When it comes to incorporating gender-related policies and interventions into their HIV/AIDS programmes, three of the largest global AIDS donors talk the talk, but have largely failed to walk the walk.
These are the findings of a new study, Moving Beyond Gender as Usual, by the Washington-based Centre for Global Development (CDG).
Based on interviews with donor staff, government representatives, and recipient organizations in Mozambique, Uganda and Zambia, the study aimed to determine the gender-related activities of the US President's Emergency Plan for AIDS Relief (PEPFAR), the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the World Bank's Multi-Country AIDS Program (MAP).
Researchers from the CDG's HIV/AIDS Monitor and the International Centre for Research on Women looked at how the three donors incorporated gender issues into their policies, and to what extent they have been put into practice and monitored.
Sixty-one percent of people living with HIV in sub-Saharan Africa are women, up from about 33 percent in the 1980s. The authors argue that gender inequality seriously undermines efforts to curb the epidemic and has fuelled the spread of HIV in the region, making women vulnerable to sexual violence, hindering their ability to have safe sex, and limiting their access to health, education and employment.
Although PEPFAR, the Global Fund and MAP have all made high-level commitments to address gender issues in their programming, these commitments had "not yet produced concrete and systematic action on the ground".
PEPFAR provides the most funding for HIV/AIDS programmes in the three countries, and has supported some innovative research and programmes, but has not translated its global gender goals into programmes that take into account local conditions or specific country needs, while its focus on short-term results does not bring the long-term investments needed for social change.
A manager of a PEPFAR-supported prevention of mother-to-child transmission programme in Uganda told researchers: "We ... are not looking only at HIV and AIDS; we are also looking at social effects of HIV and AIDS, so we have asked [the donor] to allow us to use this money in education and [micro]credit. I think this is not their interest."
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Some PEPFAR policies, such as age restrictions on condom distribution and restrictions on working with sex workers, conflict with the donor's goals on gender.
Although the Global Fund introduced a new gender equality strategy in 2008, its Country Coordinating Mechanisms - the national bodies that oversee Global Fund grants - still lack knowledge and experience of gender issues, and gender-related indicators are not included in grant monitoring and evaluation.
The study identified the World Bank as having the best record in promoting gender equality. Its five-year cycles allow support of long-term interventions for social change, such as funding gender ministries and community initiatives, but a lack of accountability in gender-related programming was a weakness.
The authors urge the three donors to collaborate on gender issues to make the most of their individual strengths and avoid duplication. This should include helping countries establish gender-related goals in their HIV/AIDS response, and sharing research and knowledge about innovative and effective gender-related programmes.
"As PEPFAR, the Global Fund and the MAP feel the squeeze of the global economic crisis, they will be pressed to do more with less," the authors noted. "One important way to increase success across donor programmes will be to address gender inequality that hampers prevention, treatment and care."