Why a gender lens is needed to tackle the roots of health inequity

What are the biggest gender-related barriers to good health in low- and middle-income countries?

When it comes to people at risk of acquiring HIV, we see that 46% of new infections globally are now in adolescent women and young girls, with that figure rising to 63% in sub-Saharan Africa. There has been a change in the epidemiology of the HIV epidemic over the past few years, and the reason is because of gender-based violence and women not having the agency to choose their sexual partners. You're talking about people who are living in really challenging circumstances where they don't have the opportunity to decide how they respond to the sexual advances of those around them.

I've been to many clinics across sub-Saharan Africa where women have tested HIV positive while pregnant, and subsequently give birth to babies that also test positive. We’re funding community-based programs with mothers2mothers, where groups of older women who have lived through the same experience support these young women with HIV, TB, and malaria. Each girl is assigned a “mentor” — who receives a salary for their work — to support them through the journey that they're on so that they don't feel isolated and alone.

Sometimes the HIV and TB epidemics carry with them a huge stigma, but it's often worse for women than for men. So the mentor mothers are helping women to also deal with the stigma that their community puts upon them, even their self-stigma, and to help them see how they can live a life where they have agency through taking their treatment, having access to contraception, and through keeping their babies healthy. This gives them confidence and helps the women get to a point where they have more status, agency, and information, and are ultimately able to live a better life.

How are discrimination and stigma against adolescent girls, young women, and gender-diverse communities leading to poorer health outcomes for these groups?

Many of the women we work with often encounter gender-based violence, some even became pregnant or HIV positive through rape. Many don’t have economic means, so older men or so-called “sugar daddies” give gifts and money to the younger girls. These men are much more likely to be living with HIV because they're older and have been sexually active for much longer, and therefore young girls are more likely to acquire HIV, become pregnant, or both.

This diminishes their chances of becoming a “worthy” wife because it's hugely stigmatized to be HIV positive. Therefore, all of this makes women much more vulnerable. If you’re living with HIV and you need access to HIV medication and contraception, often the men in your life have to give permission and you don't want to ask for that permission. Or worse still, you get the medication and somebody finds it in your house and realizes that you're living with HIV, and that can lead to gender-based violence and even rejection from your community. 

Women need freedom and empowerment to take back control over what happens to them and their bodies.

Why is a gender lens needed if we are to tackle HIV and TB and ensure everyone who needs treatment has access to it? And how are ViiV Healthcare and GSK working to reach adolescent girls and young women at risk?

Health care is like a lightning rod — it's where gender equity and a thriving future meet. Because if you have a voice, education, and economic power, you will have access to health. That means you're more likely to live a long, healthy, and thriving life. The work that we do is, wherever possible, at a very grassroots level to empower women to have a voice, understanding, and education. For example, we set up the Gender Equality Fund together with The Global Fund to Fight AIDS, Tuberculosis and Malaria to ensure that women can find their power and participate in all parts of society, including as policymakers and decision-makers that can push through change for women. We recently announced the recipients of that fund — a fantastic group of community-based organizations.

It helps women change policy and helps them demand what they have the right to, whether it's contraception, HIV treatment, prevention or treatment of malaria and TB, or access to comprehensive sexual and reproductive health services. Another part of the work that we do is to develop medicines that treat and prevent these diseases. There are two malaria vaccines for endemic countries and a potential TB vaccine that’s just entering a phase three clinical study. And hopefully, it will be the first vaccine ever to help prevent the acquisition of TB in lower-income countries.

What’s the role of local, women-led organizations in advancing women’s access to health services and information?

It's very clear that women are more likely to acquire HIV than men, and in high HIV prevalence countries, younger women are increasingly represented among people diagnosed with active TB. The question is, why? There's no physiological reason why that should be. We know that in society, women are less likely to have access to medication than men — so what if we started at the top with the access question? 

Then we go into the grassroots level to find ways to ensure women and men are as likely to have access to vaccines and treatment. That's why we give hundreds of grants to local communities to ensure that treatment is there and that it’s reaching all women. That's why these grassroots programs are critical for bringing about greater levels of gender equity.

SPONSORED BY