Gender & Health Melissa Watt, Ph.D. GLHLTH 310 October 23, 2012 Assistant Professor, Duke Global Health Institute Coordinator, Duke CFAR Social & Behavioral Sciences Core

Outline Sex vs. Gender: What matters? Gender disparities in global health Addressing gender in health programming Gender & HIV

SEX vs. GENDER

Gender is learned, socially determined behavior Gender is the social construction of the biological differences between men and women Gender is not “Sex” Gender is not “Women” Gender is learned, socially determined behavior

GENDER THE DIVISION OF LABOUR, POWER AND RESPONSIBILITIES Roles, status, norms, values Responsibilities, needs, expectations Sexuality and Sexual behavior GENDER THE DIVISION OF LABOUR, POWER AND RESPONSIBILITIES THE DISTRIBUTION OF RESOURCES AND REWARDS

Gender, interacting with other variables defines: ACCESS TO AND CONTROL OVER: FAMILY RESOURCES ECONOMIC AND SOCIAL RESOURCES POLITICAL RESOURCES INFORMATION & EDUCATION TIME POWER AND DECISION-MAKING

Gender equity in health Achieving gender equity in health implies eliminating inequalities between women and men which are unnecessary, avoidable and therefore unjust. Achieving gender equity in health implies eliminating inequalities between women and men which are unnecessary, avoidable and therefore unjust.

POVERTY Gender Inequality Poor Health Caste Ethnicity Disability Sexual orientation

Gender in international organizations Integrate/mainstream gender considerations in all facets of work Collect and review disaggregated data by sex Initiate work to specifically address gender inequalities Ensure gender equity in hiring

UN guiding documents to promote gender equality Convention on the Elimination of All Forms of Discrimination against Women (1979) Beijing Platform for Action (1995) UN Security Resolution 1325 on Women, Peace and Security (2000) Millennium Declaration / Millennium Development Goals (2000)

UN Millennium Development Goals Agreed by 189 countries in 2000, to be achieved by 2015!

What are the gender & health issues relevant to the MDG? Group work: How is this MDG related to gender and health? What are gender issues that need to be addressed and mainstreamed into this MDG?

GENDER and HIV

South Africa: HIV Prevalence by gender & age http://www.avert.org/safricastats.htm Overall 60% of those with HIV are women Data from Avert.org, 2008

Gender and HIV risk Vulnerability of HIV infection is different for men and women Two sets of reasons: SEX: Biological and physiological reasons GENDER: Social norms and values: risks that are socially and culturally created

Gender and HIV risk Biological and Physiological Reasons Women’s biology makes HIV transmission more efficient from a man to a woman that a woman to man. Reasons include: There are higher concentrations of HIV in semen than in vaginal fluids Coercive or forced sex might lead to micro lesions in the genital tract that facilitate entry of the virus. Women often have STIs that are left untreated, which increases vulnerability to HIV

Gender and HIV risk Social Reasons: Risks Socially and Culturally Created Keeping women ignorant and passive about sex is the norm in many cultures. This greatly constrains their ability to negotiate Safe sex Condom use Access to appropriate services, care and treatment Women don’t always have the power / ability to negotiate the terms of sex Early marriages Economic dependence Violence / threats

Gender and HIV risk Vulnerability of men Men are also subject to social and cultural pressures that increase their susceptibility to infection and likelihood of spreading HIV Multiple partners and sexual infidelity are condoned and often encouraged Certain occupations tend to encourage risk taking behavior Spending long periods away from families Commercial sex behavior can be linked to business and peer social behaviors

HIV prevention strategies Abstain Be faithful Condomize

Abstain

Be faithful

Condomize

Alternative HIV prevention strategies Gender relations Economics Migration

Gender relations Individual decision making is not always possible Relationship power facilitates or hinders HIV protection behavior Property rights, literacy/education, assets shape HIV risk Sexual violence

Gender relations Intervention approaches Give women sex negotiation skills Emphasize to women: your own monogamy is not protective Intervene with men/couples: address gender norms Female-initiated methods (e.g., female condoms, microbicides) Recognize tension with desires for children

Economics Transactional sex (both formal and informal) Economic dependence Sense of hopelessness Substance use/ addiction

Economics Interventions Schooling for girls Training and employment for women Addiction treatment Cash transfers Money = Bargaining power = Choice

Migration Family instability Opportunities for sexual “mixing” (migrant & partner left behind)

Migration Interventions Economic policies, rural development Multisectoral strategies: sexual and reproductive health, coupled with negotiation skills and economic empowerment Network approaches

Abstain Gender relations Economics Be faithful Migration Condomize Social Drivers Behavior Change Abstain Gender relations Economics Be faithful Migration Condomize

In Global Health, GENDER MATTERS. In summary: In Global Health, GENDER MATTERS.