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Published: 06 January 2025

Gender Equality

The Challenge

In every region of the world, deep-rooted gender inequality is undermining health and well-being.

Gender inequality has long been recognized as a powerful driver of the HIV epidemic in particular. Adolescent girls and young women are still disproportionately affected: Despite improvements over the past decade, HIV prevalence among adolescent girls and young women living in sub-Saharan Africa is three times higher than among adolescent boys and young men. Gender-based violence is both a cause and consequence of HIV, increasing the risk of HIV transmission and intensifying the harmful consequences of disclosure for people living with HIV.

Gender differences and inequalities can also influence TB outcomes. While women generally face greater barriers to TB care, men are more than twice as likely to have active TB. Harmful gender norms around masculinity may also lead to greater exposure to risk factors for men, like smoking and working in high-risk occupations, as well as a lower likelihood to seek care.

Gender roles, relations and dynamics have an impact on the malaria epidemic as well. Women’s limited economic and decision-making power may impede their ability to access insecticide-treated nets, attend antenatal care and receive malaria prevention, or seek treatment for febrile children. In many regions, men and adolescent boys have a greater occupational risk of exposure to malaria and higher incidence, which in turn leads to transmission to other household members.

Ending HIV, TB and malaria as epidemics cannot be achieved through biomedical interventions alone. We must confront the injustices that make some people especially vulnerable to diseases and unable to access the health services they need. We cannot end HIV, TB and malaria as epidemics without making gender equality a priority.

Our Response

The Global Fund is committed to addressing gender inequality in all the work that we do. Through our 2023-2028 Strategy, our approach goes beyond responding to gender differences and aims to help transform social and cultural norms, as well as address discriminatory laws, policies and practices that contribute to gender inequalities and increase vulnerabilities to HIV, TB and malaria. Our key priorities are scaling up programs to remove human rights and gender-related barriers to health; supporting comprehensive sexual and reproductive health and rights; developing programs that amplify the voices and priorities of young people, particularly adolescent girls and young women; and collecting, analyzing and using age- and sex-disaggregated data to identify drivers of inequality and inform responses. As part of our commitment to advancing gender equality, we have also adopted a Gender Equality Marker to track and improve the gender focus across all our grants.  

Pushback against gender equality and human rights is growing in many countries around the world through punitive and regressive policies and actions. Opposition to gender equality has existed for a long time, but in recent years it has become increasingly organized, more systemic and very well-resourced. The expanding influence of anti-gender and anti-rights movements is a major and growing threat to the goal of ending HIV, TB, and malaria.

To help support locally led efforts to tackle the anti-gender movement, the Global Fund, alongside partners GSK and ViiV Healthcare, have established a multi-country Gender Equality Fund. The Fund takes a community-led, feminist funding approach, and delivers resources directly to communities and civil society on the frontlines of the fight for gender equality. It supports them to stem the tide of anti-gender movements, ensures the meaningful engagement of women and girls in decision-making spaces and makes progress toward equality and better health in their communities.

Our Breaking Down Barriers initiative supports countries to design, fund, implement and scale up programs that use community data and feedback to identify and remove human rights-related barriers to HIV, TB and malaria services, including gender discrimination. Through this initiative we have provided grants and technical support to drive the development and implementation of country-owned programs that provide a comprehensive response to the barriers that continue to threaten access, uptake and retention in HIV, TB and malaria services. The initiative also supports the collection of data and evaluates the progress made by the programs.

Adolescent girls and young women remain a key focus of the Global Fund’s response to HIV. Between 2018 and 2020, Global Fund investments in HIV prevention and testing for adolescent girls and young women increased by 107% within the 13 priority countries where the HIV burden is highest. Between 2010 and 2023, the number of new HIV infections among adolescent girls and young women decreased by 51% in these countries1.

To end HIV as a public health threat, we must also work with boys and men to transform cultural and social norms that perpetuate gender inequality and continue to drive infections.

Find out more

We support the HER Voice Fund, which provides small grants to organizations in 13 priority countries (Botswana, Cameroon, Eswatini, Lesotho, Kenya, Malawi, Mozambique, Namibia, South Africa, Tanzania, Uganda, Zimbabwe and Zambia) to amplify the voices of adolescent girls and young women to inform the decisions that affect their lives, including through training, mentoring and involvement in advocacy campaigns. We also supported the VOIX EssentiELLES fund for three years, in collaboration with Fondation CHANEL, to help women and girls in West and Central Africa organize and engage in decision-making around health policies and programs.

Gender inequality exists across the global health workforce, with women clustered in lower-status and lower-paid roles, facing bias, discrimination, and sexual exploitation, abuse and harassment. Unequal access to pre-service education and training restricts participation of women in several health occupations and inhibits their professional growth. ​Women make up 67% of the global health workforce but only hold 25% of leadership roles. The Global Fund is working with partners to ensure that gender equality considerations are integrated across all aspects of programs to support community health workers and human resources for health, including removing gender-related barriers to hiring, career progression and decent pay, and the prevention of sexual exploitation, abuse and harassment.

In challenging operating environments – countries or regions that experience infectious disease outbreaks, natural disasters, armed conflicts or civil unrest, weak governance, climate change-related crises and/or mass displacement – gender inequalities are often particularly pronounced and sexual and gender-based violence often spikes. The Global Fund supports sexual and gender-based violence prevention services in these environments, as well as services for post-violence care, protection and access to justice to help ensure equal access to HIV, TB and malaria services and better health outcomes overall.

Conflicts, Crises and Displaced People: How the Global Fund Works in Challenging Operating Environments [ download in عربي | English | Français | Italiano ]

The Global Fund approved over US$1.8 million in emergency funding to urgently provide HIV and TB prevention services to displaced people, victims/survivors of gender-based violence, and other vulnerable groups in June 2024 in Haiti.

Find out more