Gender Analysis: AIDS + Microbicides Preventing the transmission of HIV

The development of microbicides — compounds that women can apply vaginally to prevent the transmission of HIV — promises to revolutionize anti-AIDS strategies in developing countries that are being devastated by the epidemic. The inspiration for this relatively low-tech innovation came not from the research lab but from gender analysis.

“If someone had asked 20 years ago, ‘What will women need in order to protect themselves?’” says Lori Heise of the Program for Appropriate Technology in Health, the AIDS epidemic in the developing world, where 60 percent of victims are now women, “might have been a different story.” But a “gender blind spot,” according to Heise, kept the question off the table during the early years of the epidemic.

That changed in 1990, at an international preventive health care conference in Washington, D.C. Frontline health workers from developing countries argued that the strategy of the day — “condom education and condom distribution” — took no account of the social reality of the women they worked with and, as a result, was simply ineffectual.

The health workers had in effect conducted their own gender analysis. Their findings challenged current practice. First, the at-risk women they needed to reach were married — to men who were having “outside relationships.” Second, the women were often economically dependent on their husbands. In “epidemiological discourse,” says Heise, “we say risky behavior is not using a condom.” But insisting that their husbands use condoms — “not for a one-night stand, but forever, as part of their marriage” — put women at real risk of ending up rejected or divorced, “thrown out of the house.” Third, many of the women were young and wanted children. They needed to be able to protect themselves and get pregnant — using a means they could control.

In other words, the social position of women made the apparently gender-neutral idea of condom use profoundly impractical. Taking account of that social situation led to the launch of the Global Campaign for Microbicides, a broad-based coalition of NGOs working toward new prevention options for women: “If they can send a man to the moon,” asked a Ugandan health organizer, “why can’t science produce something that women can use to protect themselves and allow them to get pregnant while staying healthy?”

As Heise found when she began questioning scientists immediately after the conference, science can produce such a thing – if someone thinks to ask for it and supports its development. The recently created International Partnership for Microbicides has helped do both by accelerating the development of several products for the large-scale trials needed to gain regulatory approval.

With those approvals still several years away, “it’s important not to let the gender perspective slip,” argues one grant maker. In fact, a good interim solution, he suggests, might be the female condom. And as with microbicides, moving it off the “back burner” will mean getting past “paying lip service to the gender perspective.”


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