Thunder is Not Yet Rain: Highlights from the Launch of the New HIV/AIDS Monitor Report on HIV/AIDS and Gender Inequality

Last week, CGD launched a new report at the National Museum for Women in the Arts. The report examines how three major HIV/AIDS funders have worked to address the needs of women and girls in three African countries.For those of you who were unable to attend the event, the presentation (with audio from the presenters!) can be watched online and we will post clips from the video in the coming weeks.The event featured a presentation by Nandini Oomman, Director of the HIV/AIDS Monitor, and Kim Ashburn, Gender and HIV/AIDS Scientist at ICRW, highlighting key findings and recommendations of the report. This was followed by a panel discussion, moderated by Ruth Levine, where representatives of PEPFAR (Nomi Fuchs-Montgomery, Senior Technical Advisor for Prevention and Gender), the Global Fund (Dr. Françoise Ndayishimiye, Senior Gender Expert), and the World Bank (Elizabeth Lule, ActAfrica Manager) responded to questions derived from the report’s recommendations. In addition, Ms. Jane Mpagi contributed her perspectives from decades of experience working within the Ugandan Ministry of Gender, Labour and Social Development. Karen Hardee, Vice President of Research at PAI, contributed the knowledge she cultivated through creating a compendium (forthcoming) of HIV/AIDS interventions that have worked to address gender issues.Discussion Highlights:

The questions put to the panel by Dr. Levine challenged the donors and the broader global health community to make some critical changes to the way we do business. The ensuing discussion had many dimensions. Everyone seems to agree that HIV/AIDS donors have to pursue transformative social change concerning gender inequalities if we are to be effective in the fight against HIV/AIDS. This means: doing the necessary context specific analysis of how gender inequalities affect the fight against HIV/AIDS so that programs can be designed based on this evidence; ensuring that assorted programs are designed and properly resourced to address these issues; measuring the progress of these interventions; and investing in the technical know-how for this work as a core-competency in the fight against HIV/AIDS.There were some honest admissions. For instance, Elizabeth Lule described how the hasty start to MAP meant they did without the necessary gender analysis. Françoise Ndayishimiye from the Global Fund was regretful that after a year of effort between the GF and their partners, they had failed to agree on gender indicators to include in the upcoming version of their M&E toolkit.Nomi Fuchs-Montgomery discussed a hopeful future for addressing gender within PEPFAR. She said there is strong commitment at the global level, though implementation must be driven by countries. They are hoping that the new gender narrative portion of the Country Operational Plans will help ensure that PEPFAR country teams analyze and address gender inequalities as needed in countries.Jane Mpagi reminded us that governments are not monolithic, particularly in their perspectives and understandings of addressing the needs of women and girls. For instance, the Ministry of Health often claims they are addressing gender inherently because they are providing services to women and girls, while the Ministry of Gender is looking to pursue structural change in social norms, and the Ministry of Finance is focused on macro-economic growth. So a “country driven” initiative could go in many directions.On measuring progress, Karen Hardee suggested that gender and HIV/AIDS experts should be locked in a room together, and not allowed to come out until we have some clear and measurable indicators for addressing gender inequalities through HIV/AIDS programs.

In her closing remarks, Geeta Rao Gupta, the president of ICRW, made a number of important points to sum-up the issues raised by the panel (please forgive me for not doing them justice. We will try to get the video up so you can see for yourselves):

• First, context matters. The needed changes in programs can only happen through analysis of the issues within local contexts.
• Second, there are too few people out there with the technical know-how to do this work. This pool of expertise needs to be broadened by investing in the necessary technical skills. Jane Mpagi seconded the view that we need to move past sensitizing people to gender inequalities to building know-how.
• Third, we need evidence. Randomized control trials are not necessarily the gold standard in issues of social change. Useful intelligence could be gained by integrating social factors into regular national surveillance efforts.
• Fourth, our obsession with “scaling-up” may be misleading. Changing social norms is a retail exercise, not a wholesale exercise. It can be achieved by replicating initiatives in many places simultaneously in pursuit of a normative tipping point.

Many people reading this blog, watching the presentation, and reading the report might think to themselves: this is nothing new. We have known about these issues for decades, yet in the fight against HIV/AIDS, gender inequality is often an add-on concern.Throughout the panel discussion we get a glimpse of progress and opportunities amongst PEPFAR, the GF and the WB. In particular, the high level commitment is there, with exciting new forthcoming policies and programs. But as Geeta Rao Gupta rightly said: “thunder is not yet rain”. We need to continue to make specific changes to move beyond gender as usual.