1. Gender-Specific Approaches to Best Practices in HIV Service Delivery U.S. Department of Health and Human Services Office on Women’s Health

2. 2 Sex Gender Unsure

3. 3 Sex refers to the biological and physiological differences between women and men. Gender refers to the economic, social, political, and cultural attributes and opportunities associated with being female and male. The social definitions of what it means to be female or male vary among cultures and changes over time.

4. 4 About OWH Established in 1991 to improve women’s health Vision - All women and girls are healthier and have a better sense of well-being. Mission - Provide leadership to promote health equity for women and girls through sex/gender- specific approaches  Goals  To develop and impact national women’s health policy  To develop, adapt, evaluate and replicate model programs on women’s health  To educate, influence and collaborate with health organizations, health care professionals and the public  To increase OWH’s capacity to achieve maximum operational performance and objective documentation of accomplishments

5. 5 Workshop Objectives Identify gender issues in HIV/AIDS Identify best practices and strategies for integrating gender into HIV/AIDS programs Develop and adapt ideas to apply to your own HIV/AIDS work

6. 6 Social Determinants of Health “The social determinants of health are the conditions in which people are born, grow, live, work and age, including the health system. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels, which are themselves influenced by policy choices. The social determinants of health are mostly responsible for health inequities - the unfair and avoidable differences in health status seen within and between countries.”

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8. 8 Disparities …  Sexism  Racism  Homophobia  Oppression  Stigma  Social  Cultural  Socio-Economic  Psycho-Social  Education  Poverty  Under/Unemployment  Crime  Incarceration  Limited Resources  Geography  Isolation  Biological

9. 9 Gender-Based Constraints & Opportunities …structural and institutional factors that inhibit or facilitate men’s and women’s equitable access to resources, behavior and participation, time use, mobility, rights, and exercise of power based on their GENDER IDENTITY.

10. 10 Biological Women more likely to contract HIV and others STDs due to their biology and physiology Younger and Older women –Thin mucosal lining –Birth control –Hormone Replacement Therapy Hygiene –washing & douching, over the counter yeast creams Male-Female Ratio Deficit –Blacks in 30’s where whites are in their 60’s –Years of potential life lost

11. 11 STDs HIV/AIDS Lack of symptoms of many STDs in women Increased risk of HIV Early sexual debut Teenage girls with untreated STDs Increase screening Improve education

12. 12 Socio-Cultural Male / Female socialization –Imbalance of power…limits female assertion Gender Role…in the World of Sex –Sexual domination Societal Norms –young women/older men –concurrent partners of males –Multiple sex partners The “NEED” to Reproduce Stigma  discrimination, isolation

13. 13 Socio-Cultural cont. Myths and Secrets around Sex and Sexuality Social and Information Network –HIV/AIDS whispered, closeted –Presumption of knowledge relating to HIV, health, etc Distrust…Disbelief –mainstream prognosis Empathetic to Minority Male Oppression Little, poor or no communication with Healthcare Providers –influenced by ethnicity, race, gender, class, language divides

14. 14 Socio-Cultural & Youth Special vulnerabilities of youth Age intersects with gender in determining distribution of power Important factors for adolescent sexual health: –Age of sexual initiation, incidence of sexually transmitted infections, consequences of early motherhood –Socialization of young people –Sexual privileges for young men –Sexual responsibilities for young women

15. 15 Social Network HIV/AIDS

16. 16 Socio-Economic Economic power, dependence and insecurity Control over resources Poverty…low income Limited education…functional illiteracy Heads Up Barely…No Time Living in Severely Distressed Communities

17. 17 Socio-Economic cont. Outside mainstream –weak messages back in the neighborhood Limited Access to Primary Care & Prevention Screening –no money, no insurance Little or No influence on decision makers, program designers and/or service providers No relationship to public models of PLWAs –Lost in the FACE of AIDS

18. 18 Money and Power HIV/AIDS $$$ to Women Independence Stability Negotiating Power Assertive in Relationship Saying “NO”  Condom Use Reduced Risk for Infection

19. 19 Psycho-Social Living Poor…stressful, low self-esteem Broken Spirits…Broken Dreams Emotional and Physical Strains –Balancing oneself in a Hostile Land Family Care giving…Family Breadwinner Excess Deaths, a Constant Experience –Homicide, Stroke, Cardiovascular, Diabetes, Infant Mortality, Drugs…and AIDS

20. 20 Psycho-Social cont. Gender Socialization – no interest or coy about sex Homosexuality and Bisexuality – taboos…no openness No female barriers…Confronting the Male Condom Microbicide is “hidden,” not a partnership Social / Sexual Networks

21. 21 Violence Against Women HIV/AIDS History of Trauma –childhood sexual abuse, incest, domestic violence, IPV Power imbalance  Dependence on partner Physical and sexual violent experiences increase a woman’s risk of: –vaginal tearing or lacerations –exacerbation of chronic health problems –delaying prenatal care = negative birth outcomes –HIV and STD transmission Abused women are more likely to be forced to engage in behaviors that increase their risk of being exposed to STDs

22. 22 What We Can Do Reaching women where they are –Location: workplaces, hair salons, bars, daycare centers, schools, –public assistance recipients, church, home, etc –Level of knowledge –Communication: discrete, non-condescending/judgmental, common language Empowerment  Building Self-Esteem and Self-Determination Woman-Centered Services and Approaches –consideration to how women live and environmental influences Prevention Education, Outreach, Retention Encourage Routine Wellness –Risk counseling, STD testing during routine female reproductive health wellness visits

23. 23 Thanks! Mary Bowers – Mary.Bowers@hhs.govMary.Bowers@hhs.gov Office on Women’s Health www.womenshealth.gov