GENDER ISSUES IN SCALING UP COUNSELLING AND TESTING FOR HIV - PowerPoint PPT Presentation

Loading...

PPT – GENDER ISSUES IN SCALING UP COUNSELLING AND TESTING FOR HIV PowerPoint presentation | free to view - id: 20fdde-ZDc1Z



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

GENDER ISSUES IN SCALING UP COUNSELLING AND TESTING FOR HIV

Description:

Monogamy based. Kenya's HIV - CT history. Liverpool VCT, Care & Treatment (LVCT) ... Serial monogamy' knowledge of couple' HIV status at each point of engagement ... – PowerPoint PPT presentation

Number of Views:56
Avg rating:3.0/5.0
Slides: 22
Provided by: Rut1103
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: GENDER ISSUES IN SCALING UP COUNSELLING AND TESTING FOR HIV


1
  • GENDER ISSUES IN SCALING UP COUNSELLING AND
    TESTING FOR HIV
  • XVII International AIDS Conference 2008, Mexico
    City
  • Nduku Kilonzo, PhD,
  • Liverpool VCT, Care Treatment (LVCT) Kenya

2
Presentation outline
  • Background
  • Gendered dimensions of HIV in Kenya
  • HIV counseling and testing in Kenya
  • History assumptions
  • Current status models
  • Impact of new approaches on uptake of CT
  • Gender issues and concerns emerging
  • Opportunities for responding
  • Recommendations

3
HIV and gender in Kenya the s
  • HIV prevalence (KAIS 07)
  • Females 9.2 Males 5.8
  • Females 15-24yrs 4X more likely to be infected
  • Increasing HIV prevalence in rural Kenya
  • 70 of general popn, 84 of female popn
  • Womens lower education co-related to HIV
    infection
  • Rate of new infections higher among men
  • 45 discordance among married couples
  • Polygamous unions more likely to be HIV
    infected (11 vs 7)

4
Gender HIV in Kenya beyond the s
  • Sexual practice and behaviour
  • Based on perceptions of masculinity femininity
  • Framed within socio-cultural norms
  • Women are less likely to have access to VCT than
    males (NASCOP 05)
  • Males more decision making power in sexual
    relations (Erulkar 2005)
  • Blurred boundaries - consent, coercion force
    with -ve implications for seeking HIV services
    (Kilonzo et. al, 08)
  • Perceptions of low/no risk among married women
    (KDHS 2003)
  • my partners results are mine (Njeri 08
    unpublished) reason for not testing by both
    women men

5
Background of VCT
  • Knowledge of HIV status 80s 90s..
  • Protect stigmatized persons confidentiality
  • Human rights vs public health approach- consent
  • Support coping (no treatment) counselling
  • HIV counseling and testing
  • Responsibility for prevention on individuals
  • VCT models - western located with different
    contexts
  • individualized health care sexual decision
    making power
  • Monogamy based

6
Kenyas HIV - CT history
  • Liverpool VCT, Care Treatment (LVCT)
  • Started 3 VCT sites 1998
  • national standards development
  • Services Quality Assurance system
  • Social mobilization campaign
  • gt 1,000 VCT sites in 2007
  • LVCT - HCT services - gt940,000 people
  • New approaches 2006 onwards
  • Mobile VCT, Provider Initiated CT, Community
    Based HIV testing and counseling
  • Kenya committed to universal access to counseling
    and testing GOAL 80 knowledge of HIV status
    by 2010

7
  • SO, WHAT HAVE THESE NEW APPROACHES MEANT FOR
    UPTAKE OF CT SERVICES?
  • Knowledge of HIV status
  • Necessary for Care Treatment
  • A RIGHT FOR ALL
  • primary to PREVENTION - ??

8
- Increase in uptake of HIV testing by women
linked to new testing approaches
9
  • LVCT HIV counseling and testing data - June 2007
    June 2008
  • Womens uptake higher than males

10
  • AND WHAT GENDER ISSUES EMERGE FOR COUNSELLING AND
    TESTING IN THE CONTEXT OF THESE APPROACHES FOR
    PREVENTION, FOR TREATMENT AND CARE?

