Bringing Clarity to Gender Equity Programs
In the past decade, expanding resources have been devoted to fostering gender equity in a variety of social programs, including those dealing with HIV. This effort has been particularly urgent in sub-Saharan Africa, where female/male HIV infection ratios in young populations (aged 15-24) have reached 3-to-1 and sometimes higher. Programs addressing "gender and HIV" vary greatly with regard to target audiences, content, and measurable results. They range from microcredit programs for HIV-positive women to workplace programs seeking to change negative male norms and efforts to increase respect for diverse sexual and gender identities. A team of researchers, led by Population Council social scientist Nicole Haberland and policy analyst Judith Bruce, recently assessed a large subsample of the first generation of programs that address gender and HIV. They made recommendations to shape and improve the next generation of programs.
Girls' and boys' differential risks over the life cycle
The persistently high female/male HIV infection ratios among young people have numerous causes. Girls' biological and social puberty comes years before boys'. For girls, puberty results in less freedom and fewer choices, while for boys it leads to wider opportunities. This situation puts girls at a higher risk for harm related to restrictive, often exploitative, gender norms. A significant proportion of adolescent girls describe their first sexual experience as forced or tricked. In some countries, especially those in sub-Saharan Africa, the majority of girls aged 10-14 live in urban communities, often with only one or no parent. In some areas, 10 percent or more of girls live with neither parent and do not attend school.
"Although work to establish gender equity and safety is important for all," states Bruce, "we must focus scarce resources on those who are at the highest risk of the worst outcomes at the youngest ages. This frequently means girls in late childhood and early adolescence. 'Gender and HIV' programs are promising vehicles for this human rights and health equity investment."
The researchers examined 63 illustrative gender and HIV programs from across the globe, among them some of the largest and best-known initiatives. Data--about how programs selected their beneficiaries and targeted their interventions and whether, and to what degree, they address the distinct needs of females and males--were garnered largely through interviews. The researchers used several different scales to rate the strength of each program's approach to confronting gender issues.
Selection of female and male participants: Ships in the night
Of programs surveyed, more than half (64 percent) worked with both females and males, with a fourth working only with females and the rest working only with males. The vast majority of programs surveyed included young people; only 11 percent were for adults only. Forty percent focused exclusively on young people and very young adolescents (defined as those between ages 10 and 14). Strikingly, of the programs that work with both females and males, only 34 percent ever involved females in identifying appropriate male participants, that is, the males who have the largest impact on their lives with regard to the gender norms that the programs were meant to deal with. The researchers considered this a troubling use of scarce resources that arguably undermines program effectiveness.
Confirming behavior changes with the affected parties
The neglect of the female/male dynamic continues in monitoring and evaluation strategies. Of those programs that included males, 62 percent reported that they tried to assess whether men's gender attitudes or behaviors had changed as a result of their involvement in the program. A majority of these sought only males' self-reports (of being, for example, less likely to "abuse their partners" or more likely to "participate in household chores"). When probed, few programs that engaged males (13 percent) sought confirmation of the reported male changes directly from men's partners and peers. It is far from a standard practice.
Researchers assessed the gender-related components of each program independently and rated them based on three scales--a gender-continuum scale, a gender-alignment scale, and a gender-elements indicator--that evaluate the extent to which the programs addressed specific issues. Not surprisingly, almost all (93 percent) of the gender-and-HIV programs being assessed reported that they had a meaningful gender component. Only one-third of the programs, however, were found by the authors to have a clear focus on specific dimensions of male/female relations. Nor did program managers have a clear sense of how to work in parallel with males and females to resolve the issues between them or an explicit theory of change about how to improve gender relations.
But the authors did not despair as there were stand-outs, programs that began with a specific constituency (whether male or female), systematically identified challenges, and measured--responsibly and sometimes imaginatively--changes in females and males.
Recommendations: The value of clarity and synergy
The researchers concluded their review with several recommendations. First, it is essential to have a clear hierarchy of values and to identify a core set of clients. The authors suggest that because HIV prevalence among adolescent females is several times higher than among males of this age, girls and young women deserve a larger share of preventive program resources and policy attention than they have been receiving.
Second, programs should select primary clients/participants deliberately and then determine secondary clients in relation to them. For example, start by identifying the females of interest, and then ask them to identify the males in their lives (for example, partners, fathers, brothers, peers, friends, clients) who are most crucial to their avoiding negative circumstances and achieving positive outcomes. Just as female core clients are a heterogeneous population, so are the males who are likely to be most consequential to their well-being.
"Programs need to tailor interventions as closely as possible to specific age, gender, and partnership status profiles. They need to learn from females what will make the most difference to them. And, they need to cross-check results when there is a parallel intervention among females and males. These procedures will lead to far more effective programs," said Haberland.
Finally, as an overarching need in the field, more rigorous and formal evaluation is required to determine whether burgeoning "gender" programs are working and for whom. Longitudinal studies are needed to assess change over longer periods of time and to evaluate the degree to which changes are sustained and in which populations. Whether males and females acquire new protective assets, skills, and perceptions and adopt positive behaviors can be verified at the level of both the participant and the community. Programs can measure reductions in the proportion of girls reporting that "a man is justified in beating his wife when she refuses sex." They can find out the proportion of girls who have an explicit understanding of the legal age of marriage and the legal status of female genital mutilation. Programs can determine whether female populations at risk have specific plans about, for example, protecting themselves when attending school or how to respond when danger or pressure arises in a relationship. In couples--for example, young married couples expecting a first birth or couples with a history of violence--both males' and females' perceptions and actions should be accounted for.
Measuring changes in "violence" per se is tricky; violence can be a moving target. As females (and males) become more sensitive to rights and appropriate boundaries, reports of violence and abusive behaviors may increase because females feel greater permission to report them or they begin to define behaviors that were previously accepted as less acceptable. Furthermore, violent incidents themselves may increase as females begin to behave more freely before the males in their lives accept these changes. Reductions in structural violence (such as child marriage, as there is an objective standard of age at marriage, or female genital mutilation, as females are either circumcised to some degree or not) are more easily measured in the context of community-level approaches.
"Investing in improving the norms and behaviors of both females and males is important, but these programs must approach these investments with a clear sense of where home base is," said Bruce. "Prioritizing the allocation of resources to the most vulnerable people is crucial to program success, and it is an ethical imperative."
Bruce, Judith, Nicole Haberland, Amy Joyce, Eva Roca, and Tobey Nelson Sapiano. 2011. "First generation of gender and HIV programs: Seeking clarity and synergy" Poverty, Gender, and Youth Working Paper no. 23. New York: Population Council.
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Publication information: Article title: Bringing Clarity to Gender Equity Programs. Contributors: Not available. Magazine title: Population Briefs. Volume: 17. Issue: 3 Publication date: December 2011. Page number: 8+. © 2008 The Population Council, Inc. COPYRIGHT 2011 Gale Group.
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