E-discussion on the socioeconomic impact of HIV on women and girls in Asia and the Pacific
Message from the Guest Moderator
Aradhana Johri
Additional Secretary
National AIDS Control Office,
Government of India
HIV has an adverse, and often debilitating, socio-economic impact on individuals living with HIV and their households. In several countries, especially in Asia and the Pacific, traditional and entrenched gender inequities exacerbate the disproportionate impact of this socio-economic burden on women and girls living with HIV or from HIV affected households, by restricting their access to social and economic resources, coping mechanisms, and care and support services.
Over the past several years, governments in Asia and the Pacific have planned and implemented a broad range of policy responses aimed at mitigating the socio-economic impact of HIV. However, these measures have either been inadequate or not completely effective to directly address the impact on women and girls. In the absence of adequate data, efforts towards evidence-based policy advocacy for impact-mitigation have not always been effective.
To address this gap, UNDP has undertaken a regional analysis of the socio-economic impact of HIV on women and girls in Asia [Note: Link for draft summary report has been removed following completion of the e-discussion. Full report will be posted to Resources library once released.], based on national studies conducted in Cambodia, China, India, Indonesia and Vietnam, during the last few years.
Despite its limitations in terms of the data (India report for example was released in 2006), this analysis clearly indicated that in all the countries where the studies were conducted, women living with HIV or in HIV-affected households shouldered additional economic burden (women were more likely to head HIV-affected households, compared to non-affected households) and additional social and care-giving burdens in spite of the constraints on their opportunities for education and income generation (women living with HIV had lower levels of education, compared to men living with HIV).
In addition, the analysis identified the following key areas of concern:
- Unlike men, women and girls with HIV or in HIV-affected households, in general, have higher labour force participation rates and employment levels, compared to women in non-affected households, indicating the need for women to continue to work in spite of their poor health;
- Female headed HIV-affected households are more likely to have limited access to coping mechanisms – including lower levels of asset ownership and higher levels of indebtedness – compared to male headed HIV-affected households
- In general, there are lower rates of school attendance and higher rates of dropout and absenteeism among girls, than among boys in HIV-affected households, signifying higher incidence of economic/care-giving burden on girls;
- Women living with HIV experience both a higher level of internal stigma and external discrimination, compared to men living with HIV;
- Women’s vulnerability to HIV is enhanced by gender-based variations in key drivers of intimate partner transmission (women are less aware of condoms as a harm reduction technology, and less equipped to negotiate its use;
- As compared to women, men are less likely to be diagnosed through the voluntary counseling and testing facilities and are also less likely to disclose their status to their partners after diagnosis); and
- Widows, especially those living with HIV, are more likely to be denied their inheritance rights and, are often, even excluded from the communal use of household property.
In the context of these findings, it is imperative that comprehensive policy options are identified and advocated to mitigate the socio-economic impact of HIV on women and girls. In this regard, it is my pleasure to launch this e-discussion, which will run for two weeks, and focus on key areas of impact based on the above findings. These include:
- Policies to mitigate impact on women’s economic opportunities
- Policies to mitigate impact on girls’ education
- Policies to mitigate social impact (including stigma and discrimination)
- Policies to reduce women’s increased vulnerability to HIV through intimate partner transmission.
- Any studies/ research that further strengthens the evidence on impact of HIV and AIDS on women and girls
I look forward to your contributions, with a hope that this dialogue can provide the springboard for innovative, effective strategies to improve the socio-economic circumstances for women and girls living with or affected by HIV throughout the region.
Please find below inputs from UNDP Indonesia in response to the following comments received on the survey
“In Indonesia, for example, married women need their husband's authorisation to open a bank account. Such practices are reinforced by national processes, e.g. the national census assumes that a male is the 'head' of a household and the main income earner”
In order to address these sorts of issues the following is suggested:
Currently, social protection schemes do not cover people living with HIV. Existing social protection schemes either target the poor or workers, leaving a lot of HIV people unattended. The current health insurance schemes are not HIV friendly in that private health insurance exclude HIV and the national health insurance (ASKES) is for opportunistic illnesses except for HIV/AIDS. However, with forthcoming UNDP support (in process) NAC is developing an action plan for including HIV in social protection schemes. The Action Plan will provide options for coverage, bundle of services and cost as well as management alternatives.
Dear HIV-APCoP members,
We have now come to the end of the e-discussion on the socioeconomic impact of HIV on women and girls in Asia and the Pacific. While we struggled a bit at the beginning with contributions we picked up pace after the first week. Thank you very much for the substantive inputs we received, we particularly appreciate the examples of ongoing social protection schemes that mitigate the socio-economic impacts of women from a number of countries across the region.
Your inputs to the discussion, together with the information we received from the survey will feed into the summary of the e-discussion. This will assist us and our partners in strategizing our work on mitigating the socio-economic impact of HIV on women and girls.
Nashida Sattar
Programme Specialist- HIV
UNDP Asia-Pacific Regional Centre
3rd Floor, UN Service Building
Rajdamnern Nok Avenue, Bangkok, Thailand
Tel.: +66 (0) 22882751
Fax: +66 (0) 22883032
URL: http://asia-pacific.undp.org
Dear Colleagues,
In Cambodia, the results from “The Socioeconomic Impact of HIV at the Household Level in Cambodia”, which is based on a national survey of 4172 households, both HIV-affected and non-HIV affected, revels a great concern of livelihood needs for and discrimination against women living with HIV.
In addition to unsurprising findings regarding the decreased earning potential and participation in income-generating activities of all people living with HIV (27% of people living with HIV reported losing their job/source of income after they were diagnosed and for those who kept their jobs, income levels were 47% lower post-diagnosis; HIV-affected households were more likely to have reduced savings available and were more likely than non-affected households to have taken out loans), this report sheds important light on the economic and social impact of HIV on women and girls in Cambodia in particular:
Some additional findings from this report include:
These findings, although not as dire as in some of the other countries in the region, nonetheless highlight the need for increased attention given to social safety mechanisms for women and girls in HIV-affected households. The current social protection strategy of the Royal Government of Cambodia highlights this need to shift to greater integration of social services through the development of a national social safety net program. Additional recommendations for the Cambodian context could include increased donor and NGO harmonization of aid, resources, and programming, and increased utilization of the burgeoning networks of people living with HIV to influence policy and programming decisions.
The currently available livelihood programmes are not adequate for women to maintain their nutritional status towards improved health as they are on ART. It is very important to provide with a comprehensive package for women including food crisis relief as well as skills development for their economic activities. The package also should include developing leadership of Women Living with HIV so that they are able to equally utilize the available opportunities in their settlements. The PLHIV networks should take robust actions towards providing economic opportunities and linking them with market but not limiting them to advocate for merely providing ART.
Best wishes.
