What Works for Women and Girls

combining microfinance and training on gender and HIV, which is discussed in more detailin this chapter, provides an example of an intervention to strengthen social capital by creatinga support network among the women involved (Pronyk et al., 2006).The following interventions and supporting evidence demonstrate a number of ways tostrengthen the enabling environment for women and girls and tackle the underlying roots ofwomen’s greater vulnerabilities to HIV and AIDS. Each topic is introduced in more detail inthe sections outlined below. Although many of the interventions in this chapter are “promising;”a number could be scaled up to achieve a larger effect.11A. Strengthening the Enabling Environment:Transforming Gender Norms“The global HIV pandemic in its current form cannot be effectively arrested without fundamentaltransformation of gender norms” (Dunkle and Jewkes, 2007: 173). The social issueswomen face that make them particularly vulnerable to HIV are related to gender norms thatprivilege men over women in most societies. Women are particularly harmed by discriminatorygender norms, although evidence is mounting that gender norms harm both women’s andmen’s health (WHO, 2007a). For both women and men, gender norms are codified throughpublic policy in a range of issues (Barker et al., 2010). Gender norms, including those thatinfluence sexual and power relations, influence all program areas related to HIV/AIDS, fromprevention of HIV for girls, to treatment, care and support.Traditional Gender Norms Lead to Behaviors That Put Women at Risk for HIVWomen are less likely to have access to resources and more likely to depend on men for financialsurvival for themselves and their children. Such dependence makes it difficult for womento negotiate sex or safer sex with their partners. Women’s mobility is often curtailed. For manywomen, a central survival strategy for themselves and their children involves having morethan one partner. For example, a study in Haiti showed that to balance the multiple demandsof family and economic survival, single mothers enter into a series of sexual relationships inorder to obtain food and housing for themselves and their children (Fitzgerald et al., 2000). Astudy in Tanzania found that 70 percent of sexually active girls reported granting sexual favorsto meet their basic daily needs (Maganja et al., 2007).In sexual relationships, women often lack power to protect themselves. A survey of 812young women in Vientiane, Lao People’s Democratic Republic, along with 18 focus groupdiscussions and 13 in-depth interviews found that young women lacked power to negotiateboth sexual activity and condom use, with 25% reporting coerced sex and 30% of sexuallyactive women having multiple partners in 2007 (Songbandith et al., 2008). Cross-sectionaldata from 135 sexually active female students at a university in South Africa found that thewomen’s perceptions of HIV risk were related to a feeling of lack of control over risk dueWHAT WORKS FOR WOMEN AND GIRLS289