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HIV/AIDS

Pathways among Human Security, Gender, and HIV/AIDS in Sub-Saharan Africa

Citation:

O'Manique, Colleen, and Sandra J. MacLean. 2010. “Pathways among Human Security, Gender, and HIV/AIDS in Sub-Saharan Africa.” Canadian Journal of African Studies / Revue Canadienne Des Études Africaines 44 (3): 457-78.

 

Authors: Colleen O'Manique, Sandra J. MacLean

Abstract:

FRENCH ABSTRACT:
La théorie traditionnelle de la sécurité perçoit les préoccupations d'ordre sanitaire comme menaces isolées à l'intérêt national, séparés analytiquement de leurs causes et contextes sociaux et politico-économiques élargis. Si la notion de la sécurité humaine est limitée à ces mêmes paramètres, comme dans la définition étroite de la sécurité humaine comme "absence de la peur," et que la santé n'est perçue comme question de sécurité qu'une fois qu' apparaît la violence ouverte, en particulier la violence militaire, le potentiel tant explicatif qu'émancipateur de la notion est diminuée. Cependant, un vaste concept de la sécurité humaine qui englobe "l'absence du besoin" offre un espace conceptuel permettant d'identifier et d'analyser la nature des relations sociales, politiques et économiques qui caractérisent aujourd'hui les problèmes de santé mondiaux, tels que le VIH/sida. Dans le cadre conceptuel de la sécurité humaine, une analyse qui éclaire les dimensions sexospécifiques de la sécurité humaine — en termes de prédisposition individuelle à la maladie, d'accès au traitement et de d'impacts sur les moyens de subsistance — est essentielle afin de fournir des éclairements pouvant orienter des politiques efficaces contre le VIH/sida. En outre, les politiques doivent prendre en compte les multiples facteurs sociaux, culturels, économiques et politiques qui déterminent le cheminement de la maladie.
 
ENGLISH ABSTRACT:
Traditional security theory has treated health concerns as isolated threats to national interest, separated analytically from their broader social and political economy causes and contexts. If the concept of human-security is restricted to these same parameters, as in the narrow definition of human security as "freedom from fear," and health is considered to be an issue of security only when overt physical, especially military, violence is involved, the explanatory as well as emancipatory potential of the concept is diminished. However, a broad concept of human security that encompasses "freedom from want" offers a conceptual space for identifying and analyzing the relevant social, political and economic connections that characterize contemporary global health problems such as HIV/AIDS. Within the conceptual framework of human security, a gender analysis that illuminates the gender dimensions of human security — in terms of individual disease risk, access to treatment, and impacts on livelihood — is critical to providing insights to guide effective policy on HIV/AIDS. Also, policies need to take into account the multiple social, cultural, economic and political factors that determine the disease pathways.
 

Topics: Economies, Gender, Gender Analysis, Health, HIV/AIDS, Livelihoods, Security, Human Security

Year: 2010

Human Security, Gender-Based Violence and the Spread of HIV/AIDS in Africa: A Feminist Analysis

Citation:

Thomas, Lahoma, and Rebecca Tiessen. 2010. "Human Security, Gender-Based Violence and the Spread of HIV/AIDS in Africa: A Feminist Analysis." Canadian Journal of African Studies / Revue Canadienne Des Études Africaines 44 (3): 479-502.

Authors: Lahoma Thomas , Rebecca Tiessen

Abstract:

FRENCH ABSTRACT:
La santé et la sécurité des femmes de tous âges sont menacées en situations de conflit et d'après-conflit partout en Afrique. La violence sexuelle et sexiste et la propagation du virus de l'immunodéficience humaine/syndrome d'immunodéficience acquise (VIH/sida) sont autant d'armes utilisées en périodes de conflit, mais elles ont aussi des effets à long terme sur la santé et la sécurité postconflictuelles des femmes et des jeunes filles. Cet article s'appuie sur des recherches empiriques et pratiques menées en Ouganda entre 2007 et 2008 auprès de membres de collectivités du nord de l'Ouganda victimes de la violence sexuelle et sexiste et des intervenants auprès des victimes du viol et des personnes séropositives. Les résultats de ces recherches empiriques soulignent la persistance de la violence faite aux femmes en situation d'après-conflit et pourquoi l'expression de cette violence doit être placée dans le contexte de la sexospécificité et des masculinités. Nos résultats mettent en évidence la façon dont la violence faite aux femmes en situation d'après-conflit (en particulier, la violence domestique envers les femmes, l'inceste et la maltraitance sexuelle des enfants) sert à réaffirmer la masculinité et à récupérer le sens de la virilité mis en cause lors de conflits quand les membres masculins de la communauté ont été incapables de protéger leurs familles.
 
