n an assessment and understanding of the numbers,
characteristics and needs of men who have sex
with men and transgender people regarding HIV
and related issues, including risks associated with
injecting drug use, sex work, and prison confinement
n ensuring that men who have sex with men and
transgender people are appropriately addressed in
national and local AIDS plans, that sufficient funding
is budgeted for work, and that this work is planned
and undertaken by suitably qualified and appropriate
staff
n the empowerment of men who have sex with men
and transgender communities to participate equally
in social and political life
n ensuring the participation of men who have sex
with men and transgender people in the planning,
implementation and review of HIV-related responses,
including the support of non-governmental
and community-based organisations, including
organisations of people living with HIV
n public campaigns to address homophobia and
transgender discrimination
n training and sensitisation of health care providers
to avoid discriminating against, and ensure the
provision of appropriate HIV-related services for men
who have sex with men and transgender people
n access to medical and legal assistance for boys,
men and transgender people who experience sexual
abuse
n the promotion of multi-sectoral links and coordinated
policy-making, planning and programming, including
ministries of health, justice (including the police),
home, and social welfare (and similar and related
ministries), at the national, regional and local levels.
All interventions should be evidence-informed,
developed with, and protect the rights of men who
have sex with men and transgender people and should
include safe access to:
n information and education about HIV and other
sexually transmitted infections, and support for safer
sex and safer drug use, through appropriate services
(including peer-led, managed and provided services)
n condoms and water-based lubricants
n confidential, voluntary HIV counselling and testing
n detection and management of sexually transmitted
infections through the provision of clinical services
(by staff members trained to deal with sexually
transmitted infections as they affect men who have
sex with men and transgender people)
n referral systems for legal, welfare and health
services, and access to appropriate services
n safer drug-use commodities and services
n appropriate antiretroviral and related treatments,
where necessary, together with HIV care and support
n prevention and treatment of viral hepatitis
n referrals between prevention, care and treatment
services
n services that address the HIV-related risks and needs
of the female sexual partners of men who have sex
with men and transgender people.
Issues that need to be addressed specifically in relation
to transgender people:
n access to appropriate information, counselling and
support on transgender issuesAPPROACHES tO GENdER ANd SExuALIty: RESPONdING tO HIV
40
n access to drugs, gender reassignment procedures
and support, where necessary
n the ability to change one’s name and gender identity
on official documents, and the legal right to live as
another gender, free from stigma and discrimination
n an understanding of the effects of HIV antiretroviral
medicines and HIV opportunistic infection treatments
for transgender people taking gender reassignment
drugs
n work to understand HIV risk in relation to gender
reassignment drug treatment and surgical
procedures.
(Based on the recommendations from the WHO
consultation meeting on men who have sex with men,
HIV and other STIs, held in Geneva, 15–17 September
2008, WHO’s August 2008 publication, ‘Priority
Interventions: HIV/AIDS Prevention, Treatment and Care
in the Health Sector, the UNAIDS 2007 publication,
Practical Guidelines for Intensifying HIV Prevention:
Towards Universal Access’, and the UNAIDS Policy
Brief on HIV and Sex Between Men.)APPROACHES tO GENdER ANd SExuALIty: RESPONdING tO HIV
An MSM couple living with HIV. After taking part in a photographic project, working for an outreach
service and with counselling from KHANA the couple were empowered to seek treatment and
disclose to their families. Battambang, Cambodia. © Eugenie dolberg for the Alliance
Isaiah Wabwire an outreach worker with dARAt sits with injecting drug users ‘Niko’ and ‘Omar’,
Mombasa, Kenya. © Nell Freeman for the AllianceAbout the International HIV/AIDS Alliance
Established in 1993, the International HIV/AIDS Alliance (the Alliance) is
a global alliance of nationally-based organisations working to support
community action on AIDS in developing countries. To date we have
provided support to organisations from more than 40 developing countries
for over 3,000 projects, reaching some of the poorest and most vulnerable
communities with HIV prevention, care and support, and improved access to
HIV treatment.
The Alliance’s national members help local community groups and other
NGOs to take action on HIV, and are supported by technical expertise, policy
work, knowledge sharing and fundraising carried out across the Alliance.
In addition, the Alliance has extensive regional programmes, representative
offices in the USA and Brussels, and works on a range of international
activities such as support for South-South cooperation, operations research,
training and good practice programme development, as well as policy
analysis and advocacy.
International HIV/AIDS Alliance
(International secretariat)
Preece House
91-101 Davigdor Road
Hove, BN3 1RE
UK
Telephone: +44(0)1273 718900
Fax: +44(0)1273 718901
mail@aidsalliance.org
www.aidsalliance.org

G&SR_02/11
Registered charity number: 1038860