Gender & Health

GLHLTH 310 October 31, 2013

Melissa Watt, Ph.D.Assistant Professor, Duke Global Health Institute

Coordinator, Duke CFAR Social & Behavioral Sciences CoreAssociate Director, MSc-Global Health

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

Outline

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SEXvs.

GENDER

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

Roles, status, norms, values

Responsibilities, needs, expectations

GENDER

THE DIVISION OF LABOUR, POWER AND

RESPONSIBILITIES

THE DISTRIBUTION OF RESOURCES AND REWARDS

Sexuality and Sexual behavior

FAMILYRESOURCES

ECONOMIC AND SOCIALRESOURCES

POLITICALRESOURCES

INFORMATION & EDUCATION TIME

ACCESS TO AND CONTROL OVER:

POWER AND DECISION-MAKING

Gender, interacting with other variables defines:

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.

Gender equity in health

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Gender Inequality

Poor Health

POVERTY

Caste

Ethnicity

Disability

Sexual orientation

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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

• 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 guiding documents to promote gender equality

UN Millennium Development Goals

Agreed by 189 countries in 2000, to be achieved by 2015!

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?

What are the gender & health issues relevant to the MDG?

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GENDERand HIV

South Africa:HIV Prevalence by gender & age

Data from Avert.org, 2008

Overall 60% of those with HIV are women

15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60+0

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10

15

20

25

30

35

FemaleMale

Age

Prev

alen

ce o

f HIV

(%)

• 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 ReasonsWomen’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 CreatedKeeping 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

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

behaviorSpending long periods away from familiesCommercial sex behavior can be linked to business

and peer social behaviors

Vulnerability of men

Gender and HIV risk

HIV prevention strategies

Abstain

Be faithful

Condomize

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Abstain

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Be faithful

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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 relationsIntervention 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

• 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

Migration

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Abstain

Be faithful

Condomize

Behavior Change

Gender relations

Economics

Migration

Social Drivers

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In summary:

In Global Health, GENDER

MATTERS.