gender & health glhlth 310 october 31, 2013 melissa watt, ph.d. assistant professor, duke global...
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Gender & Health
GLHLTH 310 October 31, 2013
Melissa Watt, Ph.D.Assistant Professor, Duke Global Health Institute
Coordinator, Duke CFAR Social & Behavioral Sciences CoreAssociate Director, MSc-Global Health
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• Sex vs. Gender: What matters?• Gender disparities in global health• Addressing gender in health programming• Gender & HIV
Outline
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SEXvs.
GENDER
Gender is the social construction of the biological differences between men and women
Gender is not “Sex”Gender is not “Women”
Gender is learned, socially determined behavior
Roles, status, norms, values
Responsibilities, needs, expectations
GENDER
THE DIVISION OF LABOUR, POWER AND
RESPONSIBILITIES
THE DISTRIBUTION OF RESOURCES AND REWARDS
Sexuality and Sexual behavior
FAMILYRESOURCES
ECONOMIC AND SOCIALRESOURCES
POLITICALRESOURCES
INFORMATION & EDUCATION TIME
ACCESS TO AND CONTROL OVER:
POWER AND DECISION-MAKING
Gender, interacting with other variables defines:
Achieving gender equity in health implies eliminating inequalities between women and men which are unnecessary, avoidable and therefore unjust. Achieving gender equity in health implies eliminating inequalities between women and men which are unnecessary, avoidable and therefore unjust.
Gender equity in health
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Gender Inequality
Poor Health
POVERTY
Caste
Ethnicity
Disability
Sexual orientation
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Gender in international organizations
• Integrate/mainstream gender considerations in all facets of work
• Collect and review disaggregated data by sex
• Initiate work to specifically address gender inequalities
• Ensure gender equity in hiring
• Convention on the Elimination of All Forms of Discrimination against Women (1979)
• Beijing Platform for Action (1995)• UN Security Resolution 1325 on Women,
Peace and Security (2000)• Millennium Declaration / Millennium
Development Goals (2000)
UN guiding documents to promote gender equality
UN Millennium Development Goals
Agreed by 189 countries in 2000, to be achieved by 2015!
Group work:• How is this MDG related to gender
and health?• What are gender issues that need to
be addressed and mainstreamed into this MDG?
What are the gender & health issues relevant to the MDG?
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GENDERand HIV
South Africa:HIV Prevalence by gender & age
Data from Avert.org, 2008
Overall 60% of those with HIV are women
15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60+0
5
10
15
20
25
30
35
FemaleMale
Age
Prev
alen
ce o
f HIV
(%)
• Vulnerability of HIV infection is different for men and women
• Two sets of reasons:– SEX: Biological and physiological reasons– GENDER: Social norms and values: risks that are
socially and culturally created
Gender and HIV risk
Biological and Physiological ReasonsWomen’s biology makes HIV transmission more efficient from
a man to a woman that a woman to man. Reasons include: There are higher concentrations of HIV in semen than in vaginal
fluids Coercive or forced sex might lead to micro lesions in the genital
tract that facilitate entry of the virus. Women often have STIs that are left untreated, which increases
vulnerability to HIV
Gender and HIV risk
Social Reasons: Risks Socially and Culturally CreatedKeeping women ignorant and passive about sex is the norm
in many cultures. This greatly constrains their ability to negotiate Safe sex Condom use Access to appropriate services, care and treatment
Women don’t always have the power / ability to negotiate the terms of sex Early marriages Economic dependence Violence / threats
Gender and HIV risk
Men are also subject to social and cultural pressures that increase their susceptibility to infection and likelihood of spreading HIV Multiple partners and sexual infidelity are condoned
and often encouraged Certain occupations tend to encourage risk taking
behaviorSpending long periods away from familiesCommercial sex behavior can be linked to business
and peer social behaviors
Vulnerability of men
Gender and HIV risk
HIV prevention strategies
Abstain
Be faithful
Condomize
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Abstain
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Be faithful
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Condomize
Alternative HIV prevention strategies
Gender relations
Economics
Migration
Gender relations• Individual decision making is not always
possible• Relationship power facilitates or hinders HIV
protection behavior• Property rights, literacy/education, assets
shape HIV risk• Sexual violence
Gender relationsIntervention approaches• Give women sex negotiation skills• Emphasize to women: your own monogamy is
not protective• Intervene with men/couples: address gender
norms• Female-initiated methods (e.g., female
condoms, microbicides)• Recognize tension with desires for children
Economics
• Transactional sex (both formal and informal)
• Economic dependence• Sense of hopelessness• Substance use/
addiction
Economics
Interventions• Schooling for girls• Training and employment for women• Addiction treatment• Cash transfers Money = Bargaining power = Choice
• Family instability• Opportunities for sexual “mixing” (migrant &
partner left behind)
Migration
Interventions• Economic policies, rural development• Multisectoral strategies: sexual and
reproductive health, coupled with negotiation skills and economic empowerment
• Network approaches
Migration
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Abstain
Be faithful
Condomize
Behavior Change
Gender relations
Economics
Migration
Social Drivers
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In summary:
In Global Health, GENDER
MATTERS.
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