Narmada
_____________________________________________
Narmada Acharya
Social Mobilization and Partnerships Adviser
UNAIDS Cambodia
221, Street Pasteur (51), Khan Chamkar Mon
Phnom Penh, Cambodia
Tel: (855 23) 219340; Mobile: 017-911959
Fax: (855 23) 721 153
E-mail: acharyan@unaids.org
Towards: Zero New Infections-Zero Discrimination-Zero AIDS Related Deaths
Dear colleagues,
Thanks for this timely and rich discussion and we are happy to read many good contributions received so far. We would like to address the question - social protection to reduce the impact of HIV on women and girls. Even though social protection and HIV is a developing field, there is increasing evidence that social protection can significantly contribute towards all the three aspects of universal access outcomes – impact mitigation, treatment and prevention.
Social protection is considered a framework for putting in place comprehensive policies and programmes to protect poor and marginalized individuals and groups from socio-economic shocks. In its broadest sense, microcredit, social transfers, health insurance and protection, transformative legislative laws and regulation are all considered part of social protection (please read UNAIDS business case on SP for different types of social protection programmes). While there are benefits of social protection for poor people including people living with HIV and HIV-affected household, some researchers have also raised caution and questioned sustainability, reachability, targeting and capacity constraints in developing countries to implement such programmes. Without discussing pros and cons of social protection overall, in this contribution we highlight examples of the benefits of HIV-sensitive social protection for women and girls living with and affected by HIV. Since most of these examples are from African countries and from generalized epidemic contexts, some adjustments may be necessary in order to adapt in other countries and regions.
Cash transfers including pensions and HIV
Cash transfers (conditional and unconditional) are increasingly promoted to reduce poverty, facilitate consumption among households and protect from economic shocks. Many developing countries, including both low and middle income, are adopting cash transfers programmes. The most obvious benefit of cash transfers for HIV outcomes is in the area of providing care and support; that is helping vulnerable households and individuals to withstand the economic impacts of AIDS. Since care and support for people living with HIV and HIV-affected households is disproportionately the responsibility of women and girls (often elderly women and/or young girls), this alone has a positive impact for women and girls. It is also very important because it can protect the already poor households from slipping further into destitution that can result from HIV related health expenditure as well as from stigma and discrimination. HIV related stigma and discrimination affects people living with HIV and poor HIV-affected households by loss of jobs, lack of access to prevention and treatment services and lack of access to poverty reduction and other impact mitigation programmes.
A government scheme in Rajasthan, India, provides a good example of HIV impact mitigation for women and girls. In the state of Rajasthan, the widow pension scheme was reformed so that women whose husbands had died as a result of HIV would be eligible to receive a monthly pension irrespective of the woman’s age. Across all states with modified pension schemes, approximately 23,000 women benefitted from this change in 2010. Other notable reforms include states where people with HIV now have access to subsidized food, housing, transportation, and health care – all of which were previously restricted to those below the poverty line. The Ministry of Labour has also removed an HIV-exclusion clause from special health insurance schemes for informal workers (UNDP, 2010).
Food transfers - women, food security and HIV
Nutrition and food security are fundamental to reducing HIV impact on households. Women are often primarily responsible for daily household work including producing, purchasing and preparing food, gathering water and fuel, among other tasks. When a woman is living with or affected by HIV, household food security can be reduced as a result. Women are also primary caregivers for family members living with HIV. Caring for an ill family member means less time for preparing food, while other aspects of care may require significantly more time – for example, accessing sufficient clean water. A study conducted by UNICEF in Zambia, Malawi and South African founds that in Zambia (almost 70% of the beneficiaries were estimated to be HIV affected households) a social transfer (cash) programme has significantly improved the nutritional intake of the beneficiaries. Even though the data was not segregated according to gender but out of the total beneficiaries, 61.8 percent were women headed households and the study notes that there is significant increase in the nutritional value of the beneficiaries. It is important to look into women’s and girls’ nutritional and food security needs while assessing the impact of food transfers because in many cases, community members who receive and distribute food to be transferred may not ensure that everyone gets equal share – to the detriment of women and girls. Here is the link to the study: http://www.ipc-undp.org/publications/cct/africa/SocialCashTransfersChildrenHIV_AIDS.pdf
Impact mitigation and reducing stigma attached to food collection
In Zambia, WFP has embraced innovative technology to support government social protection programmes that target the most vulnerable. Social transfers are designed to ensure access to a basket of nutritious foods, and increasingly, where markets are functioning, WFP is providing electronic vouchers to beneficiaries that empower them to collect food rations at the local shop of their choice. Households are targeted on the basis of food insecurity and one member receiving ART or tuberculosis treatment or attending mother-and-child health and nutrition centers for pregnant women, lactating mothers and children aged less than 24 months. Such an approach has eliminated the stigma attached with collecting food commodities, especially at local health clinics, and allows recipients to collect rations at a convenient time, based on their work and other priorities. Here is a short video on this http://www.wfp.org/countries/Zambia/Media/WFP-Zambia---Mobile-Delivery---Tracking-System
In conclusion, social protection in the context of HIV is widely considered as a promising approach in the HIV and development world. It is increasingly believed that, when done well, social protection has a role to play in advancing universal access by reducing susceptibility and vulnerability. UNAIDS business case on social protection (see above) illustrates linkages between HIV and social protection and makes a strong case for HIV-sensitive social protection as a way forward. Attached is also a UNICEF evidence paper which illustrates examples on HIV-sensitive social protection from different countries.
With kind regards,
Atif Khurshid, Research Analyst, with Susana T. Fried, Senior Policy Adviser, Brian Lutz, Policy Specialist
Hello everyone,
I do agree with those who have contributed from PNG.
I work for ChildFund PNG, an International NGO, a child focused organization and is one of the very few organizations that are working in the very remote villages and communities in PNG. Poverty is defined by ChildFund PNG as Deprivation, Exclusion and Vulnerability (DEV) to all aspects of lively hood and we work according how we define it and that is to bring changes to children’s lives by addressing issues identified in communities according to the DEV framework we have in place.
There is lack of access to correct and sufficient information in most rural areas in PNG. In PNG 85% of the population live in the rural areas where there is limited or no government services at all. People have heard of HIV but have very slim or negative knowledge of HIV and related issues in detail and therefore there is negative impact on women and girls both infected and affected by HIV and AIDS.
In my role as a HIV and AIDS Program Officer working with young out of school youths and children in the communities the challenges I encounter are:
All of the above contributes to stigma and discrimination that is not obvious among the community members but is accepted as a norm.
My simple respond to the three questions according to PNG are:
1. How best can we address the socio-economic impacts of HIV on women and girls
2. Interesting examples of impact mitigation from your country or other countries that you are aware of.
3. Suggestions and examples for social protection to reduce the impact of HIV on women and girls
Thank you
Stella
Stella-Marie KOMBUL | Program Officer- Youth, HIV and AIDS | ChildFund PNG
P O Box 671, Gordons, NCD. Papua New Guinea
P: +675 323 2544 | F: +675 323 2562 | M: +675 7658 9482
E: skombul@childfund.org.pg | W: www.childfund.org.au
I agree with the comments above that the question on how to use monitoring for programme planning and for the assessment/evaluation of programme impact is an important one; and also with Pramod’s observation that monitoring needs to reflect where interventions take place: at national, provincial, and local levels. As the comments from PNG elucidate so well, programmes and activities need to address local circumstances, and the ways that gender is interpreted and played out in particular contexts.
