Gender assessments - Capacity Development for Health

Gender assessments of HIV, TB, and malaria interventions

What is a gender assessment?

A gender assessment is a consultative, multi-stakeholder process that aims to analyse and understand the national context for health issues, such as sexual and reproductive health, HIV, TB and malaria, from a gender perspective. It looks at structural factors, such as laws, policies, practices, socio-economic, cultural and political factors, to consider issues of gender inequality, harmful gender norms and gender-based violence and how they increase people’s vulnerability to HIV, TB and malaria and other health risks.

It also considers how these human rights issues block access to health care services and the ways in which laws, policies, plans and programmes have and can promote gender transformative responses.

Finally, it looks at ways in which to address gender inequality, harmful gender norms and gender-based violence in comprehensive health information, prevention, treatment, care and support programmes.

Integrating gender asssessments into Global Fund grant design

UNDP serves as interim Principal Recipient of Global Fund programmes for HIV, TB, malaria, and health systems strengthening in challenging country contexts. In the context of these programmes, as in other health programmes, it is critical to integrate gender considerations from the beginning of the grant design process. Grants should be based on gender and intersectional analysis of disease risk and service access (including age, mobility status, key population status, where most relevant), particularly in TB and malaria grants, where gender considerations are often less prominent, compared to HIV grants.

For a quality and useful gender analysis, the following three components are required:

Documentation of sex-disaggregated data of disease risk, service access and treatment outcomes in the country;
Identification of the socially-constructed gender norms and inequities that explain any gender differences in disease risk, service access and treatment outcomes in each country’s context (and/or drawing on relevant regional evidence);
Identification of effective interventions and approaches to address the identified gender inequities as drawn from the local context, and/or from international literature and experiences.

The grant development phase should draw on, and advocate for investment in, local gender data and primary research. This might include engaging with local experts, academics, community researchers, and key population communities, to commission prioritized data collection, evidence generation and research. It is also important to utilize the practice-based knowledge of programming partners, as well as international research, to gain a formative understanding of gender-related barriers and to inform more systematic documentation, local research design and data analysis. These could draw on expert consultation, community surveys, participatory action research, and in-depth qualitative interviews, among others.

Data needed for a gender-sensitive HIV response

Assessing HIV-related health issues for adolescent girls and young women (AGYW) requires various forms of data, not simply on HIV incidence, prevalence, morbidity and mortality. It requires gathering information on:

The HIV epidemic amongst AGYW, including in different locations and amongst different sub-populations, including disaggregated HIV epidemiological data by sex, age group, marital status, AGYW in and out of school, geographical area and other demographic factors.
Behavioural factors linked to the behaviour of young women and male partners, such as:
- Age disparate sex
- Multiple partnerships
- Sex work
- Sexual exploitation of adolescent girls
- Transactional sex
- Early sexual debut
- Gaps in knowledge and limited personalized risk perception
Biological factors linked to their own biological susceptibility and that of male partners, such as:
- Biological susceptibility of women
- Biological susceptibility of adolescent girls
- High HIV viral load amongst male partners
- Low prevalence of male circumcision
- Harmful practices
- Other infections
Structural factors – contextual factors that contribute causally and may also be linked to barriers to access to services, such as:
- Harmful social and gender norms, gender inequality and unequal power dynamics
- Human rights violations, stigma and discrimination, punitive and discriminatory laws and policies
- Low secondary school attendance
- Labour migration and spousal separation
- Barriers to access to sexual and reproductive health care services
- Orphanhood
- Child sexual abuse
- Gender-based violence
- Marriage patterns, including low marriage rates and early marriage.

Challenges in accessing HIV prevention, accessing and adhering to treatment and maintaining care
The current national HIV response, including existing programmes and their effectiveness, existing providers, health systems-related capacity and constraints
Programmes to respond adequately to the HIV-related health rights of AGYW, including the impact of COVID-19 on HIV risk.

Learn more:

UNAIDS (2016) HIV Prevention Among Adolescent Girls and Young Women

Global Fund (2020) Adolescent Girls and Young Women in High-HIV Burden Settings: Technical Brief

UNDP (2020) Gender-based violence and COVID-19

UNAIDS (2020) Six Concrete Measures to Support Women and Girls in all their Diversity in the Context of the COVID-19 Pandemic

Tools for participatory gender assessments

There are various tools available to support countries to assess and respond to the gender dimensions of HIV, TB and malaria responses. Several of these are included in the key resources below.

The meaningful participation of adolescent girls and young women in the planning, design, implementation, and monitoring of health programmes is particularly important for ensuring their needs and interests are addressed in health services.

AGWY-led and serving organisations should be supported to be representatives on multi-stakeholder co-ordination and decision-making structures, such as Country Coordinating Mechanisms in the context of Global Fund programmes, and to participate more broadly in processes, country dialogues and consultations, and the implementation and monitoring of programs. This may also require capacity strengthening to participate in advocacy, decision-making and planning, implementing and monitoring programs.

Meaningful participation of adolescent girls and young women in health programmes

The Global Fund, PACT and UNAIDS Youth Participation Tool shows how youth can be involved in planning processes, including Global Fund processes, from start to finish. This tool can also be specifically adapted to AGYW.

Meaningful participation requires programmes to:

Ensure AGYW are beneficiaries of programmes to address their specific needs;
Engage AGYW as partners to collaborate on the design, implementation, M&E of programs, policies and interventions that affect them
Support AGYW as leaders, to initiate and direct their own interventions.

Learn more:
Global Fund, PACT and UNAIDS Youth Participation Tool
Global Fund (2020) Adolescent Girls and Young Women in High-HIV Burden Settings: Technical Brief