What Works for Women and Girls

dealing with their sorrow, grief, and facing an uncertain future (Ogden et al., 2004). In addition,women who mother and care for children living with HIV in resource-limited settingsface many challenges, ranging from the routine of pill-taking to disturbing discussions onhealth. One eight-year-old girl said: “Mummy tells me to take my pills, otherwise I will die andto not tell anybody…because it’s AIDS” (Hejoaka, 2009: 873).Gender norms keep men from participating more fully in care and support, althoughsome programming to increase the role of men is underway (Gomo, ND). Providing monetarysupport for men and boys who provide care and support could also expand their participation.However, shifting some of the burden of care to men will be insufficient to “address theprofound issues of poverty, strain and hardship of caregiving on families and households.Nor is it likely to meet the ever growing gaps in services and safety nets on the part of governmentsassociated with health sector reforms, decentralization, privatization and cuts to socialspending” (United Nations, 2008b: 9). A 2008 study of 31 focus groups with 264 people invillages, health clinics and hospitals in three districts in Lesotho to assess HIV/AIDS care fromthose participating in and potentially affected by health care initiatives found that men stand tolose respect from other men and discretionary time by entering into community home-basedcare, but stand to gain economically by now working as a remunerated community healthworker. While men’s participation in community-based home care can alleviate the disproportionateburden of HIV/AIDS care, women stand to lose the benefit of social recognitionand may face competition from men for community health worker jobs. Training for maleand female community health workers should involve critical reflections on gender roles andresponsibilities. More than 70% of men in Lesotho were willing to care for a family memberwith AIDS in their home with training and support (Newman et al., 2009).The Financial Toll of HIV and AIDS is GreatHIV and AIDS can take a tremendous financial toll on households. Asset liquidation amongAIDS caregivers to cope with the economic impact occurs, first liquidating savings, then businessincome, then household assets, then productive assets, and finally, land (Strickland,2004). Profits from sales of assets may offset losses resulting from caregivers (usually womenand girls) being diverted from other income-generating activities. Of note, land is the lastasset to be sold given its centrality to sustaining women and families (Drimie, 2002, cited inStrickland, 2004). Up to 41% of female-headed households live below local poverty levels andlack resources to buy land or property or develop land allocated to them (UN Habitat, 2002cited in Strickland, 2004). A study of 300 households in Nigeria found that costs for HIV treatmentand care consumed between 17–25% of household income. Expenditures greater than10% usually require that household members do not meet their basic needs (Odiahl, 2008).Assessment of HBCB programs in South Africa found that poverty is a constant underlyingissue for many HIV-affected households (Horizons, 2005).For those who are linked to programs, a number of studies find that more women thanmen attend care facilities, reflecting both that women have more access to health servicesduring pregnancy, to obtain contraception or to obtain health care for their children, as wellWHAT WORKS FOR WOMEN AND GIRLS345