I also concur with the need to generate data that lends itself to comparative analysis as a means to lobby for approaches that are effective and that have an impact. At the same time (taking a YES - AND position), I would like to argue that present monitoring frameworks which continue to focus on quantitative indicators do not lend themselves easily to measuring the “how” of social change efforts - particularly those aimed towards empowerment and transforming notions and practices related to gender - nor do they capture the complexities lived out at grassroots levels well.
As an example, two MSM CBOs and one women’s CBO I have assisted in the preparation of their reports to donors were requested – and evaluated against – the criterion of how many condoms they had distributed, and how many persons they had reached through their outreach activities. While this is relevant information, both these CBOs also included broader social transformation aims around empowerment, stigma and discrimination, none of which were included in the reporting formats of their donors. Relatedly, one of the pitfalls of monitoring, I argue, is that if we are not careful, it functions to establish what the most valuable interventions are and the most valuable organisations are on the basis of data that does not necessarily reflect or do justice to the organisation’s / programme’s / intervention’s broader goals, nor provide relevant information on how to maintain past successes (which also need to be maintained to avoid backlash), and where adjustments should be made to improve a programme or intervention.
An interesting read on different monitoring frameworks from the point of view of women's organisations and networks is: Batliwala & Pittman (2010) Capturing Change in Women’s Realities: A Critical Overview of Current Monitoring & Evaluation Frameworks and Approaches.
Dear Colleagues,
I'd like to share some information about the situation of positive women in Sri Lanka and respond to the question of possible social protection/impact mitigation schemes.
According to the 2ndquarter data released by the National STD and AIDS Control Programme (www.aidscontrol.gov.lk) for 2011, out of a cumulative total of 1349 positive persons in Sri Lanka 564 are female. The ratio of male against female HIV positive persons are 1.5:1.Stigma and Discrimination is still very much a major issue faced by positive people in Sri Lanka, particularly women. Findings of the Stigma Index conducted in Sri Lanka in November 2010 indicated that being positive did not relieve women from the duties and responsibilities expected of them by their families and society in general.As a positive women’s activist put it, ’in situations where a HIV positive female heads the household, she bares the sole responsibility of educating children, ensuring their nutrition, as well as the upkeep and maintenance of the family while managing her own fears and anxieties of being positive. We also have to manage various sexual advances from men in the village…..and mentally we are under a lot of pressure.’ Self stigma is high among positive people and for women it is twice as high.
In Sri Lanka, ARVs are provided free by the Government, however the burden of household and family expenses remains the same. Currently the Ministry of Social Welfare has a scheme whereby the Grama Niladhari verification can be presented to the assigned officer at the District Secretariat for a family to claim a monthly stipend for persons with disabilities in their families. A similar scheme for HIV positive women headed households can also be done. However the system of verification should ideally go through their health service provider at the STD clinic, who can certify their eligibility. Many positive people in Sri Lanka are reluctant to reveal their HIV status at the village level due to the high stigma and discrimination in the country.
Looking forward to hearing of how such schemes have worked well in other countries.Thank you.
Swairee Rupasinghe
UNDP, Sri Lanka
1. How best can we address the socio-economic impacts of HIV on women and girls;
this question is always of concern to me. I working for a National PLHIV organisation and every time someone mentions the word “GENDER” I get very nervous. This is because gender sensitization should be focused on family, how it impacts on families, what is the relationship within the family within the home. PNG in its many diversities can also include martial and partial societies and therefore upbringing can and do vary from the highlands to coastal to the islands and that it still impacts and or influences on how people go about their lives, their conduct and behaviour.
The society of my origins, in most part is partial; recognises the value women, women are partners to their husbands, they garden together and also share the duties of hunting and fishing. They eat together, and sleep in the same room or space within the home. Women have a place in society. The practices of society and its knowhow are also passed down from generation to generation. That is what it is like in the rural communities and villages. However Papua New Guinea as a country and society is also in transition. Western influences have introduce cities, towns, money, western education, western fashions, mixed marriages etc……, this in a way has introduced competition and greed even within families. People’s perspective on life are therefore changing, ones value and self worth is also altered.
So to effectively address or provide support for women and children, we must support and strengthen the family core. Strengthening relationships between siblings, mothers and fathers. PNG government does not provide or have a social security benefits or welfare schemes safety net and therefore family is the only safety net for women and children. High cost of living especially in urban centres means that they cannot survive on their own. By improving the lives of families you are providing for the women and children. In a way it just might help reduce gender based violence especially when we know that in PNG this is a problem raging out of control within families
2. Suggestions and examples for social protection to reduce the impact of HIV on women and girls;
Income generation schemes that is supportive of family, family need to feel and know that they are being empowered to own the infection and or the person infected. Through this support, individuals are strengthened. The scheme should ensure that all proceeds are evenly distributed, and that the child/children are cared for and educated.
The scheme should also be extended to include the community and that the community is collectively responsibility for its health and wellbeing, economic and social growth. Subsistence farming is still a way of life in over 80% of the population. Grow food to firstly feed themselves and secondly earn income for other needs. Community sawmills, small scale rice farming, Poultry farming etc……..
We cannot keep talking about infected and affected without talking about the FAMILY. Papua New Guinea society has and will always be about family, the fabric of PNG society.. When one has nowhere to go, one always turn to the family. Person/persons living with HIV & or AIDS want to feel and be part of the family and the community. When we continue to boxed them through labeling and tags we are in fact adding fuel to already high levels of stigma & discrimination. We continue to create parallel and systems of segregations.
Many people living with the virus are viewed as burden to family / society and therefore rejection becomes an easy way out. That should not be happening if family or home environment is strengthened and that there is a sense of economic independence. No-one wants to be a burden, no-one wants to be the cause of family break-downs least of all someone living with HIV.
Economic empowerment for the family.
Annie.
One of the dynamics of the situation in Asia is that while the number of poor countries has decreased, the number of people living in absolute poverty has not. In Cambodia, while the number of poor has decreased from 47 percent in 1993 to 30 percent in 2003, there is increasing inequality, the latest MDG report (2010) tells us, between and within urban and rural populations. Landless urban populations are particularly vulnerable as they cannot grow crops themselves. However, as various studies (such as UNDP’s recent survey) demonstrate, PLHIV living in rural areas have lost assets and have become more vulnerable to food insecurity etc. as a consequence. Further, the vulnerability of the rural poor is compounded by high levels of illiteracy and limited livelihood opportunities. Agricultural development has been identified as key to the improvement of rural livelihoods as subsistence farming - the main livelihood source in Cambodia - produces little, if any, disposable income which is necessary to covering costs for health expenditure, for example.
