Women at Barcelona Satellite Meeting July 7, 2002 Prevention Panel Avni Amin, Ph.D. Senior Program Associate Center for Health and Gender Equity (CHANGE) 6930 Carroll Avenue, Suite 910 Takoma Park, MD Conceptualizing the female condom as a gender and rights-based approach to HIV prevention Center for Health and Gender Equity

Objectives of this presentation To present a gender and rights-based framework for HIV prevention To discuss the role of the female condom as an example of gender and rights-based approaches to prevention

The female condom as a gender and rights-based approach Presenting the gender and rights-based framework

A gender and rights-based approach… Integrates human rights with public health principles in HIV prevention by: Assuming the right to bodily integrity, freedom from coercion, of choice, and to attain the highest standard of health Addressing the realities of power disparities in determining risk Promoting equitable partnerships between men and women Expanding beyond changing individual “risk behavior” to address their “vulnerability” Emphasizing participatory processes as much as outcomes

In practice… This gender and rights-based framework proposes a bare minimum agenda in any HIV prevention effort The framework should be implemented at three interlinked levels: Policy Health systems Programmatic

Translating a gender and rights-based approach into practice Policy level Sensitize policy makers and implementers in gender issues HIV prevention policies should explicitly articulate gender issues and address them meaningfully: Involve women, girls, and youth in policy formulation and development of programs Allocate budgets to implement strategies that address gender issues

Translating a gender and rights-based approach into practice Health systems level Basic health services for primary prevention of HIV should: Train providers to recognize that risk of sexual intercourse and women’s needs are indivisible: i.e. in the same act of intercourse woman can get pregnant or infected Organize health services to integrally respond to women’s simultaneous needs for family planning, STI and HIV prevention

Provide reproductive and sexual health and rights education Address violence against women Emphasize skill-building, collective action, self-esteem Promote male responsibility in sexual and reproductive decision-making Offer women multiple options to protect themselves Translating a gender and rights-based approach into practice Programmatic level Prevention programs should:

The female condom as a gender and rights-based approach Presenting the gender and rights-based framework

What do we know about the female condom? Female initiated method of dual protection Proven safe and efficacious against pregnancy The only female initiated HIV prevention method available NOW Unaffordable for a majority of women Increasing investment through bulk purchase will result in lowering costs

Key lessons from female condom programming Ensuring success Increases protected sex when offered along with male condoms Interventions should motivate women to continue practicing insertion until it becomes routine Providers are agents of change, and need to be trained and supervised Interventions that address reproductive anatomy,sexuality, partner communication have effects on multiple areas of women's lives Therefore, success should be defined beyond acceptability and use Nature of intervention as important as method itself

Group-based interventions build on the benefits of collective strength on women Along with skills and knowledge to practice safe sex and learn about their bodies, female condoms empower women Addressing sexuality, quality of counseling, stigma,and respecting women’s choices is as critical as the technology itself Interventions must address violence, and reach out to men Key lessons from female condom programming Empowering women

Reframing the female condom in a gender and rights- based approach Dual protection debate HIV prevention and family planning are separate programs Compartmentalized approach that does not meet women’s indivisible risks associated with sex Targeting only sex workers leaves out women in primary partnerships Family planning programs reach out to women in primary partnerships many of whom are at risk for HIV

Technology The female and male condoms are KEY as dual protection methods Health-systems response Strategic integration of HIV prevention and family planning efforts to: Assess risk for STI and HIV in family planning settings Offer relevant counseling Community-level response Reach out to men and promote male responsibility Reproductive and sexual health education to women Reframing the female condom in a gender and rights- based approach Dual protection strategies: 3 components

Specifically: Tool for reproductive/sexual health education Opportunity to discuss sexuality As a dual protection method, to promote integral responses to women’s multiple needs Opportunity to sensitize health care providers to gender issues Accompanied by efforts to promote male responsibility, protect women from violence By including women in primary partnerships Conclusions Female condom: An entry point for gender and rights-based prevention

Finally…... Female condoms should be viewed as one of the expanding set of options for HIV prevention, which currently include male condoms, and in the future microbicides Gender and rights-based approach to female condom programming can be applied to better programming for male condoms, and in the future for microbicides The issues raised in a gender and rights-based framework highlight the need to think of HIV prevention as an integral part of efforts to promote reproductive health and rights

Key papers reviewed Amin (2000) Ankrah and Attika (1997) Baume et al. (2001) Gollub (2000) Jacobson (2000) Kaler (2001) Latka (2001) Latka et al (2000) Mantell et al (2001) Villela (1998)