Geeta Rao Gupta

Structural approaches to HIV prevention

Recognition that social, economic, political, and environmental factors directly affect HIV risk and vulnerability has stimulated interest in structural approaches to HIV prevention. Progress in the use of structural approaches has been limited for several reasons: absence of a clear definition; lack of operational guidance; and limited data on the effectiveness of structural approaches to the reduction of HIV incidence. In this paper we build on evidence and experience to address these gaps. We begin by defining structural factors and approaches. We describe the available evidence on their effectiveness and discuss methodological challenges to the assessment of these often complex efforts to reduce HIV risk and vulnerability. We identify core principles for implementing this kind of work. We also provide recommendations for ensuring the integration of structural approaches as part of combined prevention strategies.

How men's power over women fuels the HIV epidemic : It limits women's ability to control sexual interactions

In sub-Saharan Africa 12-13 women are infected by HIV for every 10 men, and the average rate of infection for teenage girls in some countries is five times higher than that for teenage boys.1 Most of these infections occur through unprotected heterosexual interactions. Women are limited in their ability to control these interactions because of their low economic and social status and because of the power that men have over womens sexuality. Most of the worlds women are poor and most of the worlds poor are women. Women make up almost two thirds of the worlds illiterate people and are often denied property rights or access to credit. They earn 30-40% less than men for the same work, and most of those who are working are employed outside the formal sector in jobs characterised by income insecurity and poor working conditions.2 Womens economic vulnerability and dependence on men increases their vulnerability to HIV by constraining their ability to negotiate the use of a condom, discuss …

Women's lives and sex: Implications for AIDS prevention

Preliminary findings from the Women and AIDS program, a research grants program of the International Center for Research on Women in Washington, D.C. that supports 17 studies in developing countries worldwide, provide a glimpse into the complex interaction between womens social and economic status and risk of HIV infection. In many settings, the cultural norms that demand sexual fidelity and docile and acquiescent sexual behavior among women permit — and sometimes even encourage —early sexual experimentation, multiple partnerships, and aggressive and dominating sexual behavior among men. Drawing upon the findings from the program, the paper analyzes how such cultural norms, together with womens social and economic dependency, can limit a womans ability to negotiate safer sex with her partner; restrict her access to information and knowledge about her body; force her to sometimes barter sex for survival; increase her vulnerability to physical violence in sexual interaction; and compromise her self-esteem. The findings highlight the limitations of the current HIV/AIDS prevention strategy for reducing womens risk of HIV, and underline the urgency for an approach to prevention that is grounded in the realities of womens lives and sexual experiences — an approach that recognizes the relationship between the dynamics of gender relations, sexual behavior, and HIV risk.

Taking action to improve women's health through gender equality and women's empowerment

Over the past few decades great strides have been made in improvement of women’s health status; more than a decade has been added to life expectancy and fertility rates in both developed and developing countries have declined substantially helping to reduce burdens associated with childbirth and childrearing. Despite this progress more than half a million women—99% of whom live in the developing world—continue to die every year in pregnancy and childbirth due to entirely preventable reasons. Additionally amid the HIV/AIDS pandemic women today face new and worsening health risks: 50% of all adults living with HIV/AIDS worldwide are women and those age 15–24 years are disproportionately affected. (excerpt)

Gender, sexuality and HIV: making a difference in the lives of young women in developing countries

Most new HIV infections are occurring in young people, with young women hit particularly hard in parts of the developing world. This paper explores the impact of gender and sexual norms on young womens sexual experiences, expectations and vulnerability to HIV/AIDS. It argues that the power imbalance characteristic of sexual relations among men and women has many of its roots in adolescence. The data that support these findings were collected from studies conducted in Africa, Latin America, and Asia and the Pacific as part of the Women and AIDS Research Programme of the International Center for Research on Women. The paper concludes with recommendations for educators, therapists, and counsellors who work with young people and their families.

Combination HIV prevention

Michael Merson a, Nancy Padian b, Thomas J Coates c, Geeta Rao Gupta d, Stefano M Bertozzi e, Peter Piot f, Purnima Mane i, Michael Bartos f , for the Lancet HIV Prevention Series authors g h Although we applaud David Wilson and Daniel Halperins endorsement of the UNAIDS call to “know your epidemic and response” (Aug 9, p 423),1 they seem to imply an unfortunate narrowing of HIV prevention to just one or two stand-alone “interventions”. The real world of HIV programming is not so simple.

Moving forward on women's gender-related HIV vulnerability: The good news, the bad news and what to do about it

The global response to AIDS has triggered unprecedented attention to gender inequality and the role it plays in shaping the vulnerability of women. Tragically, however, this attention has not yet led to wide-scale transformations in gender roles, or reductions in gender-related risk. This paper reviews both knowledge and action on the impact of gender inequality on women in the context of HIV prevention, and argues that, while much is known, and while effective strategies do exist, impact on a population level will not be achieved unless gender considerations are integrated into an evidence-informed comprehensive national strategy. Such a strategy must be implemented by national governments within an enabling policy and legal environment for change; be driven and owned as much as possible, by communities who are empowered with skills and resources to put their own ideas and capabilities into action; and include people living with HIV as equal partners.

Revolutionising the AIDS response

Individual behaviour change interventions and technological approaches to HIV prevention can only be effective over time if the broader social environment in which health-related decisions are made facilitate their uptake. People need to be not only willing but also able to take up and maintain preventive behaviours, seek testing, treatment and care for HIV. This paper presents findings and recommendations of the Social Drivers Working Group of the aids2031 initiative, which focus on how to ensure that efforts to address the root causes of HIV vulnerability are integrated into AIDS responses at the national level. Specific guidance is given on how to operationalise a structural approach.

Looking back, moving forward: Towards a game-changing response to AIDS

The aids2031 consortium was initiated by UNAIDS in 2007 to consider lessons from the AIDS response of the prior three decades and to make recommendations for the subsequent two. The aids2031 consortium was not about what we should do in 2031 but what we should do differently now to change the face of the pandemic by 2031 -- 50 years from the discovery of the first cases of AIDS. The initiative convened nine multi-disciplinary working groups to ‘question conventional wisdom stimulate new research and spark public debate. This Special Supplement synthesises findings of the group concerned with understanding the key political social and economic ‘drivers’ -- or determinants -- of HIV and AIDS. The aim of the Social Drivers Group was to illustrate how HIV epidemics interact with social (cultural political and economic) factors and to advise policy-makers and planners on how to address these factors to achieve their HIV prevention care and treatment objectives. The Social Drivers Group undertook this work between 2007 and 2009 through white papers workshops and public conversations each of which addressed social determinants from a unique standpoint. A key message emerging from these activities is that a successful shift in emphasis from individualised approaches to prevention care and treatment to approaches that take key structural determinants of vulnerability (and resilience) into account will be the critical ‘game changer’ that the AIDS response has been seeking. Such a shift must occur in local- and national-level action not just in international discourse and policy. (Excerpts)

From Beneficiaries to Change Agents: The Rise of Women's Leadership in International Development

Women are unquestionably the largest new international player on the world stage today, and are shaping local, national, and global change in a variety of innovative ways. In recent years, most notably, women have been morphing from the passive beneficiaries of international development efforts to the powerful leaders that help bring about such change. The implications for practitioners of development are clear: focused research and bold policies are needed to better explore the contours of this change, and to maximize the rich leadership potential offered by women in today’s world.