Promoting Gender Equality and Women's Empowerment in HIV and AIDS Responses

Photo of a mother holding her child.
Jon Hrusa/EPA

Gender refers to a culturally-defined set of economic, social, and political roles, responsibilities, rights, entitlements and obligations, associated with being female and male, as well as the power relations between and among women and men, boys and girls. Sex refers to the biological classification of people (male or female) that is assigned at birth based on bodily characteristics including chromosomes, hormones, internal reproductive organs, and genitalia. Gender norms are the definitions and expectations of what it means to be a woman or girl and a man or boy, as well as the sanctions for not adhering to those expectations. Gender norms vary across cultures and over time, and often intersect with other factors such as race, class, age and sexual orientation. Transgender individuals, whether they identify as men or women, are subject to the same set of expectations and sanctions.


Gender influences an individuals’ status within society as well as the roles, norms, behavior that in turn shape opportunities to access and utilize health services – all of which influence dynamics of the HIV and AIDS epidemic and the success of programs to prevent and/or respond to HIV and AIDS. For example, gender norms may discourage women from asserting control over the timing and circumstances of sex, including negotiating protection against HIV and other sexually transmitted infections. At the same time, gender norms surrounding masculinity can discourage men’s use of HIV testing and other health services. Such norms may encourage male dominance in sexual decision-making and discrimination against male same-sex behavior. In some cases, expectations about exerting power and control over others can result in gender-based violence(GBV) and may be overlooked in health services and aggravated by justice and legal systems that do not adequately protect vulnerable groups.

HIV/AIDS Health Clinic
Diana Prieto/USAID


The U.S. Agency for International Development (USAID) is responding to the U.S. Government’s call of advancing gender equality and women’s empowerment in all of its development work. Addressing gender norms and inequities, preventing and responding to GBV, transforming power dynamics, and promoting gender equality are essential to addressing the HIV epidemic. USAID is a key implementing partner of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and provides leadership for the PEPFAR Gender Technical Working Group. In 2014, the Gender Technical Working Group updated the PEPFAR Gender Strategy to include a framework outlining specific activities that programs should implement to integrate gender issues into HIV prevention, care, treatment, and support, as well as the intended outputs, outcomes, and impacts that may result from these activities. The framework specifies principles for engaging in gender activities and identifies target populations to be considered. The activities reflect the commitment of the US government to women, girls, and gender equality. However, PEPFAR recognizes that gender issues are relevant for men and boys, and for populations made vulnerable due to the fact that their gender identity, sexual orientation or sexual behavior do not conform to existing norms.

USAID provides technical assistance to ensure gender analyses and interventions are integrated throughout HIV prevention, treatment, and care and support programs, and emphasizes five strategic approaches to the design, implementation and monitoring of programs. The activities we support aim to do one or more of the following:

An essential aspect of USAID’s gender portfolio is monitoring and evaluation. Work in this area ranges from building the capacity of local organizations to incorporate gender into their monitoring and evaluation plans and implementing evaluations of gender- sensitive programs, to developing indicators and evaluation frameworks for global gender issues and initiatives, such as the Global Health Initiative (GHI).

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Gender-based Violence Program Cost Calculator

As global investment in gender-based violence (GBV) programs has accelerated and countries design strategies related to GBV and HIV services, being able to cost GBV interventions is becoming increasingly important. Such data are a foundation for effective decision-making and strengthened policies. They also inform which interventions should be integrated in the context of HIV efforts. USAID worked with the Future Group, its PEPFAR Health Policy Project (HPP) partner, to develop the GBV Program Cost Calculator, a tool to assist program managers, policy makers, donors, and other stakeholders estimate the cost of discrete components of GBV-related clinical and community-based services. The tool reflects a comprehensive framework of GBV programs, with flexibility to respond to unique country priorities. It is currently being used to conduct a study of discrete unit costs for providing GBV services in health care facilities in Tanzania.

Integrating GBV Services Within HIV Testing and Counseling

USAID is working with Population Council, its PEPFAR HIVCore partner, to pilot and conduct operations research in Kenya on an approach to integrating gender-based violence (GBV) training, screening and referrals in the context of HIV testing and counseling (HTC). The results will fill an important gap in the literature and contribute to efforts by the HIV and sexual and reproductive health field globally to better address GBV in its work. The specific objectives are to assess providers’ perspectives, including comfort and experience implementing the intervention and clients’ knowledge regarding GBV; awareness of GBV services; and agency regarding talking with their partner about HIV testing, and reports of receiving referrals for GBV services, and of receiving meaningful support during HTC.

