Gender-responsive/-transformative interventions in HIV, TB, and Malaria programmes

INTRODUCTION

HIV, TB, and malaria remain leading causes of infectious disease morbidity and mortality, disproportionately affecting the most marginalised and poorest populations, particularly women, girls, and gender-diverse communities in LMICs. It is widely recognised that achieving global goals to end these infectious diseases rests upon the maximisation of health equity, gender equality, and human rights. Gender inequalities, including stigma, discrimination, resource distribution, violence, and other gender-related barriers restrict access to critical health services and heighten vulnerabilities.

Over the past thirty years, significant progress has been made in tackling these infectious diseases. However, such progress appears under threat as recent and far-reaching cuts in international aid, ongoing wars and geopolitical instability, widening inequalities, COVID-19’s pervasive impacts, alongside climate change and persistent attacks against gender equality and rights, are starting to reverse these gains. Thus, the cruciality of building on and leveraging the evidence base of existing gender-responsive and -transformative interventions that demonstrably improve health- and gender-related outcomes is incontestable.

The Global Fund’s 2023-2028 Strategy recognises that ending HIV, TB, and malaria cannot be achieved without maximising health equity, gender equality, and human rights. However, knowledge gaps on existing and proven effective gender-responsive and transformative approaches, coupled with uncertainties about which interventions should be prioritised for investment hinder the identification and operationalisation of a set of prioritised gender equality intervention areas for use across Global Fund grants.

OBJECTIVES

The objectives of the project titled “Gender-responsive/-transformative interventions in HIV, TB, and Malaria programmes” included:

1. Conducting a rapid review to synthese evidence of changes in health- and gender-related outcomes attributable to such interventions. This review highlights strategic approaches, identifies promising practices, and distills key lessons for designing and implementing more effective gender-focused interventions in HIV, TB, and malaria programmes.
2. Recommending a prioritised package of gender-responsive interventions for Global Fund-supported HIV, TB, and malaria programmes.

METHODOLOGY

A rapid review approach was employed to synthesize evidence on changes in health- and gender-related outcomes from gender-responsive and transformative interventions in HIV, tuberculosis, and malaria programmes. The review analysed programmes shown to have, or to contribute to, a positive impact on shifting harmful gender norms and unequal power dynamics while also improving health outcomes, at least in intermediary terms. Examples include reducing risk of infection or transmission, reducing barriers to access, increasing uptake of services, increasing adherence to treatment.

PROJECT OUTPUTS

• Evidence Review [Full report]
• Evidence Review [Detailed summary]
• A peer-review journal article
• Policy Briefs: [English] [French]

KEY FINDINGS

1. Effective gender-responsive and -transformative interventions target not just individual behaviours but also structural factors
2. Multi-component interventions implemented at multiple levels and employing a socioecological lens were more likely to achieve the intended health and gender-responsive / -transformative outcomes
3. Evidence supports the effectiveness of couple-based interventions in changing harmful gender norms, to the condition that these effectively ensure safety and private spaces for women (especially when tests are taken and diagnosis and advice given)
4. Interventions that engage men only need to avoid common limitations, such as focus on individual agency or behaviour rather than structural issues, at the risk of resulting in backlash or the reinforcement of existing gendered inequalities
5. Working with women and men in both mixed-sex groups and separately best enables a gender-equitable environment for sexual and reproductive health and rights (SRHR)/HIV
6. Improved health-related outcomes of gender-focused interventions notably include: increased testing and referral to HIV services, increased partner disclosure of HIV serostatus, improved non-judgmental care by health care providers, increased uptake of ART and voluntary male medical circumcision, etc.

KEY IMPLEMENTATION INSIGHTS

1. Civil society organizations and community-led networks have been key implementation partners for gender-focused interventions
2. Contextualisation and localisation, through consideration of user preferences and their participation in intervention design, are critical features of successful implementation
3. Strengthened capacity in gender-focused and rights-based approaches of government stakeholders help improve engagement in health programmes, which in turn helps ensure sustainable funding
4. Tackling gender inequalities and deeply entrenched gender norms and power structures must be conducted at multiple levels, through multiple stakeholders, and via multiple approaches
5. Interventions should clearly articulate gendered theories of change, measure intermediate outcomes and use designs that enable assessment of intended structural changes in order to accurately evaluate the effects of multi-component, multi-level structural interventions