According to the World Health Organization, AIDS is the leading cause of death among women between the ages of 15-44 worldwide. Nearly 60 percent of those living with HIV in sub-Saharan Africa are women. There is a critical need to address inequalities between women and men that influence sexual behavior and the norms that put women at higher risk of infection and create barriers to accessing HIV/AIDS services. In response to women’s advocacy groups, the Office of the Global AIDS Coordinator (OGAC) recognized that addressing gender issues is essential to reducing the vulnerability of women to HIV infection and responded by integrating gender strategies into its care, treatment, and prevention programs.

PEPFAR focuses on five key cross-cutting gender strategies in its attempt to curb HIV/AIDS, ensure access to quality services and mitigate consequences of HIV. These strategic focus areas include: increasing gender equity, addressing male norms and behaviors, reducing violence and coercion, increasing women’s and girls’ access to income and productive resources, and increasing women’s legal protection. Activities in support of these focus areas are assessed annually during the Country Operational Plan review process. In FY 2008, approximately $1 billion was dedicated to more than 1,000 activities that included interventions to address one or more gender focus areas. However, there has been no way to assess the extent or quality of these activities.

These strategies fall short in adequately addressing the AIDS pandemic among women and girls because prevention policies fail to meet the needs of women. Through U.S. preferences for abstinence and faithfulness programs, the prevention needs of married women are ignored.  Moreover, young women need to have access to full information and services, not the piecemeal, abstinence-focused programs offered to youth by many U.S. grantees. The fact that most women and young women are contracting HIV within marriage or primary partnerships is a clear sign that focusing on abstinence and fidelity does nothing to empower them in protecting themselves.  Innovative strategies for prevention that provide women and young women with the tools  required to protect themselves – including female and male condoms and programming - need to be emphasized and implemented broadly.

Recent Developments

The new U.S. Global Health Initiative (GHI) prioritizes a woman- and girl-centered approach, which prioritizes the health of women and girls as vital to the health of their communities.  As part of the GHI, PEPFAR has also expressed a commitment to this approach, embracing the idea that the marginalization of women negatively affects women’s access to health care and the protection of their health and rights.

Female Condoms: A Woman-Centered Prevention Tool

Women around the world are demanding increased access to female condoms. The female condom, which protects against HIV transmission and allows women to plan their families, is a tool that women can initiate themselves, giving them a say in their own protection. In "Choosing Prevention," documentary filmmaker Martha Dodge talks with women and men in Malawi about why female condoms are necessary.