ENGLISH ABSTRACT:
Women and girls face specific health and human security threats in conflict and post-conflict situations throughout Africa. Gender and sexual-based violence (GSBV) and the spread of the human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) are weapons used in conflict, but they also have long term effects on the human security and well-being of women and girls post-conflict. This article draws on empirical and field research carried out in Uganda between 2007 and 2008 with community members in northern Uganda who have experienced GSBV and those who are working to help survivors of rape and HIV infection. The findings from empirical research carried out in northern Uganda underscores the ongoing violence women face in a post-conflict environment and why the expression of violence against women must be understood in the context of gender relations and masculinities. Our findings highlight the ways in which violence against women in post-conflict situations (particularly domestic abuse against women, incest and child sexual assaults) is used to re-assert masculinities and to reclaim a sense of manhood that was challenged during the conflict when male community members were unable to protect their families.

Topics: Domestic Violence, Gender, Women, Girls, Masculinity/ies, Gender-Based Violence, Gendered Power Relations, Health, HIV/AIDS, Post-Conflict, Security, Human Security, Sexual Violence, Rape, SV against Women Regions: Africa, East Africa Countries: Uganda

Year: 2010

Climate Disasters Contaminate Women: Investigating Cross-National Linkages between Disasters, Food Insecurity, and Women's HIV in Less-Developed Countries

Citation:

Austin, Kelly F., Mark D. Noble, Laura A. McKinney. 2020. "Climate Disasters Contaminate Women: Investigating Cross-National Linkages between Disasters, Food Insecurity, and Women's HIV in Less-Developed Countries." Global Health Governance (May): 85-102.

Authors: Kelly F. Austin, Mark D. Noble, Laura A. McKinney

Abstract:

HIV/AIDS remains a serious public health threat in less-developed countries, especially for women. Drawing on ecofeminist perspectives, we explore linkages between climaterelated disasters, food insecurity, and HIV transmission. Using data from over 90 lessdeveloped countries, we construct a structural equation model to analyze the direct and indirect influences on the percent of the adult population living with HIV who are women. We find that climate-related disasters are a significant factor shaping women’s HIV vulnerability indirectly through increased food insecurity. Food insecurity is theorized to alter social relationships and behaviors, including risky sexual behaviors, forced sex, and transactional sexual relationships. Our results confirm that disasters lead to conditions of hunger and resource deprivation, which serve to escalate HIV transmission among vulnerable women in poor countries.

Topics: Environment, Environmental Disasters, Feminisms, Ecofeminism, Gender, Women, Health, HIV/AIDS, Security, Food Security

Year: 2020

Engendering Care: HIV, Humanitarian Assistance in Africa and the Reproduction of Gender Stereotypes

Citation:

Mindry, Deborah. 2010. "Engendering Care: HIV, Humanitarian Assistance in Africa and the Reproduction of Gender Stereotypes." Culture, Health & Sexuality 12 (5): 555-68.

 

Author: Deborah Mindry

Abstract:

