Studies indicate that harmful gender norms and practices, cultural perceptions and beliefs surrounding pregnancy and childbirth, and a distrust of health-care services all can pose barriers to HIV prevention and treatment. In particular, women face difficulties related to unequal gender power relations and stigma.
This Joint United Nations Programme on HIV/AIDS (UNAIDS) document presents evidence that timely and continued access to antiretroviral medicines would reduce new infections in children and give HIV-infected women access to HIV treatment and care for their own health and well-being. Because 1) women’s lack of autonomy, 2) mistrust of health services, particularly due to a lack of cultural sensitivity and confidentiality among health-service providers, and 3) fear of stigma and related abuse can affect women’s access to treatment, key gender-related barriers stand in the way of preventing new HIV infections among children and keeping their mothers alive.
The following recommendations, based upon discussions in Democratic Republic of the Congo, Ethiopia, India, Nigeria, and Uganda, are proposed to overcome gender-related and cultural barriers to services.
- address stigma and discrimination against women living with HIV to increase utilization of and adherence to services”, by, for example, building awareness and sensitivity in communities, including through the use of local media and local language(s), and engaging community leaders at all levels, including religious leaders, in dialogue on stigma
- address violence against women as part of programmes to prevent new HIV infections among children and keep mothers alive and healthy”, by integrating services for survivors of violence in all health-care settings and training health services to work in a non-judgmental manner with the complexities around violence against women and the underlying gender inequalities, using confidentiality and promoting the right to respect
- support transformation of traditional gender roles related to maternal health, providing correct information on HIV by using culturally-appropriate, gender-sensitive and rights-based approaches” by, for example, creating opportunities for voluntary attendance, counselling, and testing for couples
- address lack of awareness and mistrust of existing services to prevent new HIV infections among children and keep mothers alive and healthy”, by, for example, reaching communities, beyond individual clients and healthcare providers, as part of “decentralized approaches and awareness campaigns. For consistency in messaging and the effective use of expertise, both women living with HIV and traditional birth attendants must be engaged in community mobilization efforts