Gender-responsive and -transformative interventions in HIV, TB and malaria programmes: a review of evidence

Abstract

Gender-responsive and -transformative interventions are essential for tackling harmful social norms and discriminatory laws, policies, and practices that drive gender inequalities and health inequities especially for women, girls, and gender-diverse communities. Despite a growing evidence base of interventions, no comprehensive review has synthesized gender-responsive and -transformative approaches related to Human Immunodeficiency Virus (HIV), tuberculosis (TB), and malaria. Strengthening this evidence is vital to inform strategies addressing structural drivers of gender-based vulnerability—especially amid rising backlash against gender equality and significant global health funding cuts. This rapid review addressed this gap by synthesizing evidence on changes in health- and gender-related outcomes from gender-responsive and -transformative interventions in HIV, TB, and malaria programmes. Systematic searches of PubMed and Scopus for English-language studies from low-and middle-income countries published between 2004 and 2024 were completed. Included studies clearly described gender-focused interventions and outcomes and incorporated evaluation designs or analysis frameworks. From 11,844 articles identified, 42 primary research articles were included—all focused-on HIV, with none on TB or malaria. These were categorized into five intervention types: resilient and sustainable health systems (n = 6); gender norms change (n = 9); social empowerment (n = 8); economic empowerment (n = 18); and law and policy reform (n = 1). Most interventions (n = 36) targeted HIV prevention and addressed both individual behaviours and structural factors. Multi-component, multi-level interventions using a socio-ecological framework showed more sustained improvements in health- and gender-related outcomes compared to single-component efforts. There was more evidence of couples-based approaches changing harmful gender norms than interventions engaging individuals, however these need to ensure safety and private spaces for women, especially when tests are taken and diagnosis and advice given. Given the importance of local context, identifying a universal set of priority interventions is difficult. However, this review highlights strategic approaches, promising practices, and lessons learned for designing and implementing more effective gender-focused interventions. However, this review highlights strategic approaches, promising practices, and lessons learned for designing and implementing more effective gender-focused interventions.