Women & Girls

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Women and girls continue to be disproportionately affected by HIV, TB and malaria.

HIV is the leading cause of death of women of reproductive age in low- and middle-income countries. In the hardest hit countries, girls account for more than 80 percent of all new HIV infections among adolescents. Globally, young women aged 15-24 are most vulnerable to HIV, with infection rates twice as high as those in young men.

Sexual and gender-based violence increases a woman’s vulnerability to HIV, and can result in additional physical, mental, sexual, reproductive and other health problems.

While TB generally strikes more men than women, it remains among the top five causes of death for women between 15 and 44 in low- and middle-income countries. As for malaria, pregnant women are particularly susceptible to this disease, which can also cause miscarriage, low birth weight or premature births.

These vulnerabilities are exacerbated by gender inequality and discrimination.

Biomedical interventions such as access to ARVs or condoms for prevention, while urgent and necessary, will not reduce their vulnerability to HIV. Only structural transformations – social, political and cultural – will end the spread of HIV.

A question of circumstance: The fight to keep young women HIV-free

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 she marries and how many children she’ll have. 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.

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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.

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Investments in women and girls

We have been steadily increasing our investments in programs for women and girls, and as of 2015, the cumulative investment amounted to approximately US$18 billion, or almost 60 percent of total spending. This investment has led to a doubling of the number of women accessing – and staying on – ARV therapy, from 21 percent of those in need to 53 percent in 2015.

One example of our investment in women is helping countries scale up antenatal services, particularly for women who are HIV-positive. Through 2016 more than 4.25 million women have received treatment to prevent the transmission of HIV to their babies.

Other investments focus on education, which can be a powerful tool in preventing HIV among adolescent girls. A study in Botswana showed that an extra year of secondary education can reduce a girl’s risk of becoming infected by as much as 8 percent.

Our funding model supports programs designed to reach women and girls with critical services. In particular, we encourage countries to link HIV services with other reproductive health services, including those for newborns, their mothers, and adolescents.

Interventions that support adolescent girls and women 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.

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-transformative 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. During the 2014-2016 allocation period, we have seen a significant improvement in how countries have engaged with the gender dynamics of their epidemics.

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

Beatrice Miguoke knows what it means to take up a calling to save lives. In the 1980s she became her village’s traditional birth attendant. And for more than ten years, she helped hundreds of women safely birth their babies in her house with her bare hands. While she never set a price on the deliveries – insisting that such a special act was priceless – she made a decent income from the rewards that happy families offered her as they departed with their babies.

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The trekking ‘doctors’

Clutching her medicine box, Tibre Desu rounded a bend and sauntered down a rough road towards the distant hills on the horizon. She had just replenished her stock of medical supplies at Work Amba Health Center. Now her mind was on Dembela Health Post, her work station at the heart of her village in the Tigray region of northern Ethiopia.

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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.

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Learn more about some of the programs that support women and girls.

News & Stories

Published 20 July 2017