ENGLISH ABSTRACT
This paper draws upon recent research in Durban, South Africa to unravel the complexities of care ethics in the context of humanitarian aid. It investigates how the gendering of care shapes the provision of aid in the context of the HIV in Africa constructing an image of ‘virile’ and ‘violent’ African masculinity. Humanitarian organisations construct imagined relations of caring, invoking notions of a shared humanity as informing the imperative to facilitate change. This paper draws on varied examples of research and NGO activity to illustrate how these relations of care are strongly gendered. Humanitarian interventions that invoke universalising conceptions of need could instead draw on feminist care ethics that seeks to balance rights, justice and care in ways that attend to the webs of relationships through which specific lived realities are shaped. Essentialising feminised discourses on care result in a skewed analysis of international crises that invariably construct women (and children) as victims in need of care, which at best ignore the lived experiences of men and, at worst, cast men as virile and violent vectors of disease and social disorder.
FRENCH ABSTRACT:
Cet article s'inspire d'une récente recherche à Durban, en Afrique du Sud, pour révéler les complexités de l'éthique des soins dans le contexte de l'aide humanitaire. Il examine la manière dont l'intégration des notions de genre aux soins détermine l'approvisionnement en aide dans le contexte du VIH en Afrique, en conceptualisant une image de la masculinité africaine «virile» et «violente». Les organisations humanitaires conceptualisent des relations imaginées du soin, basées sur des notions d'humanité solidaire qui informent l'impératif de la facilitation du changement. Cet article s'inspire d'exemples variés de recherche et d'activité des ONG pour illustrer l'intensité avec laquelle ces relations de soins sont basées sur le genre. Les interventions humanitaires qui invoquent l'universalisation des conceptions des besoins devraient plutôt s'inspirer de l'éthique féministe des soins, qui cherche à équilibrer les droits, la justice et les soins de manière à assister les réseaux des relations à travers lesquelles les réalités spécifiques vécues sont définies. L'essentialisation des discours féminisés sur les soins a pour résultat une analyse faussée des crises internationales qui, de manière invariable, conceptualisent les femmes (et les enfants) comme des victimes nécessitant des soins et, au mieux, ignorent les expériences vécues des hommes; au pire, représentent ces derniers comme des vecteurs virils et violents de la maladie et du désordre social.
SPANISH ABSTRACT:
Este artículo se basa en los recientes estudios en Durban, Sudáfrica, que revelan las complejidades de la ética asistencial en el contexto de la ayuda humanitaria. Analizamos cómo la cuestión del género en la asistencia determina la concesión de ayudas en el contexto del VIH en África construyendo una imagen de masculinidad africana ‘viril’ y ‘violenta. Las organizaciones humanitarias construyen relaciones imaginarias de asistencia invocando nociones de una humanidad compartida que hace imperativo facilitar cambios. En este artículo presentamos varios ejemplos de investigaciones y de las actividades de las ONG para ilustrar cómo estas relaciones de asistencia vienen determinadas en gran medida por el sexo. Las intervenciones humanitarias que invocan conceptos universales de necesidad podrían basarse mejor en la ética de asistencia feminista que intenta equilibrar los derechos, la justicia y la asistencia prestando atención a las redes de relaciones que forman las realidades específicas vividas. Los discursos feministas que esencializan la atención llevan a un análisis sesgado de las crisis internacionales que invariablemente caracteriza a las mujeres (y niños) como víctimas que necesitan cuidados y, en el mejor de los casos, ignora las experiencias vividas por los hombres y, en el peor, representa a los hombres como vectores viriles y violentos de trastornos sociales y enfermedades.

Keywords: gender, Africa, masculinity, HIV/AIDS, humanitarian aid

Topics: Feminisms, Gender, Masculinity/ies, Health, HIV/AIDS, Humanitarian Assistance, NGOs Regions: Africa, Southern Africa Countries: South Africa

Year: 2010

Girlhood, Violence, and Humanitarian Assistance

Citation:

Namuggala, Victoria Flavia. 2018. "Girlhood, Violence, and Humanitarian Assistance." In Childhood, Youth Identity, and Violence in Formerly Displaced Communities in Uganda, 107-37. Cham: Palgrave Macmillan.

Author: Victoria Flavia Namuggala

Abstract:

This chapter concentrates on humanitarian assistance as a major component of survival during situations of displacement. Despite its contribution in saving lives, humanitarian assistance has its own controversies especially from the perspective of the beneficiaries. My discussion centers on such complexities concentrating on young women in northern Uganda. To bring this out clearly, I examine the nature of aid provided and how recipients conceptualize it, the gendered experiences involved and the sociocultural dynamics that inform the implementation of humanitarian assistance. I conclude that humanitarian assistance at times facilitates violence against young women characterized by starvation, sexual violence, survival sex, early and forced marriages, and increased spread of HIV/AIDS. This is due to operation through cultural patriarchal structures that sustain power hierarchies in favor of men.