Gender and Microbicides Introduction

USAID has worked with FHI 360, its Preventive Technologies Agreement (PTA) partner, to develop microbicides, a much-needed female controlled HIV prevention method. However, technology will not alter the underlying gender inequalities that make women vulnerable to HIV. When microbicides are introduced, women might face significant barriers to access and adherence. FHI360 conducted gender analyses in Kenya and South Africa, comprising a global literature review of gender issues in microbicide studies, a review of national HIV and gender policies, and interviews with keys stakeholders, including women who used microbicides in clinical trials and their male partners. The purpose of these analyses was to examine how gender norms and inequalities may affect women’s access to and use of a microbicide product. A discrete component focused on gauging women’s perspectives around engaging male partners in decisions related to microbicides, with attention paid to prioritizing women’s agency.

Economic and Social Empowerment Intervention Evaluation

The Accelerating Strategies for Practical Innovation and Research in Economic Strengthening (ASPIRES) project supports evidence-based, gender-sensitive programming to improve the economic security and improve health outcomes of families and children infected or affected by HIV/AIDS, as well as others at high risk of acquiring HIV. The OHA gender team has provided funds for this project to conduct an evaluation of a USAID-funded community development program in Mozambique to determine if the economic and social empowerment interventions being implemented help to reduce adolescent girls’ vulnerability to HIV. The evaluation hypothesis, namely that a combined economic and social intervention is more effective than a stand-alone intervention, is based on the premise that addressing the structural drivers of adolescent girls’ vulnerability to HIV requires an integrated, multi-sectoral approach.

Gender-Based Violence Impact Evaluation – Tathmini GBV

Tathmini GBV, under Project SEARCH, is a 3-year rigorous evaluation of the combined effects of the comprehensive GBV program delivered through health facilities and the community, in the Mbeya Region in Tanzania. The evaluation focuses on two types of GBV highly prevalent in Tanzania: intimate partner violence and sexual violence against adults and children. Primary outcomes of the study are the decline in GBV and increased care of GBV survivors; secondary outcomes include a shift in community norms toward greater gender equality, increased utilization of HIV services and reduction in HIV risk behaviors. The evaluation is implemented by Futures Group in partnership with Muhimbili University, Pangaea Global AIDS Foundation and Population Council. Findings will be used for policymaking and programming in Tanzania and globally.

What’s New

Compendium of Gender Equality and HIV Indicators

This compendium is the result of an international collaboration of multi and bilateral donors (including USAID, PEPFAR/OGAC, UNWomen, UNAIDS, WHO, US, GFATM), civil society, NGOs, researchers and other experts who came to agreement on a set of standardized indicators to measure programmatic areas vital to the intersection of gender and HIV. This compendium, developed through MEASURE Evaluation with USAID/PEPFAR support, provides program managers, organizations, and policy makers with a menu of indicators to better “know their HIV epidemic/know their response” from a gender equality perspective in order to: strengthen national and sub-national stakeholders’ understanding of their HIV epidemic and response; monitor progress towards eliminating gender-based inequities in HIV responses, and; monitor and evaluate programs that address specific types of gender equality interventions in the context of HIV.

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Key Populations

These two technical papers aim to improve the ability of PEPFAR and its partners to better understand and respond to the heightened risk for and vulnerability to HIV of four key populations - sex workers, men who have sex with men (MSM), transgender persons, and people who inject drugs (PWID). The Global Health Needs of Transgender Populations [PDF, 1.6MB] presents findings on the heightened risk factors for HIV transmission facing transgender persons and outlines the social ecological model as a conceptual framework for understanding their multiple levels of risk. The Review of Training and Programming Resources on Gender-Based Violence against Key Populations [PDF, 1.3MB]focuses on the intersection of HIV and gender-based violence against the men, women, boys, girls, and sexual and gender minorities in the four key populations.

What Works for Women and Girls: Evidence for HIV and AIDS Programming

What Works is a comprehensive review of data from HIV and AIDS interventions for women and girls in nearly 100 countries. What Works highlights successful interventions for a range of women and girls living with or at risk of HIV: adolescents; adult women; sex workers; women who use drugs; orphans; women who do not know their serostatus; women who want to reduce the risk of transmitting HIV to their infants; women living with HIV who have an unmet need for contraception; women living with HIV who are co-infected with malaria, tuberculosis or hepatitis C; and women who provide the bulk of care and support to their families.

Gender Analysis for Microbicides Introduction

These resources, developed with FHI 360, examine how gender norms and inequalities may affect women’s access to and use of a microbicide product.

Program Guide for Integrating GBV Prevention and Response in PEPFAR Programs [PDF, 908KB]

This guide serves as a tool for program managers to not only begin to address GBV within their programs, but also to plan for greater integration and coordination within country teams when designing work plans and budgets.

Resources for the Clinical Management of Children and Adolescents Who Have Experienced Sexual Violence

These technical considerations and accompanying job aids serve as a guide for medical providers to address and respond to the unique needs and rights of children and adolescents who have experienced sexual violence and exploitation. These resources focus on the delivery of clinical post-rape care services and include information on establishing services tailored to the unique needs of children and adolescents, preparing for and performing a head-to-toe physical examination, conducting forensics evidence collection and ensuring follow-up care and referrals for psychosocial and community support services.



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Last updated: February 23, 2016

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