The Global Fund: Women & Girls
Women and girls continue to be disproportionately affected by HIV, TB and malaria. Gender inequality, discrimination, violence, limited access to education and a lack of tailored services inhibit women’s and girls’ access to health care and fuel new infections.
HIV remains the leading cause of death of women of reproductive age in low- and middle-income countries. Worldwide, about 1,000 young women and girls are infected with HIV every day. In the hardest hit countries, girls account for more than 80 percent of all new HIV infections among adolescents and are up to eight times more likely to be living with HIV than their male peers.
While TB generally strikes more men than women, it remains among the top five causes of death for women between age 15 and 44 in low- and middle-income countries. As for malaria, pregnant women are particularly susceptible to this disease. Potentially fatal for the woman, it can also cause miscarriage, low birth weight or premature births.
Biomedical interventions such as access to treatment and mosquito nets, while urgent and necessary, are not sufficient to reduce women’s vulnerability to HIV, TB and malaria. Only structural transformations – social, political and cultural – will end the spread of the diseases.
To end HIV, keep girls in school If we invest in girls’ schooling, health benefits will follow. A better-educated girl is less likely to get HIV, and more likely to have control over her body and be able to make her own choices about when or if she will marry or have children. And it not only makes a difference for her, it makes a difference for generations to come. Her children are more likely to survive infanthood, more likely to be vaccinated and more likely to go to school themselves.
Sex for fish
With a furrowed brow, Elizabeth Masere faced the camera and told the story of her life matter-of-factly. She spoke of the tough job of trying to raise her six children by selling fish at the shores of Lake Victoria – East Africa’s largest lake. She told about the men who controlled fishing and who exploited women for sex. As hard as money was to come by, having it did not guarantee she would get the fish she needed to sell, Elizabeth said. To sell her their fish, the fishermen demanded not just money, but sex.
Investments in women and girls
We have been steadily increasing our investments in programs for women and girls. US$105 million of US$200 million in catalytic funding for HIV has been allocated for prevention, including matching funds to leverage even greater investment in programs for key populations and adolescent girls and young women. We are also expanding our investments to support malaria control efforts and strengthen access to antenatal care. In 2017, 696,000 mothers received medicine to prevent transmitting HIV to their babies in countries where the Global Fund invests.
Interventions that support women and girls in gaining access to health services vary by country. For example, in Afghanistan, the Global Fund is investing in female community health nurses, supporting them to deliver TB prevention and care to women in remote communities who otherwise cannot visit health facilities without the escort of a male relative. In Lesotho, the Global Fund has invested in the development of National Guidelines for Prevention of Mother-to-Child Transmission of HIV, as well as in integrating sexual and reproductive health with HIV services so that women can access both services in one place.
Other investments focus on education, which can be a powerful tool in preventing HIV among adolescent girls. A study showed that secondary school students in Botswana who stayed in school for an additional year had an 8 percent lower risk of HIV infection about a decade later.
Our funding model supports programs designed to reach women and girls with comprehensive health services. In particular, we encourage countries to link HIV services with reproductive health services, newborn and pediatric care, and adolescent health services.
Much more needs to be done. The Global Fund’s Gender Equality Strategy Action Plan lays out a roadmap for achieving strategic, high-impact and gender-responsive investments to prevent new infections and save more lives.
Women and decision-making
The Global Fund strongly supports efforts to address gender inequalities. This starts with an analysis of the role of gender in the epidemics and in each country context as an obligatory part of the funding request. We are seeing a significant improvement in how countries are addressing gender-related barriers to health.
More women are getting involved in the design and implementation of programs. At the country level, 40 percent of decision-makers in grant committees are women. Country Coordinating Mechanisms now have guidelines for expertise on gender and for striving toward equal representation of men and women in Global Fund-related decision-making.
Giving up a living, to save lives In areas around Lake Victoria in Kenya, malaria presents significant risk to mothers and children under five. To stay free of the challenges wrought by the disease, health volunteers, like Beatrice Miguoke, engage the community with health education on how to use to use mosquito nets, how to eliminate mosquito breeding grounds, and how to seek timely treatment when the disease happens.
Saving lives, transforming gender roles in Ethiopia
As one of the 38,000 frontline health extension workers spread across the country, Tibre’s job is to trek dirt paths and knock on doors with the single-minded mission of stopping diseases from occurring and spreading. She and her fellow health extension workers are bringing access to health care to the homes of underserved rural communities out of reach of bricks and mortar health clinics.
Beyond the cut
Lutgard Oketch raised her finger and used it to mimic a penis. She sat surrounded by roughly three dozen men, most of them bikers, who run motorbike taxis in Nyanza, western Kenya. With a job title of a “circumcision mobilizer,” she traverses villages in Siaya County in Nyanza calling men who haven’t been circumcised to take up the practice as a way to protect themselves against HIV.