11
Models of HCT
  • Individualized approaches counselling, risk
    reduction, testing forward planning
  • Sexual practice socially defined (who can have
    sex with whom, where, when and how),
  • Multiple partners largely sanctioned
  • Limited sexual decision making power among women
  • Conceptualizing risk moral framework? based
    on monogamy? what is high risk?
  • Polygamy is accepted
  • Understandings of risk by gender (married women
    perceive themselves as low risk in Kenya DHS 03)
  • Assumptions of consensual sex

12
HIV CT Models
  • Assumptions of heterogeneity in womens/mens
    populations - one size CT fits all
  • Messaging for CT HIV prevention not gender
    dissagregated
  • No targeted prevention messaging for women by
    age, disease burden
  • HIV risk (e.g alcohol consumption) not engaged
  • Referral services following CT gender blind
  • Gender impacts on health seeking, access, ability
    and desire to uptake as individual by family
    retention in health systems (report on social
    determinants of Health_

13
Current definitions - Couples
  • Focus on couples as monogamous
  • Polygamy extended relations basis for family
    problem solving
  • Serial monogamy knowledge of couple HIV
    status at each point of engagement
  • Womens agency to engage in these relationships
    has been documented
  • Youth (boys girls) a left out group in the
    couples discussion
  • Current definition of couples problematic

14
CONSENT
  • Consent for what? information, testing, results
    to self and/or partner? Who asks consent from
    whom? M/F?
  • Consent in health provider-client relations
    (Molyneux 06)
  • Contextual who asks, potential consequences/
    benefits, male/female understandings difer
  • Perceptions of consent - by health providers,
    general populations and human rights advocates?
  • Lessons learnt anonymous vs confidential VCT?
  • CT in varied context - reproductive health
    (PMTCT), medical management (PITC), self
    determined (VCT), or supply driven services
    (CBHCT) different standards?

15
Disclosure
  • Disclosure of sexual practice/consequences is
    socially constructed gender and age lines
  • What can be disclosed to whom by women men
  • Intended disclosure higher than actual
  • Supported disclosure highly contested issue
  • Fear of the consequences of disclosure esp women
  • Experiences of violence documented (Maman 01, 2)
  • Women largely supported (Kilewo 01 Maman 01)
  • Additional concerns for disclosure
  • Children
  • Extended families challenging for women

16
Data on married couples that are HIV
ve Pathways, motivations of actual HIV status
disclosure by gender are unknown knowledge of
partner HIV status primary to engaging sexual
discussions among couples
17
  • HOW DO WE RESPOND TO THESE ISSUES TO STRENGTHEN
    ACCESS TO KNOWLEDGE OF HIV STATUS?
  • WHAT OPPORTUNITIES EXIST?
  • HOW CAN THEY BE UTILIZED TO OPTIMIZE ON SHORT AND
    LONG-TERM OBJECTIVES OF CT?

18
Proportion of HIV infected Kenyans in need of CTX
The question can no longer be whether to scale up
counseling and testing, it can only be, how do we
make this scale up gender responsive
19
Gender responsive HIV CT - forward directions…
  • Re-engaging counseling - Gender responsive
    counseling
  • Opportunity to facilitate sexual discussions
    among couples families
  • Offer supported disclosure partner notification
    - options to support negotiation of knowledge of
    partner status
  • Used to harness family community risk
    reduction planning rather than individuals
  • Re-define risk focus social mobiliization on
    knowledge of self status and that of sexual
    partner status is not shared

20
Gender responsive HIV CT
  • Develop gender audits for HIV CT services lobby
    for inclusion as minimum package for scale up of
    HTC
  • Evaluate responsiveness of CT programming at
    programme start through scale up
  • Develop service QA that is explores the needs and
    implications for women and men
  • Gender targeted messaging for prevention is
    essential with a focus on gendered
    heterogeneities on youth
  • Re-focus on male uptake of HIV counseling and
    testing
  • Scale up services that provide CT for couples
    families

21
Acknowledgements
  • LVCT colleagues
  • Ministry of Health
  • National AIDS Control Council
  • PEPFAR/CDC - Kenya
About PowerShow.com