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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 or HIV, 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.
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 respond to promote gender equality. 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.
The United Nations Capacity Development Assessment Tool provides guidance on the capacity required to undertake a gender assessment for HIV.
Data needed for an effective HIV response
Assessing HIV-related health issues for 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 are 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
- 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, and
Programmes to respond adequately to the HIV-related health rights of AGYW.
Empowering and involving adolescent girls and young women
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 programs 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.
AGYW-led and serving organisations should be supported to be representatives on multi-stakeholder co-ordination and decision-making structures, such as Country Coordinating Mechanisms, 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.