Elizabeth Futrell is an associate technical officer at FHI, where she works on activities related to community-based family planning and youth sexual and reproductive health.
In recent years, campaigns like the The Girl Effect and publications such as Half the Sky have called attention to the key role of women and girls in combating poverty and its many challenges, including HIV/AIDS. At a recent talk in Chicago titled, “Transmitting Hope for Women in the HIV/AIDS Pandemic,” Geeta Rao Gupta, former president of the International Center for Research on Women (ICRW), elaborated on why and how the global health community must focus on girls and women.
Geeta began her focus on HIV prevention among women in sub-Saharan Africa in 1990, when a USAID colleague noticed that although most efforts to prevent HIV among women were targeted at women who sell sex, they were not the only women becoming infected with HIV. A team of researchers embarked on a 15-country research program to learn more about the realities of women’s sexual health and found that three key factors made women and girls disproportionately susceptible to HIV: (1) economic vulnerability, (2) harmful gender norms, and (3) disparities in access to health information and services. Compounding these challenges was the fact that, in many cases, even if women and girls did have access to HIV prevention information and services, unequal power dynamics left them unable to negotiate safer sexual practices with their partners. Further, many women felt unable to leave risky sexual relationships because of economic dependence or threat of violence. For these women, the immediate threats of physical harm and extreme poverty posed far greater risks than the possibility of dying of AIDS 10 years down the road. Public health messages about abstinence, faithfulness, and condom use did no good for the women who lacked power to negotiate these practices.
Therefore, Geeta argues that HIV prevention efforts must address not only individual risk behaviors, but also the societal structures that make women and girls vulnerable to HIV and other health threats. How do we do this? She says we must start with the understanding that broad generalizations about what works do not ring true for every context. While promising, single approaches like microfinance are not a magic bullet but just one of many tools to be used in creating long-term, structural solutions. Central to the wellbeing of women and girls is the creation of an enabling environment in which women and girls can apply their empowerment. The development, implementation, and enforcement of supportive laws and policy regarding education, land and inheritance rights, age of marriage, and gender-based violence are critical to this endeavor. So is legal literacy—women need to know what their rights are and how to obtain them. Educating women and girls on their rights, training judges and law enforcement to uphold and enforce protective laws, and deploying community legal workers to help women and girls navigate the legal system are important strategies for upholding the rights of women and girls.
Effective, evidence-based programming borne from context-specific research is also necessary. In other words, implementing organizations need to get the facts, understand the context, and mobilize resources for each unique setting rather than rushing to quick solutions. These organizations also must focus on building local capacity to sustain and scale up effective programs. Geeta notes that successful scale-up does not mean giving a local organization that has successfully implemented a program more money and telling it to reach an additional 10,000 people, but rather finding other organizations that can effectively replicate the program and asking them to help reach new audiences.
Just before the talk closed, an audience member asked whether any of the Millennium Development Goals are achievable. “Absolutely,” Geeta asserted. Some of these goals, including elimination of mother-to-child transmission of HIV by 2015 are within reach. We have the tools and the cost is low—all it will take is good partnerships, capacity building, and a critical mass of support to overcome the stigma still associated with HIV, another challenge faced disproportionately by women and girls.