STOPAIDS Policy Officer, Alysa Remtulla, explains the correlation between gender inequality and HIV; and celebrates Act4Africa’s HEAL (Health, Empowerment and Livelihoods) programme for its achievements in fighting the disease through women’s economic empowerment. This blog first appeared on the Oxfam Policy & Practice website as part of their HER SERIES, a collection of commentaries on women’s economic empowerment. Read the full article here.
Women’s Economic Empowerment and the HIV and AIDS Response
We know that gender inequality fuels the HIV epidemic and that women’s economic empowerment is a powerful tool to change gender relations. Does that mean that women’s economic empowerment can reduce women’s vulnerability to HIV? Evidence reveals the relationship may be more complicated.
In 2015, young women (15-24) made up 20% of all new HIV infections (despite representing just 11% of the population). The relationship is more pronounced in some geographic contexts than others; in South Africa HIV prevalence among women is nearly twice as high as men.
The link between wealth and HIV is less clear. Studies in the early 2000s, for example, showed a positive correlation between household income and HIV prevalence, where income was associated with living in urban settings, surviving with HIV for longer and attracting more partners (for men).
Feminist economists breakdown the household as the unit of analysis, and suggest economic dependence on men, makes women more likely to acquire HIV. Some studies have demonstrated that economic dependence limits a woman’s ability to negotiate safe sex, making her more likely to accept a partner having sex outside the relationship and less likely to insist on condoms, because she has no economic alternatives to remaining in the relationship. Economic dependence is also used to explain age discordant couples where adolescent girls form relationships with older men who provide them with material goods. These men are likely to have already have had multiple partners, and can pass HIV on to their younger partners.
Dependence aside, low household income is also demonstrated to negatively impact school attendance, and subsequently access to information about HIV. Insufficient income can also be a motivating factor to take part in sex work, which in the context of criminalisation, carries an increased risk of HIV acquisition.
For women living with HIV, economic dependence can be further impeded by HIV related illnesses, as well as stigma and discrimination which impact the ability to work. Insufficient income can in turn impact women’s ability to access healthcare. When privatised healthcare results in user fees, women and girls are the first to lose out given that spending on their health is a low priority within the household. Even where ART is free, additional costs such as travel to the clinic can be prohibitive. In families affected by HIV, women bear the burden of the caring responsibility for sick family members, further restricting their opportunities to take up paid work outside the home.
A potential solution
The connection between HIV and economic dependence suggests women’s economic empowerment could play a powerful role in the HIV response, both in terms of reducing new infections and supporting women living with HIV. Indeed, some women’s economic empowerment programmes have demonstrated positive results in reducing women’s vulnerability to HIV.
STOPAIDS member Act4Africa has piloted a programme, Health, Empowerment and Livelihoods in Uganda and now in Malawi. The project combines HIV prevention training, testing and counselling with savings and business enterprise coaching and life skills training, helping young women to secure access to higher earnings and increasing overall levels of confidence and self-esteem. Higher earnings lead to more independence, which has had a direct positive impact on health outcomes. The project is backed up by the provision of HIV services for a wider group of men and women in the community. Since HEAL began, 6,327 men and women have accessed HIV testing and counselling, 1,150 women are actively involved in savings groups and 632 women have set up business enterprises either individually or in groups. Through questionnaires Act4Africa have established a 25% reduction in men & women reporting high risk sexual behaviour compared to at the start of the project and 80% of those testing HIV positive are now taking up healthcare referrals compared to only 48% at the start.
In contrast, other studies have shown that women’s economic empowerment programmes can have unintended consequences, for example increasing rates of violence against women and girls, perhaps as a reaction to the challenge to established gender relations. An increase in violence against women and girls is an unacceptable violation of human rights and indisputably increases vulnerability to HIV.
A 2011 report published by STOPAIDS member, STRIVE, examined the evidence behind intimate partner violence highlighting that employment is inconsistent in reducing women’s risk to violence and that the relative economic position of a women’s partner as well as cultural expectations of gender roles also affect a women’s risk of violence.
The mixed evidence demonstrates that women’s economic empowerment programmes need to be designed carefully to be effective. Programmes need to tackle the underlying gender norms and inequalities, rather than provoke backlash which reinforces them. A report from GSDRC highlights some of the critical elements of successful women’s economic empowerment programmes including involving men in programming and including specific components on information sharing and dialogue around gender, violence and health.
Act4Africa for example have found it essential to involve males from the community at the outset of the project, in order to raise awareness of how the project can have positive outcomes for everyone. They have found that women’s saving and enterprise groups which have the support of the community males are more successful and sustainable than those where there is suspicion and a perceived ‘threat’.
Source: Remtulla, Alysa. “Women’s economic empowerment and the HIV and AIDS response.” Oxfam Policy & Practice Blog. 22 Aug 2016.
Act4Africa’s Project Manager Hilary Yeates returns from her recent trip to Uganda inspired by the progress and passion of the local teams and the young women they’ve helped, and full of enthusiasm for a future project.
