1. Gender & Health Melissa Watt, Ph.D. GLHLTH 310 October 23, 2012
Assistant Professor, Duke Global Health Institute
Coordinator, Duke CFAR Social & Behavioral Sciences Core

2. Outline Sex vs. Gender: What matters?
Gender disparities in global health
Addressing gender in health programming
Gender & HIV

3. SEX
vs.
GENDER

4. Gender is learned, socially determined behavior
Gender is the social construction of the biological differences between men and women
Gender is not “Sex”
Gender is not “Women”
Gender is learned, socially determined behavior

5. GENDER THE DIVISION OF LABOUR, POWER AND RESPONSIBILITIES
Roles, status,
norms, values
Responsibilities, needs, expectations
Sexuality and Sexual behavior
GENDER
THE DIVISION OF LABOUR, POWER AND RESPONSIBILITIES
THE DISTRIBUTION OF RESOURCES AND REWARDS

6. Gender, interacting with other variables defines:
ACCESS TO AND CONTROL OVER:
FAMILY
RESOURCES
ECONOMIC
AND SOCIAL
RESOURCES
POLITICAL
RESOURCES
INFORMATION & EDUCATION
TIME
POWER AND DECISION-MAKING

7. Gender equity in health
Achieving gender equity in health implies eliminating inequalities between women and men which are unnecessary, avoidable and therefore unjust. Achieving gender equity in health implies eliminating inequalities between women and men which are unnecessary, avoidable and therefore unjust.

8. POVERTY Gender Inequality Poor Health Caste Ethnicity Disability
Sexual orientation

10. Gender in international organizations
Integrate/mainstream gender considerations in all facets of work
Collect and review disaggregated data by sex
Initiate work to specifically address gender inequalities
Ensure gender equity in hiring

11. UN guiding documents to promote gender equality
Convention on the Elimination of All Forms of Discrimination against Women (1979)
Beijing Platform for Action (1995)
UN Security Resolution 1325 on Women, Peace and Security (2000)
Millennium Declaration / Millennium Development Goals (2000)

12. UN Millennium Development Goals
Agreed by 189 countries in 2000,
to be achieved by 2015!

13. What are the gender & health issues relevant to the MDG?
Group work:
How is this MDG related to gender and health?
What are gender issues that need to be addressed and mainstreamed into this MDG?

14. GENDER and HIV

15. South Africa: HIV Prevalence by gender & age
Overall 60% of those with HIV are women
Data from Avert.org, 2008

16. Gender and HIV risk
Vulnerability of HIV infection is different for men and women
Two sets of reasons:
SEX: Biological and physiological reasons
GENDER: Social norms and values: risks that are socially and culturally created

17. Gender and HIV risk Biological and Physiological Reasons
Women’s biology makes HIV transmission more efficient from a man to a woman that a woman to man. Reasons include:
There are higher concentrations of HIV in semen than in vaginal fluids
Coercive or forced sex might lead to micro lesions in the genital tract that facilitate entry of the virus.
Women often have STIs that are left untreated, which increases vulnerability to HIV

18. Gender and HIV risk
Social Reasons: Risks Socially and Culturally Created
Keeping women ignorant and passive about sex is the norm in many cultures. This greatly constrains their ability to negotiate
Safe sex
Condom use
Access to appropriate services, care and treatment
Women don’t always have the power / ability to negotiate the terms of sex
Early marriages
Economic dependence
Violence / threats

19. Gender and HIV risk Vulnerability of men
Men are also subject to social and cultural pressures that increase their susceptibility to infection and likelihood of spreading HIV
Multiple partners and sexual infidelity are condoned and often encouraged
Certain occupations tend to encourage risk taking behavior
Spending long periods away from families
Commercial sex behavior can be linked to business and peer social behaviors

20. HIV prevention strategies
Abstain
Be faithful
Condomize

21. Abstain

22. Be faithful

23. Condomize

24. Alternative HIV prevention strategies
Gender relations
Economics
Migration

25. Gender relations Individual decision making is not always possible
Relationship power facilitates or hinders HIV protection behavior
Property rights, literacy/education, assets shape HIV risk
Sexual violence

26. Gender relations Intervention approaches
Give women sex negotiation skills
Emphasize to women: your own monogamy is not protective
Intervene with men/couples: address gender norms
Female-initiated methods (e.g., female condoms, microbicides)
Recognize tension with desires for children

27. Economics Transactional sex (both formal and informal)
Economic dependence
Sense of hopelessness
Substance use/ addiction

28. Economics Interventions Schooling for girls
Training and employment for women
Addiction treatment
Cash transfers Money = Bargaining power = Choice

29. Migration Family instability
Opportunities for sexual “mixing” (migrant & partner left behind)

30. Migration Interventions Economic policies, rural development
Multisectoral strategies: sexual and reproductive health, coupled with negotiation skills and economic empowerment
Network approaches

31. Abstain Gender relations Economics Be faithful Migration Condomize
Social Drivers
Behavior Change
Abstain
Gender relations
Economics
Be faithful
Migration
Condomize

32. In Global Health, GENDER MATTERS.
In summary:
In Global Health,
GENDER
MATTERS.