Strengthening the enabling environment for women and girls: what is the evidence in social and structural approaches in the HIV response?

Karen Hardee,Jill Gay,Melanie Croce-Galis,Amelia Peltz

doi:10.7448/ias.17.1.18619

Abstract

There is growing interest in expanding public health approaches that address social and structural drivers that affect the environment in which behaviour occurs. Half of those living with HIV infection are women. The sociocultural and political environment in which women live can enable or inhibit their ability to protect themselves from acquiring HIV. This paper examines the evidence related to six key social and structural drivers of HIV for women: transforming gender norms; addressing violence against women; transforming legal norms to empower women; promoting women’s employment, income and livelihood opportunities; advancing education for girls and reducing stigma and discrimination. The paper reviews the evidence for successful and promising social and structural interventions related to each driver. This analysis contains peer-reviewed published research and study reports with clear and transparent data on the effectiveness of interventions. Structural interventions to address these key social and structural drivers have led to increasing HIV-protective behaviours, creating more gender-equitable relationships and decreasing violence, improving services for women, increasing widows’ ability to cope with HIV and reducing behaviour that increases HIV risk, particularly among young people.

Highlights

Thirty years into the epidemic, women make up half of those living with HIV
This paper reviewed the evidence generated from structural interventions to address the six social and structural factors that constitute part of the enabling environment
The evidence shows that educating girls, and providing them with employment or income-generating opportunities, in an environment with equitable gender norms, respect for legal rights, non-acceptance of violence, and freedom from stigma and discrimination, will have beneficial HIV-related outcomes for women and girls

Summary

Introduction

In sub-Saharan Africa young women are as much as eight times more likely than men to be living with HIV [1]. While both men and women are vulnerable to HIV, renewed attention is focussing on ensuring that the factors that drive the unique vulnerabilities of women and girls are addressed in programming. While the AIDS pandemic has shaped a research agenda on gender and the social and structural vulnerabilities of various populations, including women and girls [2], there has been less attention to looking systematically at the interventions to address women’s vulnerabilities, and identifying which interventions have worked is vitally important. The Global Prevention Working Group [9] explains that ‘‘in addition to individual risk, HIV transmission dynamics are a function of vulnerability, which stems from social, economic, or legal circumstances that increase susceptibility to infection, deter individuals from seeking essential prevention services, or enhance the likelihood of engaging in unsafe behavior’’ (p. 9)

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