Gender inequality and HIV/AIDS are inextricably linked. Women account for just over 50 per cent of all people living with HIV. Last October, the ILO published a guidance tool for those who are committed to promoting gender equality, empowering women and to halting and reversing the spread of HIV/AIDS. “World of Work” spoke with Adrienne Cruz, co-author of the new ILO publication, about the link between gender and HIV/AIDS.
What is the link between gender inequality and HIV risks and vulnerabilities?
Adrienne Cruz: Societal gender norms related to “feminine” and “masculine” roles, expectations and behaviours strongly affect women’s and men’s access to HIV information and services, their attitudes and sexual behaviour, and how they cope should they or a family member be living with HIV. Much has been written on the links between gender inequality and HIV/AIDS. However, despite the fact that workplaces offer a unique and potentially effective context for responding to the epidemic, guidance on how to do this in a gender-responsive way is scarce. This guide intends to fill that gap.
Who is more likely to be infected by HIV – women or men?
Adrienne Cruz: According to the 2010 edition of the UNAIDS Global Report, of the some 33.3 million people globally living with HIV in 2009, just over half or 15.9 million were women. However infection rates among women are rising in several countries, as transmission patterns shift from high-risk groups to the general population where increasing numbers of vulnerable women and girls are becoming infected.
In sub-Saharan Africa, more women than men are living with HIV. Women and girls’ vulnerability to infection remains particularly high in this region, where 76 per cent of all HIV-positive females live. In some other regions, men are more likely to be infected than women, with concentrated epidemics involving men who have sex with men or injecting drug users. And a UNAIDS Action Framework report published in 2009 found that globally some 5 to 10 per cent of people living with HIV are men who have sex with men, of whom the majority also have sex with women.
What are some gender-related HIV risks and vulnerabilities for women and girls?
Adrienne Cruz: Women, especially adolescents, are biologically more at risk of HIV infection than men and twice as likely to contract the virus through unprotected sex. Subordination in marriages or relationships, in which women are often expected to be passive and ignorant about sexual practices, greatly diminishes their ability to negotiate condom use for safer sex – or to refuse unsafe sex. Violence against women and girls, or the threat of it, has been shown to increase their risk of HIV infection.
Economic dependency on men diminishes women’s ability to negotiate safer sex, as well as often preventing them from paying for health services including HIV testing or seeking treatment. Women and girls are more affected by the burden of caring for family members who are sick, which increases their unpaid workload while diminishing their access to schooling or income-generating activities. And discriminatory property, inheritance, custody and support laws deprive many women of financial security, which forces some into sex work and some girls and boys into commercial sexual exploitation.
What are some gender-related HIV risks and vulnerabilities for men and boys?
Adrienne Cruz: Men and boys are subjected to societal expectations of proving their “masculinity” which can make them more prone to high-risk behaviours such as increased rates of alcohol and substance abuse, as well as casual and/or multiple sexual partners. In many countries HIV/AIDS services are provided primarily through family planning, prenatal and child health clinics, which are usually designed to deliver services based on the assumption that only women have reproductive health responsibilities.
In certain sectors of economic activity where men dominate, such as transport or mining – and especially if separated from their families in men-only housing – working conditions may increase HIV risk. Boys from families where one or both parents have died due to HIV-related illness may be taken out of school to become the “breadwinner” and forced into child labour which especially in its worst forms heightens their HIV risk. In many countries sexual relations between men are outlawed or surrounded by stigma, discrimination and taboos; as a consequence these men have a heightened HIV risk as they are less likely to have access to or seek prevention and treatment services.
What about transgender persons?
Adrienne Cruz: Transgender persons have a gender identity that is different from their sex at birth; transgender people may be male-to-female (female appearance) or female-to-male (male appearance). Fear of stigma and discrimination prevents many transgender persons from getting tested for HIV, disclosing their HIV status, and seeking and accessing HIV counselling and treatment services. Male-to-female persons especially face high HIV risks, as they are often victims of the harshest forms of discrimination and stigma. Because transgender persons’ behaviour does not confirm with societal gender norms, they are also highly vulnerable to gender-based violence, which increases their exposure to HIV infection.
Why is it important that workplace initiatives on HIV/AIDS be gender-responsive?
Adrienne Cruz: The June 2009 International Labour Conference (ILC), in its Resolution concerning gender equality at the heart of decent work, identified HIV/AIDS as one of the major challenges to achieving gender equality in the world of work. Recommendation No. 200 concerning HIV and AIDS and the World of Work, adopted by the ILC in 2010, and the 2001 ILO Code of practice on HIV/AIDS and the world of work provide guidance on workplace policies and stress the importance of promoting gender equality and responding to the gender dimensions of HIV/AIDS.
Any world-of-work initiative – especially in the context of HIV/AIDS – that does not explicitly address gender dimensions or identify proactive strategies to promote gender equality and women’s empowerment will in the great majority of cases only reinforce existing unequal power relations between women and men, and boys and girls. In fact, gender-blind interventions can even exacerbate inequality.
A gender-responsive approach helps to address the root causes of HIV risks and vulnerabilities, including socio-cultural norms related to women and men’s sexual behaviour. The guide contains step-by-step practical checklists that highlight issues to take into account when planning a gender-responsive project.
Elements of a gender-responsive HIV/AIDS workplace policy
It can include a statement such as: “This company recognizes the seriousness of HIV/AIDS and its impact on women and men workers and the workplace as a whole… The purpose of this policy is to facilitate consistent and equitable access for men and women workers, their families and dependants, to HIV prevention, treatment, care and support services. This policy has been developed and will be implemented with the active involvement of women and men workers at all levels…”
Policy framework and general principles
This part can include principles such as gender equality and equitable employment opportunities and treatment, and a statement such as: “This company does not discriminate or tolerate discrimination against employees or job applicants on any grounds including sex, sexual orientation, and real or perceived HIV status.”
Specific policy provisions
This part can include statements such as: “This company does not tolerate any type of violence or harassment in the workplace, including sexual violence and sexual harassment… Because women often face greater HIV-related risks and vulnerabilities, emphasis will be placed on empowering both women and men workers with regard to their sexual and reproductive health, rights and responsibilities, while encouraging men workers to be equally involved in the HIV response...”
Guide to mainstreaming gender in workplace responses to HIV and AIDS, International Labour Office, Geneva, 2011.