While the expectation is for families to look after their sick ones, not all families are willing to do so (ostracizing PLHIV), or are in a position to do so (poverty). In Cambodia, examples of social assistance include the Health Equity Funds (which patients need to apply for, and which covers hospital expenditure, but also reimburses transport costs etc.); and direct food aid. The Health Equity Funds is characterized by under-coverage, and people continue to accrue considerable costs in accessing care and treatment, particularly in rural areas. The future direction of food aid, in turn, is moving into the direction of nutritional support to address undernourishment and malnutrition. Feedback from PLHIV networks suggests, however, that lack of food continues to be a problem, which today is affected by the global financial and economic crisis and the related inability of the poor to generate income.
Dear HIV-APCoP,
In connection with the Mid-Term Review (MTR) of the third phase of National AIDS Control Programme (NACP-III) in India, consultants had posted a query through Solution Exchange India HIV/AIDS CoP. The Consolidated Reply (CR) to this query is available at http://bit.ly/Gender-MTR-NACP-III (PDF, Size: 275 KB). I am appending the Summary of Responses here:
Summary of Responses
Epidemiological trends of HIV in India indicate an increasing feminisation. There is a clear gender difference in the prevalence of Stigma and Discrimination related to HIV. The effects are even more profound in rural areas. Against this backdrop, members responded to the query and shared examples of initiatives demonstrating Gender Equity in the third phase of National AIDS Control Programme (NACP-III).
NACP-III has clearly factored Social Inclusion and Gender Equity in its strategic plan. Yet, implementers face questions on the need to address women's issues related to HIV. The contention is that the existing healthcare facilities and welfare schemes for People Living with HIV (PLHIV) benefit women; however, it is not enough.
Organisations such as the Positive Women’s Network (PWN+) mobilise Women Living with HIV (WLHIV), conduct capacity-building programmes, and make them aware of their rights and responsibilities. It undertakes advocacy programmes with government agencies, NGOs and Community Based Organisations (CBOs) on issues related to HIV and Gender Equity. However, there are difficulties in sustaining the momentum of such activities due to lack of resources and support. In partnership with Multiple Action Research Group (MARG) and the United Nations Development Fund for Women (UNIFEM), PWN+ has also developed a handbook on HIV and legal literacy.
The Kerala Positive Women’s Network (KPWN+) through State-level Public Hearing has drawn attention to the gaps in existing health systems and discrimination, especially against WLHIV. Besides, KPWN+ has involved several agencies and organisations including the Kerala State Women's Development Corporation (KSWDC) and the State Department of Social Welfare to work on property rights of WLHIV. Property inheritance right is an area where WLHIV face serious difficulties.
The state level networks affiliated to the Indian Network of People living with HIV (INP+) undertake specific activities for women and children. For example, with the support of Assam State AIDS Control Society (ASACS), they sensitise media professionals to publish HIV-related news and on how to deal with issues related to WLHIV. The Assam network facilitates Self Help Groups (SHGs) as well, for ensuring livelihood of WLHIV. In Maharashtra, a multinational organisation has given free lease of land to WLHIV to do organic farming.
Self-Help Groups (SHGs) hold great potential in addressing the vulnerabilities of women to HIV and in improving the socio-economic status of WLHIV. Organisations like Reach India in West Bengal incorporate in their training programme for SHGs, modules on knowledge and skills necessary to save lives and to uphold the dignity of women. In Kerala, Kerala State AIDS Control Society (KSACS) and Social Welfare Department use Kudumbashree (SHGs), to provide nutritional support for women and children, who are on Anti-Retroviral Therapy (ART).
Involvement of Faith based Organisations in HIV programmes is another strategy that holds potential in improving Gender Equity in the National AIDS response. Initiatives like the Prathibha project in Tamilnadu mobilises women of faith and their leadership in taking up an active role in eradicating stigma and discrimination by speaking about issues like vulnerability, poverty, social standing, and sexuality.
The Link Worker Scheme (LWS) in the National AIDS Control Programme is yet another example of a conscious effort to include women’s rights and gender equity. One of the objectives of the LWS is to establish linkages between gender, sexuality and HIV and bring into focus factors that enhance vulnerability of young people and women. NGOs and CBOs associated with the LWS have adopted gender and workplace policies to address issues like sexual harassment.
In Gujarat, the State AIDS Control Society (SACS) is taking several steps to incorporate gender equity in their programmes including Targeted Interventions (TIs), Integrated Counselling and Testing Centres (ICTCs), and the Red Ribbon Clubs (RRCs). In addition, the Gujarat SACS observe the week around International Women’s Day on 8 March, as Tejaswini week to create awareness among females on HIV prevention and related issues. Similar initiatives such AIDS awareness, opening of clinics to provide medical support, referring Most at Risk Populations (MARPs) to ICTCs have been taken by NGOs in West Bengal (e.g. MANTRA).
Organisations like ActionAid in Karnataka work on broader goals of creating equality between men and women i.e. to achieve power balance between men and women, to improve women’s status by addressing patriarchy, etc. Through their Women Community Facilitators, ActionAid and its partner organisations have brought in tangible benefits to the HIV programme in terms of Gender Equity. Tools like the checklist proposed by NACO in the policy framework on Mainstreaming HIV and AIDS for Women’s Empowerment would be helpful in this approach.
The International Centre for Research on Women (ICRW) also undertakes broader empowerment initiatives for WLHIV. ICRW’s project in partnership with AVERT and Aamich Aamache Sanstha in Maharashtra helped to improve women's access to care and support. Similarly, in partnership with APAC and Bro Siga Social Service Trust in Tamil Nadu, the project aimed to address the gendered vulnerabilities of young boys and girls to HIV as part of a regular slum intervention programme.
Besides focussing on women’s issues, gender equity must include the issues faced by sexual minorities and transgender (TG) group. Programmes and projects tend to overlook them from the perspective of Gender Equity and Social Inclusion.
Overall, there are several examples of Gender Equity being factored in NACP-III implementation. At the same time, there is the need to scale up such examples so that the benefits are available throughout the nation. Additionally, research conducted in India re-emphasises the link between human rights and women’s vulnerability to HIV and gender based violence. Hence, NACP in future has to focus on integrated programming using a broader framework of Human Rights, Social Inclusion and Sexuality principles.
For details from individual responses, comparative experiences, and other related resources, please download the CR at http://bit.ly/Gender-MTR-NACP-III (PDF, Size: 275 KB).
With best wishes,
Nabeel
---
Dr. Nabeel M. K.
National Programme Officer, UNAIDS India, &
Moderator, Solution Exchange AIDS Community,
11, Olof Palme Marg, Vasant Vihar,
New Delhi. 110057.
Nabeel.MK@one.un.org, NabeelM@unaids.org
Phone: +91-11-41354545 Extn 334
[Facilitator's note: the e-discussion has been extended until Monday 22 August, 2011]
Dear Colleagues,
Thank you for a productive discussion, I have found it extremely interesting. I have a question that relates to all of the above, and is about the measurements of socio economic impact of HIV on women and girls? What indicators have been used to establish the need to interventions and to monitor how well existing programs address the situation? While it is critical to share best practices from the work on the ground, the impact at the program, national and regional levels need to be monitored consistently, with harmonized indicators, to establish which interventions work and how to advocate for better funding to address the issue of HIV and its socio economic impact on women and girls.
