Policy Brief
16 Sep 2015
21 views

Gender Considerations Along the HIV Treatment Cascade: An Evidence Review with Priority Actions

Melanie Croce-Galis, Jill Gay, and Karen Hardee
Melanie Croce-Galis, Jill Gay, and Karen Hardee
Global
15 mins
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What you'll learn
Understanding how gender impacts HIV services and treatment
  • A gender lens is required to understand how both men and women face obstacles accessing HIV diagnostic services and treatment
  • This brief includes reviews the evidence on men and women’s experiences accessing HIV services and provides recommendations for policy action
A gender lens is required to understand how both men and women face obstacles accessing HIV diagnostic services and treatment
Women face unique challenges
Women who are not accessing maternal care services are often neglected from testing and treatment due to domestic demands, a lack of awareness, and financial constraints. They are also discouraged to go to a clinic because of the shame associated with having HIV. Additionally, although women have higher access rates to antiretrovirals (ARVs) compared to men, they often face adherence barriers -e.g., some countries require men to be present for women to access treatment, which stands as an obstacle for many women.
Men face access barriers also
On the other hand, men are discouraged to access services because of masculine norms. Being sick is not seen as manly, so men will rely on their female partners to know their status and to access ARVs. Other marginalised groups, including transgender individuals and sex workers, face discrimination for their HIV status, therefore, are deterred from accessing services. Future policies must maintain a gender lens to change the stigma around HIV, while concurrently addressing the structural factors that perpetuate gender inequalities affecting HIV services.
A young boy in Africa holds onto a soccer ball.

Women may need family support, including redistribution of household responsibilities, to enable them to adhere to treatment. Even if drugs are free or subsidised, women may not be able to afford the time or money required to travel to a clinic.

Key Takeaways
1
Gender shapes the way people access HIV services
Gender shapes the way people access HIV services
Women and men are both discouraged from accessing HIV services due to their respective gendered norms. Other key populations including transgender individuals and sex workers are less inclined to access HIV services due to gendered biases. A gender lens is required at every stage of the HIV Care Cascade. This gender lens should transform into policy and programmes that specifically target men, women, and other marginalised groups. Other gender-sensitive policies include linking antiretroviral therapy (ART) and GBV services, and disaggregating ART clinical data by sex and gender.
2
Efforts need to be improved to reach non-pregnant women
Efforts need to be improved to reach non-pregnant women
Efforts need to be improved to reach non-pregnant women in HIV testing efforts, which may be difficult because of domestic demands, financial burdens, and illiteracy. To do so, linking GBV and HIV services could be beneficial.
3
Men require tailored programs
Men require tailored programs
To address barriers discouraging men from HIV care, such as social norms around masculinity, programs involving HIV testing and ART enrolment must intentionally cater to men.
4
Gender and sex differences should be analysed
Gender and sex differences should be analysed
Gender and sex differences should be analysed in clinical data about viral suppression and ART access.
5
Healthcare workers require adequate training
Healthcare workers require adequate training
Healthcare workers must be trained so that gender discrimination does not occur while individuals are accessing HIV services.
6
HIV transmission should be decriminalised
HIV transmission should be decriminalised
HIV transmission should be decriminalised, as most of the burden falls on women.
7
Young people should be educated about HIV prevention
Young people should be educated about HIV prevention
Youth should be educated about HIV prevention and services early on from a non-judgemental perspective.
8
Policies and programmes must address the stigma around HIV
Policies and programmes must address the stigma around HIV
The stigma around HIV must be reduced to make both men and women feel inclined to access testing and care.

Being physically strong, capable of hard work and having children were also seen as signs of masculine identity, which were threatened by being labelled HIV-positive.

A young boy in Africa holds onto a soccer ball.

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