GENDER HIV AND AIDS: Challenges and Opportunities Tanzanian Experience

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GENDER HIV AND AIDS Challenges and Opportunities
- Tanzanian Experience

• FATMA MRISHO
• Tanzania AIDS Commission (TACAIDS)

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OUTLINE

• Overview of Tanzanian epidemic and response
• Challenges
• Lessons learnt and good practices
• Opportunities
• Mainstream or targeted gender interventions?

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TANZANIA HIV INFECTION 2007 - 2008

• Prevalence of infection both sexes 5.8 (7 in
  2003).
• Females 6.8 (7.7 in 2003)
• Males 4.7 (6.3 in 2003)
• Urban Prevalence 8.7 compared to a rate of 4.7
  rural
• Estimated number of PLHIV is 2.5 million

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Higher risk sex in past 12 months for males and
females 15-24 yrs
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Tanzania

• 40 of eligeble women have been reached with
  PMTCT quality (in terms of the recommended
  4-prong strategy) requires improvement
• By mid 2008, 302,209, PLHIVs into care and
  treatment countrywide, (63 females, 47 males)
• Of the 154,813 on ART, 60 are females, 40
  males.

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HIV prevalence by age and sex
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Higher risk by sex and education
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Challenges

• Inadequate understanding of gender as a concept
  including equity equality. Seen as a foreign
  concept, culturally threatening, sometimes
  equated to justifying same sex sex
• A lot said on gender and HIV, BUT the tools for
  addressing the situation are not so readily
  available or known to most policy and program
  staff
• Does not appear to be a priority among many
  national and development partner stakeholders

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Overall gender and HIV

• Traditional male dominated gender relations and
  poor economic opportunities - especially for
  women, youth, and disabled persons - impact
  negatively on the capacities of girls and women
  to determine and control their sexual relations,
  making above groups more vulnerable to HIV
  infection

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Challenges

• Inadequate sex and gender analysis of available
  information - national surveys, service
  statistics and research data/information
• Despite a dramatic increase in services related
  to HIV and AIDS (counselling, testing, PMTCT,
  care and treatment, prevention, vulnerability
  identification and support etc.) the needs
  continue to outrun the supply in such an
  environment, gender focusing is viewed as a
  luxury and not a necesssity

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Challenges

• Deeply ingrained socio gender norms some
  improvement, but slow examples
• Polygamy, serial monogamy, wife inheritance,
  widow cleansing, female genital cutting,
  initiation/preparation for womanhood,
  treatment for infertility etc.
• Male decision making in reproductive health, in
  testing (or not), care and support
• High stigma, often more addressed to females
  (accused of withcraft, ploy for inheritence)

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Concerns/less addressed issues

• Impact (on women) of the knowledge that male
  circumsicion is protective
• Men having sex with men getting most of the
  attention not so for females having anal sex
• Addressing many of the gender issues requires
  also addressing basic rights for accessing
  quality education, health, shelter, water etc.
  Unaffordable and/or slow pace in resource limited
  countries/communities

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Sexual violence/abuse as a cause and consequence
of HIV infection

• There is an ongoing epidemic of child sexual
  abuse. The dynamic of abuse of children is often
  different from that of the sexual abuse of women
  what is common to both is the terrifying danger
  of transmission.
• Steven Lewis

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Good practices and lessons learned 

• A national Multisectoral Strategic Framework
  (NMSF 2008-2012) developed with involvenet of
  Tanzania Gender Networking Group (TGNP) a
  national strategic plan will follow the same
  pattern
• National HIV and AIDS related surveys to devote a
  chapter on Gender and HIV (Health indicator, DHS,
  Health facility surveys etc.)

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Good practices and lessons learned

• A national campaign led by the President who
  publicly tested with his wife parliamentarians
  and other leaders followed the example and
  advocated to all - leading to doubling the
  testing coverage from 15 to 35 (2008), testing
  over 4.3 million Tanzanians
• All data from the campaign disaggregated by sex
  and used to address gaps (a lot more advocacy and
  resources required)

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Opportunities

• Positive constitution that recognises equal
  rights and opportunities between males and
  females
• Positive gender policies on employment,
  education, land ownership (recent law), access to
  health services, availability of gender policy
  and poverty reduction strategy
• A very gender-convinced President won a global
  gender award/recognition in July 2008

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Opportunities

• A vibrant Tanzania Gender Networking Group
  invented gender budgeting and developed the
  tools
• Positive discrimination in education, Parliament,
  Decisión making Councils, AIDS Committees
• Committment to attaining Poverty Reduction (to
  reduce HIV infection from 7 of 2004 to 5 by
  2010) and MDG targets for women empowerment, HIV
  and AIDS, improvement of womens health,
  reduction of child deaths etc.

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Dedicated action on gender vs. mainstreaming

• The two must complement each other - they are not
  mutually exclusive
• In situations where gender is not, or poorly
  understood or opposed, dedicated action should
  take the lead
• Gender mainstreaming should be paired with
  dedicated action, starting with areas of less
  resistance e.g. access to preventive information
  and care, vulnerabilty asessment, risk reduction,
  generating information

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• THANK YOU FOR YOR ATTENTION