Regards,
SVETLANA NEGROUSTOUEVA | MEASURE Evaluation
301-572-0408 (t) | Snegroustoueva@icfi.com
ICF Macro| 11785 Beltsville Drive, Ste 300 Calverton, MD 20705 USA| 301.572.0999 (f)
According to a UNDP report (2010)*, “the HIV positive status of a family member has a substantially adverse impact on the economic circumstances of the household; to manage the diminution of income as well as the HIV-induced increase in cost of living, women often resort to economic activity in the informal sector.”
“In the context of the Philippines, where a significant proportion of the female labor force migrates for lucrative overseas employment, a positive HIV test can be as morally devastating as it is economically. In the absence of significant domestic employment opportunities, the (HIV-positive) women reported relying on welfare schemes and home-based economic activity in order to manage their loss in income and the additional HIV-related expenses of testing and treatment,” the same report said.
A number of social protection schemes are in the offing for positive women and girls in the Philippines. For one, the Philippine Government through the Department of Social Welfare and Development is currently offering a conditional cash transfer program, otherwise known as Pantawid Pamilyang Pilipino Program or 4 Ps as part of it’s effort of promoting inclusive growth and fulfilling its MDG commitments. The 4Ps is a poverty reduction and social development strategy of the national government that provides conditional cash grants to extremely poor households to improve their health, nutrition and education particularly of children aged 0-14. The program has a dual objective of social assistance and social development. It provides conditional cash grants to beneficiaries amounting to Php6,000 a year or P500 per month per household for health and nutrition expenses; and Php3,000 for one school year or 10 months or P300 /month per child for educational expenses (maximum of three children per household). Additionally, a household with three qualified children receives a subsidy of Php1,400/month during the school year or Php15,000 annually as long as they comply with the conditionalities. (See attached briefer for more details)
Secondly, the Philippine Government is also providing through its social insurance program, Philippine Health Insurance Corporation (PhilHealth), the Out-patient HIV/AIDS Treatment (OHAT) Package, which aims to increase the proportion of the population having access to effective HIV and AIDS treatment. Paid through a case payment scheme with annual reimbursement amounting to Php30,000, the OHAT covers costs of ARV drugs, laboratory examinations including CD4 level determination test and test for monitoring of ARV toxicity and professional fees of health providers. Note, however, that this package only covers confirmed HIV and AIDS cases requiring treatment. Those requiring confinement are covered under the regular inpatient benefit of PhilHealth. (See attached PhilHealth Circular for further details) Note further that, ART is currently provided free of charge with support from Global Fund.
However, access to these services is not forthcoming to some of the women as the above report indicated. There is an apparent evidence of rural/urban divide in terms of access to social support and treatment services, with urban women having better access than women who live in more remote provinces.
To mitigate this situation, UNDP Philippines has supported the Department of Social Welfare and Development in the establishment of the referral system for care and support services of PLHIVs and their affected families and the development of its program manual. The referral system provided the mechanism, strategies and tools to ensure and enhance the access of PLHIV and their families to a quality and timely delivery of psychosocial, economic and support services. It is intended to facilitate the convergence of various service providers from multi-sectoral agencies to respond to the emerging needs of PLHIVs and their families. To date, over 120 social workers, health care providers, PLHIV and their families were trained for the roll out and operationalization of the system. Moreover, more than 100 social workers from the sub-national and local offices were trained on providing care and support services to people infected and affected with HIV.
*MDG 3 and 6: What Do They Say?: Perspectives of Women and Girls Living with HIV in Asia and the Pacific, UNDP (2010)
Best regards,
Philip
Philip Castro
Programme Officer for HIV and AIDS
United Nations Development Programme
Philippine Country Office
30/F Yuchengco Tower, RCBC Plaza
6819 Ayala Ave. corner Sen. Gil J. Puyat Ave.
1229 Makati City, Metro Manila
Tel. No. (63 2) 901 0223 / 901 0100 ext. 223
Fax No. (63 2) 901 0200 / 889 6659
Email : philip.castro@undp.org
Website : www.undp.org.ph
Dear colleagues,
As you know, we have been running a very important e-discussion on the socio economic impact of HIV on women and girls and what steps could be taken to reduce that impact. The impact of HIV and interventions to mitigate it is one of the most urgent issues that are constantly raised by women living with HIV as well as community workers and civil society organizations. However, in our discussion, the response from the members on the issue has not been very encouraging. You may recall that the impact of HIV, particularly on women and girls, and the steps needed to address them has also been highlighted by the Commission on AIDS in Asia.
As an important group of people representing different stakeholders working on HIV, human rights and gender, your inputs will go a long way in influencing the policies and programmes aimed at the mitigation of impact of HIV on women and girls. Please note that this is a strategic opportunity to advocate for cause and it can be strengthened only by your contribution. We were planning to use the summary of the discussion to rally support around this issue at the ICAAP.
Therefore, I would like to request you to kindly take some time off and let’s know at least the following:
Looking forward to hearing from you.
HIV-APCoP Facilitator
[Facilitator's note: We're pleased to share two comments we received in response to Anne McPherson's posting.]
Submitted by Lisa Williams
Thank you Anne for [shedding light] on the confusion between poverty of opportunity and access to services. As a journalist in an industry where language and words build perceptions of governance, identity, and 'truth', I will make a personal effort to keep the focus on access to services and government responsibilities. Food, water and roads are amongst the basic development issues which are thrown into the spotlight by the HIV/AIDS epidemic, and I often remind my media colleagues that the epidemic has provided ample opportunity for us to address the gaps in mainstream media coverage and standards/ethics, the cultures of information secrecy and power in our region, and need for media-literate leadership and populations to help people shape and make the best choices for their lives -- rather than feel disconnected from those making these decisions.
in solidarity. lis
Submitted by Jacob Kupu
Dear Anne ,
I totall agree with you .... I strongly belive no one in the rural areas is living in poverty. I have my wantoks when I go home for Holiday from Port Moresby. I can always get fresh garden produce only for a two kina, whereas in the city I can not afford a bundle of green leaves... so the idea of people from outside perceiving PNG rural people living in poverty is unfitting. PNG can not be Africa, India or some places in the world - We're a Nation Blessed with so many things .
Thank you Anne for your boldness...I agree with you.
Jacob Kupu
Program Officer-HIV/AIDS
Department of National Planning & Monitoring
WAIGANI
Papua New Guineans traditionally have practised simple and very basic gathering of what was necessary to provide or put food on the mat for a daily meal. They looked at VALUE of goods from the eyes of what can I bring to provide for my family at the end of each day. The value of wealth was measured by ‘ how big your garden was, whether or not you had pigs, if you were a good fisherman, can you hunt, can you build a house. At the age of marriage, the family including the one that was getting married would look at; if the daughter or son was going to be provided for with all of the above, more importantly if he or she was the eldest child, they would be looked after and therefore ensuring that they would support their parents till death.