As Act4Africa’s Project Manager, I have the privilege of working alongside our team members in Uganda and have recently returned from a trip over there. As always I’ve been humbled and inspired not only by the incredible passion our team members have for the projects they run, but also by the amazing resilience, determination and grace of the Ugandan people as a whole.
My first stop was Kasese, where I was inspecting the building we’ve renovated (with the help of Big Lottery funding), into a hostel for young women and a resource, information and HIV/STI testing centre for wider members of the community. I was delighted to find that the hostel was complete and looked very welcoming, with plans in place for filling all 12 beds from January 2017 ready for the new academic year. It was also good to see that many members of the community, including a good number of young people, were regularly accessing the HIV awareness sessions being provided.
I also had the opportunity to meet with the Deputy Mayor, Peter Baluku, who happens to be a key Development Worker for KADUPEDI (the Kasese District Union of Persons with Disabilities). Peter has overcome incredible adversity in his life and is an enthusiastic supporter of the work Act4Africa has been doing in the communities and, in particular, the efforts to include marginalised groups.
One of the most rewarding aspects of being involved with Act4Africa is being able to build relationships with a variety of project beneficiaries. One such relationship I have developed is with one of our Peer Educators, Sharon. Despite being HIV positive herself, on a strict regime of antiviral medication and often victim to related stigma, she is totally committed to raising awareness about HIV. As well as working with young people in the school she attends, she works with mothers and children who attend the same health centre and also distributes condoms to local motorbike taxi riders. Sharon and I were thrilled to see each other again at her school. I also had the chance to go home with her to meet her mother, who is clearly proud of her daughter’s achievements.
After a bumpy and rather eventful 11-hour drive (involving a baboon attack, engine failure and more drop toilets than I care to mention!) I arrived at my next destination, Jinja. Our 10 staff members there are doing a superb job in delivering the UKAid funded HEAL (Health Education And Livelihoods) project and I was thrilled with the progress they have made, particularly with women’s enterprise groups. I had the pleasure of visiting 3 of these groups in rural villages and experienced first-hand their enthusiasm for building savings together, developing business ideas and sharing the responsibility of caring for livestock they now own.
Another major part of my visit was to research the possibility of setting up a model goat farm. This would not only act as an animal husbandry learning centre and provide sustainability for local community groups, but also carries the potential to raise money to pay for the education of marginalised young women. It is an exciting new initiative and led to me meeting up with local vets, farmers and agricultural college lecturers who were all very helpful, informative and encouraging about our ideas.
As always, it’s been a pleasure spending time in Uganda – meeting wonderful new people and having the opportunity to spend time face to face with our devoted team members who work so incredibly hard to improve the lives of their fellow countrymen/women. I feel extremely fortunate indeed to be a part of it.
Celebrating International Day of the Girl today in Uganda, Sharon, an Act4Africa Peer Educator trades places with Moris Kabunzugwire our Team Manager in Kasese, Western Uganda.
Today young girls around the world step into the shoes of principals, leaders, mayors in an effort to demonstrate their strength, power and ability to change the world. Sharon (aged 17) joins them and steps up to the mark giving her perspective on the priorities for teenage girls Western Uganda today.
Primarily, as a teenage girl living with HIV since a being a baby, Sharon values the work that Act4Africa does in her community to reduce the stigma of HIV/AIDS. She has been trained by Act4Africa as a Peer Educator to deliver our programme of interactive gender equality education to the youth community, providing an effective and sustainable means to educate young Africans about HIV/AIDS related issues.
“Being a Peer Educator has made me understand that even though I am HIV positive, I am still important to the community. Being a victim is not a problem but part of the solution. Through Act4Africa I have developed a talent for teaching and talking to others. As Team Manager today I would like to use these skills to communicate with a wider community to sensitize more people to the effects of HIV/AIDS and help set up HIV testing and counselling programmes with Act4Africa to prepare me for my preferred career as a nurse.”
As well as being a Peer Educator, Sharon is also a beneficiary of our Grow a Girl programme. As such she receives sponsorship for her school fees, uniform, education supplies and sanitary protection. Sharon knows the importance of educating girls through her own experience. She appreciates that she is one of the fortunate 15% who remain in school at her age.
Today, as she takes on Moris’ role as Team Manager for the day, Sharon wants to reach out to more girls to explain the importance of attending school after the age of 12. Sharon explains, “I encourage my peers not to marry young and the importance of abstinence so that they can remain in school.” In her role as Team Manager today she encourages Act4Africa to reach out to the families of girl children to communicate the benefits each girl can bring to her family through her education.
In Uganda 85% of girls drop out of school early and almost half are married before they reach 18.
Globally, 15 million girls are married as children each year.
With every year of education, girls have better economic prospects, fewer and healthier children and better chances of sending their own children to school.
This is why need International Day of the Girl and this is why we need your support to help Grow A Girl.