Many women in the cities and the rural areas don’t understand the basic bookkeeper skills. They do not understand that; if you spend K100.00 on goods you wish to then on sell. The first K100.00 is to recoup out laid cost; after that you start to make any profit. However the usual practise is that once they make their first buck, they are already thinking of what to spend that on. This is why many income earning scheme are domed for failure before they have even started.
If PNG is looking at ways and schemes to assist in elevating people out of poverty then we need to seriously look back at what was working in the past, now that will vary from one language grouping to another, province to province, highlands from the coastal areas. Maybe look at the past systems of trade especially initiatives for the rural communities because they will be familiar with their local systems of practise. If it has worked in the past then and maybe it just might work today.
On the ideas for financial empowerment of women is also good idea however I am concerned especially with the obvious increasing gender base violence, I am always mindful that this initiative is not going to further inflame an already volatile situation. Empowering for women, girls and children, has to work closely with decreasing the violence initiatives. That the perpetrators are also empowered to change behaviour. Many of these behaviors are learnt and know no different because they most likely grew up in that environment. People can change to learning and education.
I also strongly believe that Poverty should not be confused with Access to Services. Many rural communities do not think that they are in any way poor. Certainly this statement of people living in poverty is in many cases true for urban centres where people are dependent on trade stores, tap water, electricity, markets……etc. In the rural communities, people do have gardens, can go fish , can go hunting to provide a daily meal. BUT what they cannot provide for themselves is Health services, Schools/Education, Transportation.
In saying this, I do welcome external assistance but do caution care must be taken to ensure that any schemes and initiatives are imbedded well into PNG society and that the people, the culture, traditions and the history of PNG is well valued and that it was and is contributing to the changing face of Papua New Guinea and its people.
Annie McPherson
Executive Director
Igat Hope (PNG) Inc. “A National Body of People living with HIV & AIDS”
Much thanks to Carol and Peterson for the summary of progress on social protection mechanisms in Papua New Guinea. Here is another view from PNG, this time reflecting on access to health services
There are currently a wide range of barriers to accessing HIV and health services in Papua New Guinea. At a practice level, comprehensive health services lack coverage. The distance to provincial hospitals and district health centres is often too far for women and men living in remote areas. Villages are served by an Aid Post providing basic medical and first aid response, although not facilities currently have staff. Women are deterred from accessing health services, particularly if they have to travel to because they are expected to consult their husband before making decisions to access services. And although health services are free of charge, women who are economically dependent on their husband need to ask for and be given money for transport. The same applies to pregnant women whose husband doesn’t see the value of attending a health service for a three or six month check up because of the time and financial costs. A commonly held view is that women have been giving birth without medical support for millennia so why waste resources on check-ups perceived as unnecessary.
A further deterrent to women’s access to sexual and reproductive health services is the stigma associated with STIs and sex before marriage. A young and/or unmarried woman who thinks she might have an STI of be pregnant, would rather try to hide or ignore the issue for as long as possible, then risk others finding out, either by seeing her access SRH services or through indiscretion of health workers. The fear of gossip and accusations of promiscuity prevents young women from visiting SRH services even to access information. There is currently little data on the rate, methods and consequences of unsafe abortions. Sexual health is not prioritised by men either who do not present themselves at a clinic until they are seriously, and sometimes fatally, ill. A minority of men do attempt to accompany their wives, for example through the birth of their children, but find that health workers are not trained to facilitate male involvement and participation. In general, health workers at the hospitals and health centres are often under pressure because of heavy workloads and varying levels of facility standards. They may have limited time to respond to patients with sensitivity and lack investment in training around care and communications skills.
All of the above have implications for PPTCT and women’s and men’s access to health services, including VCCT and HIV treatment. Increasing demand for and access to services needs to be combined with strengthening the capacity of health workers and strengthening health services at local level. Strategies to reduce stigma and discrimination related to HIV also need to address compounding factors where high levels of stigma surround condoms ,sex work, STIs, sex before marriage, MSM, transgender, and even women who are knowledgeable about sex. This is the environment that needs to change so that women and men are able to make decisions about and prioritise the sexual health needs of themselves and their partners.
Pauline Kenna, Gender Advisor, and Jo Kaybryn, Gender & HIV TA
Timgim Laip, Papua New Guinea
Tingim Laip is Papua New Guinea’s largest community‐based HIV prevention initiative, operating in 36 sites over 11 provinces. It is a project of the National AIDS Council, funded by AusAID.
[Facilitator's note: Below is a comment by Maura Elaripe from Igat Hope Inc., followed by a response from Peterson Magoola at the UNDP Papua New Guinea Country Office.]
Submitted by Peterson Magoola
First, let me take the opportunity to thank Maura for participating and sharing these useful thoughts.
I would like to highlight a few points on the issue of PNG social protection laws and guidelines, as shared by Igat Hope.
Last week’s stakeholder’s consultation on Social Protection was at the very first stage to the process of policy development. The four day meeting had representatives from various government departments, development partners, private sector, and Civil Society Organizations including those working with HIV positive people. UNDP,UNICEF, World Bank and the national task force on social protection, facilitated the consultation.
The meeting aimed at exploring good practice models, lessons learned and major challenges of SP programmes from within the Asia and Pacific Region, Africa and South America. It also provided a platform for stakeholders to share information and feedback to the Task Force on the draft report on Social Protection Models for PNG. This report is yet to be submitted to the National Executive Council (NEC), for endorsement and approval to develop a national social protection policy. The national task force working on this process, recommended “Safety Nets” model for PNG (which entails “… establishing programs that transfer cash or in-kind resources to deserving households to help them better manage the risks they face and the investments they must make in health and education for family members...”). The report recommended three vulnerable groups to be targeted initially i.e. children, the elderly and disabled.
Secondly, I would like to stress Maura’s point of meaningful involvement of HIV positive women and girls throughout this process. As we know, an issue of concern in the context of HIV in PNG, is the severe and wide-ranging socio-economic impact on people living with HIV and their households. It is a major concern on how HIV affected and infected population groups could be supported to improve and sustain their social economic conditions and access to services such as education, HIV treatment and other health-related services, economic opportunities, etc.
In terms of support, various development partners and UN agencies, have committed technical assistance to this process. Specifically, UNDP CO support to the social protection policy development is partly aimed at facilitating a more participatory, inclusive and consultative process, and ensuring that the policy help mitigate the impact of HIV especially for families and households of People Living with HIV.
As step forward, National AIDS Council Secretariat has been added to the team, and UNDP recently supported at least two members from the social protection task force, participate in the regional consultation on HIV-sensitive social protection in Cambodia. The CO have other areas of technical assistance to this process as highlighted below:
Finally, I salute Igat Hope for moving forward the advocacy agenda on issues affecting HIV positive people; and as we know, the most recent global financial and economic crisis has impacted differently on men and women (of course, children), and disproportionally affected women and female-headed households in various countries, including PNG. This has translated into greater disparities for specific population groups including women and girls living with HIV. It is important that voices from HIV affected populations are heard and considered in developing such policies/programmes, to cope with shocks ( be it social, economic, environmental, political, etc). With NACS and other key HIV players on board, the policy development will have a much participatory process including on the social and economic impact of HIV to individuals.
Looking ahead, the CO will build upon ongoing leadership initiatives for HIV positive women and girls in Igat Hope, and support their participation and contributions to the social protection policy development as soon as the process starts. In the meantime, it would be a great opportunity for Igat Hope and NACS to begin deliberating and exploring possibilities of conducting a Socioeconomic Impact assessment of HIV at the Individual and Household Levels, which would provide more evidence to inform the Policy development in Papua New Guinea.
I will be following up on these thoughts with NACS, Igat Hope and the Social Protection Task Force.
Best,
Peterson Magoola
Programme Specialist, HIV
UNDP
PNG Country Office
Deloitte Tower, Floor 14
Port Moresby, PAPUA NEW GUINEA
Tel: (675) 3212877 (ext. 214)
Email: peterson.magoola@undp.org
Submitted by Maura Elaripe
Hello everyone, I am writing in to share views from Igat Hope's perspective here in PNG. Igat Hope is the network of positive people in PNG and we have support groups of women living with HIV as well as our membership throughout PNG is mainly made up of women from the grassroots level, who are single unemployed women, widows, married unemployed women, rural women, sex workers and the same for men who are lesser in numbers.
The biggest challange for us in terms of our programs is who can we support this women to put food on the table for themselves and their children and also ensure the access treatments on a timely basis. So many times we see women missing out on treatments just to make sure other people in the family are taken care of. HIV programs are not addressing the isuue of income generation. I know that the focus is on skills building but how can a women start her onw income generation if there is no where for us to supply her with what she needs.
Children are missing out on education because parents can not afford to pay for the fees, people are dying earlier because there is no proper food to take with their medication and even people are developing resistance to first line ART regime as they are going on and off their treatments because they simply don't have bus fares to get to the clinic to replenish their supplies on time. It's all happening.
The social protection laws and guidelines set up in PNG are done without inputs from People Living with HIV especially women living with HIV. I am so angry and upset that guidelines and laws are being developed in PNG without core inputs from the people who are facing this problems.
Igat Hope is trying it's very best to assist its membership of about more than 7, 000 people living with HIV across the nation with no funding support. We are all interested in acieving our own agendas and ticking boxes off at the end of the day but the lives of the people who we are supposed to save fades away slowly..........
I hope that out of this discussions we will seriously involve positive women as leaders an agents of change. Develop guidelines and policies with them and engage them meaningfully and not on adhoc basis.
Regards
Ms. Maura Elaripe
HIV Health Project Coordinator
Igat Hope Inc.
Papua New Guinea
[Facilitators note: The contribution below will also be posted on the newly established Asia-Pacific Inclusive Growth and Development (AP-IGD) Network. The first thematic focus of the AP-IGD discussion will be on "Social protection" and will be launched in late August.]
In Papua New Guinea, there has not been much work done so far in terms of Social Protection, and this contribution will provide an overview of the current situation in the country and the way forward, highlighting the UN's (UNDP and UNICEF's) contribution in supporting what the government has initiated.
Assessments and studies of social protection initiatives in the Pacific undertaken by the World Bank and the ADB indicate that Papua New Guinea ranks low on Social Protection Index (SPI) among other Pacific countries (SPI measured by Expenditure, Coverage, Impact, and Distribution)[i]. This means that in PNG, there are social and economic challenges such as poverty (or hardship as it is referred to in this region), access to and quality of education, and access to health services among others, which create a greater burden on Papua New Guineans, as compared to households in other Pacific countries. One would note that about 80% of the whole Pacific population is actually found in Papua New Guinea, thus accounting for a greater need to address the plight of the most vulnerable and marginalized communities. About 85% of the population of PNG lives in rural areas and depend on subsistence agriculture for their livelihoods.
Social protection mechanisms are not new in the Pacific, but the recent global economic crisis has heightened the awareness of governments that more needs to be done to strengthen resilience during better times so that communities can cope in times of hardships and crises. In this context, the PNG government through the Department for Community Development has embarked on the initiative to support the establishment of and strengthen existing social protection programmes as a means of improving access to and quality of social services at the household level as well as providing a basis for the achievement of MDGs. As we know, social protection aims at reducing the vulnerability of households. For those already below the poverty line and those susceptible to fall into poverty, it affords the opportunity to rise above it by cushioning the impact of shocks, such as sickness or crop failure, and allows access to economic opportunity. For those above the poverty line, it provides a buffer or protection that can keep them afloat even if shocks such as death of a breadwinner, drought or fire were to threaten the livelihood of the household.[ii] While the "wantok" system of Papua New Guinea provides a safety net for family members who are in need, it also puts financial and other pressure on families and communities to care for an extended group of family members.
The Government of Papua New Guinea has, for some time, been looking into the type of social protection system that is most suitable for PNG, recognizing that there are various models available. Consequently, a Social Protection Task Force has been established through a decision of the National Executive Council, based on a joint submission by the Ministers for Community Development and the Treasury respectively. The task force is chaired by the Department for Community Development, with other members including the Department of National Planning and Monitoring, the Department of Treasury, the Department of Education, the National Department of Health, the Department of Agriculture Livestock, the Department of Labour Industrial Relations, the Department of Provincial Local Level Government Affairs, as well as Development Partners, Civil Society Organizations, and the United Nations. The composition of the Task Force signals an all-inclusve approach that draws from experiences and lessons learnt from other parts of the world.
The main objective of the task force is to investigate and develop a formal policy framework on social protection for PNG and report back with relevant recommendations of the type of social protection model or approach most suited for this country. The Government has highlighted that their social protection policy can be characterized by four words:
The initial work of the task force was to analyze the current social protection models and make a recommendation for the government on which model PNG should adopt. After a detailed analysis and various rounds of reviews, a report recommended Social Safety Nets (SSN) as the most appropriate model for social protection in PNG. This model drew on the existing practices in many countries in Africa, South America, Middle East, India, and South East Asia. Following up on the report, the Task Force called for a High Level Stakeholders Consultation to review the findings and recommendations and gather additional inputs from stakeholders. The consultation will take place from 1-4th August 2011 in Port Moresby and we should be able to share more details subsequently. We should highlight that consultations have been held at provincial levels to ensure that the policy is understood by all and informed by both the reality on the ground and the indigenous culture, norms and practices of PNG.
The UN - particularly UNICEF and UNDP - has played a significant role in the process by providing technical assistance to the government as well as sharing the knowledge from within the region such as the recently concluded regional consultation on HIV sensitive social protection programmes in Cambodia. UNDP had supported two participants from the Social Protection Task Force in PNG to attend the meeting and this has strengthened national understanding of some of the key considerations that need to be applied to any social protection framework. After the Cambodia meeting, the PNG team drew up a plan of action which included developing a child-centered, HIV-sensitive and gender-equitable Social Protection Policy for PNG.
The PNG UNDP CO, through the HIV, Health and Development portfolio, provides support to this process to ensure key cross-cutting issues are part of the policy i.e.
In the final analysis, the UN's role in this process is to ensure that the upcoming Social protection policy contributes to an equitable distribution from the proceeds of high economic growth and hence targets accelerated poverty reduction in the MDG+ agenda. We know that social protection programmes only are not sufficient but need to be coupled with sound macroeconomic policy, good governance and access to basic education and health care for all so that it helps to sustain the already achieved economic gains and further contribute to human development in Papua New Guinea.
With best regards,
Carol Flore-Smereczniak
Deputy Resident Representative
Peterson Magoola
HIV Specialist
Dear HIV-APCoP members,
While we had good responses from members on the survey, we have not received sufficient comments or feedback to the discussion itself. Therefore, while we still welcome your comments to the issues outlined in the first part, i.e. economic, food & nutrition and education, we are now launching the second part that looks into the issues of health, stigma and discrimination and household burden and care. We would like to hear your comments, views and personal experiences on the impact of HIV on women and girls and how best to respond. We would also like you to share existing examples and/or ideas of social protection schemes that could address the impacts.
This discussion has the potential to inform policies and strategies on HIV and social protection for women and girls in the region. We hope you will use this opportunity to have your say.
HIV-APCoP Facilitator
I would like to begin this comment with a few observations made during a fieldtrip to four Self-Help Groups of a Cambodian network of WLHIV in May 2010. During visits to these groups, the women reported incidents of villagers refraining from buying vegetable products they had produced for sale; neighbours stigmatising WLHIV and their children; incidents of gender based violence; pregnant mothers unable to access PMTCT due to lack of money; lack of employment; the depletion of their income and capital; falling into debt with private money lenders – the list went on, in line with the findings of UNDP’s survey. While the occasional appearance of a father or uncle invited silence, these women's self narratives displayed heightened perseverence, determination and humour during moments when no men (excepting a male consultant) were around, with several young mothers sharing their experience, hopes or expectations regarding pregnancy; and their desire - brought about by the absence of their menfolk who had migrated after work - for sex (this discussion topic was accompanied by much laughter and nodding). However, in all four groups, the overall impression was one in which the prayers of women were concentrated on the hope that someone would intervene and the circumstances of their lives would be changed.
Mitigating the impact of HIV on women requires changing many things, and when many things need change, how does one go about such an effort? Lately, I have been involved in efforts to address mainly the following two elements of this puzzle: the first relates to the question of how to break the cycle of poverty (which often requires structural and/or policy changes related to employment, education and literacy, health care, and asset ownership, for instance), and the other is related to efforts to affirm a sense of agency and self-worth among HIV+ women (through psychosocial / religious support, building the skills and capabilities in WLHIV in various areas, and efforts to change social understandings and behaviours of the community regarding HIV and wo/men).
Members of the WLHIV network whose Self-Help Groups I visited have frequently underlined the needs for “food, not just medicine”, and for income and employment. Past interventions of this network have included activities designed to develop the skills of WLHIV in farming and in writing applications to access small grants, for instance. Neither intervention seems to have born much fruit, which I suggest is due, in part, to the rapid interventionist model applied, in place of long-term, sustained efforts; the lack of a detailed preliminary assessment of the employment market and the “needs and wants” of WLHIV, respecting their right to self-determination (working "with" rather than "on" the women involved in the activities); and lack of multisectoral collaboration at all levels to address issues varying from literacy and (adult) education, to rural development (roughly four-fifths of the Cambodian population live in rural areas), and efforts to facilitate women’s work outside the home.
As a closing remark, I would like to argue that there is a need to increase the involvement of WLHIV in identifying and developing strategies and interventions to mitigate the impact of HIV. On the basis of my experience in Cambodia (where gendered inequalities are pronounced in the education system, the labour market is sharply segregated, and where women and girls living with and affected by HIV and AIDS have very limited opportunities to pursue education or diverse career paths), this will, I argue, require increasing (financial and “time”) support to WLHIV who have decided to play this role, providing support on how to navigate administrative and financial requirements and changing donor priorities; how to develop workplans and monitor these; and how to develop (policy and programmatic) actions to address gaps in the response, for example.
These as brief comments.
[Facilitators note: We are pleased to share with you comments we received on the survey on economic, food and nutrition and educational impacts of HIV on women and girls. We look forward to hearing from you with more examples and your experiences and views on these issues]
Economic:
* The economic impacts vary considerably between different countries, and depend on national expectations and legislation surrounding women's ability/right to economic performance. There are some very practical changes that need to take place which overtly discriminate against women's entry into the business and financial arenas whether at local or larger scale levels. In Indonesia, for example, married women need their husband's authorisation to open a bank account. Such practices are reinforced by national processes, e.g. the national census assumes that a male is the 'head' of a household and the main income earner.
* Ownership of business or farms is another place where women have very little control. Many women in household give all they have to the family business/farm and make a substantial contribution towards it yet they do not have any legal authority and this can be crippling.
Food & Nutrition:
* Food prep and so on -- gendered roles of food preparation and provision/allocation in households will determine who has access to best food and who has unpaid work of preparation and provision especially for garden root crops.
* In the Pacific culture, women usually eat last, therefore while there is access to food and nutrition, quality of a meal depends on what the men leave after they have eaten.
* Being able to eat with and/or ahead of males would be nice; too many studies show women and children eat after men and boys, and often it is the less tasty, less nutritious foods.
Education:
* A lack of study environment in the home is what is lacking most in Pacific islands. Homework reinforces what is learnt at school. Often this is missing in the education equation. At least in most homes in Fiji.
* Free education is generally promoted by poor country. Quality of education should also be a concern.
Dear HIV-APCoP members,
Thank you very much for the responses to the short survey we conducted to identify the areas of impact that need priority attention. Please see below a short summary of the findings of the survey on the “most critical impacts of HIV on women and girls in Asia and the Pacific”.
Please find details of the survey in the form of this auto generated Summary Report.
The discussion on socio- economic impacts of HIV on women and girls in Asia and the Pacific will be divided into two 2 parts:
Part 1: Will run from 3 - 9 August and will look into impacts and responses to economic, food & nutrition and educational issues
Part 2: Will run from 10 - 16 August and will look into impacts and responses to issues relating to health, stigma & discrimination and household burden.
We would like to hear your comments, views and personal experiences on the impact of HIV on women and girls and how best to respond. It will be particularly enriching if you could cite from relevant studies or documents that strengthen your observations. Since the main aim of this discussion is to find ways and means of impact mitigation, particularly within the context of social protection, we would also like you to share existing examples and/or ideas of social protection schemes that could address the impacts.