Topics: Age, Youth, Displacement & Migration, Gender, Women, Gendered Power Relations, Patriarchy, Health, HIV/AIDS, Humanitarian Assistance, Sexual Violence, Violence Regions: Africa, East Africa Countries: Uganda

Year: 2018

Evaluating the Effectiveness of Sexual and Reproductive Health Services during Humanitarian Crises: A Systematic Review

Citation:

Singh, Neha S., James Smith, Sarindi Aryasinghe, Rajat Khosla, Lale Say, and Karl Blanchet. 2018.  “Evaluating the Effectiveness of Sexual and Reproductive Health Services during Humanitarian Crises: A Systematic Review.” PLoS One 13 (7): 1-19.

Authors: Neha S. Singh, James Smith, Sarindi Aryasinghe, Rajat Khosla, Lale Say, Karl Blanchet

Abstract:

Background: An estimated 32 million women and girls of reproductive age living in emergency situations, all of whom require sexual and reproductive health (SRH) information and services. This systematic review assessed the effect of SRH interventions, including the Minimum Initial Service Package (MISP) on a range of health outcomes from the onset of emergencies.
 
Methods and Findings: We searched EMBASE, Global Health, MEDLINE and PsychINFO databases from January 1, 1980 to April 10, 2017. This review was registered with the PROSPERO database with identifier number CRD42017082102. We found 29 studies meet the inclusion criteria. We found high quality evidence to support the effectiveness of specific SRH interventions, such as home visits and peer-led educational and counselling, training of lower-level health care providers, community health workers (CHWs) to promote SRH services, a three-tiered network of health workers providing reproductive and maternal health services, integration of HIV and SRH services, and men’s discussion groups for reducing intimate partner violence. We found moderate quality evidence to support transport-based referral systems, community-based SRH education, CHW delivery of injectable contraceptives, wider literacy programmes, and birth preparedness interventions. No studies reported interventions related to fistulae, and only one study focused on abortion services.
 
Conclusions: Despite increased attention to SRH in humanitarian crises, the sector has made little progress in advancing the evidence base for the effectiveness of SRH interventions, including the MISP, in crisis settings. A greater quantity and quality of more timely research is needed to ascertain the effectiveness of delivering SRH interventions in a variety of humanitarian crises.

 

Topics: Armed Conflict, Domestic Violence, Education, Environment, Environmental Disasters, Gender, Women, Girls, Health, HIV/AIDS, Reproductive Health, Humanitarian Assistance Regions: Americas, Caribbean countries, Asia, South Asia, Southeast Asia Countries: Haiti, Pakistan, Philippines

Year: 2018

Gendered Dimensions of Population Mobility Associated with HIV Across Three Epidemics in Rural Eastern Africa

Citation:

Camlin, Carol S., Adam Akullian, Torsten B. Neilands, Monica Getahun, Anna Bershteyn, Sarah Ssali, Elvin Geng, Monica Gandhi, Craig R. Cohen, Irene Maeri, Patrick Eyul, Maya L. Petersen, Diane V. Havlir, Moses R. Kamya, Elizabeth A. Bukusi, and Edwin Charlebois. and Charlebois. 2019. "Gendered Dimensions of Population Mobility Associated with HIV Across Three Epidemics in Rural Eastern Africa." Health & Place 57: 339-51.

Authors: Carol S. Camlin, Adam Akullian, Torsten B. Neilands, Monica Getahun, Anna Bershteyn, Sarah Ssali, Elvin Geng, Monica Gandhi, Craig R. Cohen, Irene Maeri, Patrick Eyul, Maya L. Petersen, Diane V. Havlir, Moses R. Kamya, Elizabeth A. Bukusi, Edwin D. Charlebois

Abstract:

Mobility in sub-Saharan Africa links geographically-separate HIV epidemics, intensifies transmission by enabling higher-risk sexual behavior, and disrupts care. This population-based observational cohort study measured complex dimensions of mobility in rural Uganda and Kenya. Survey data were collected every 6 months beginning in 2016 from a random sample of 2308 adults in 12 communities across three regions, stratified by intervention arm, baseline residential stability and HIV status. Analyses were survey-weighted and stratified by sex, region, and HIV status. In this study, there were large differences in the forms and magnitude of mobility across regions, between men and women, and by HIV status. We found that adult migration varied widely by region, higher proportions of men than women migrated within the past one and five years, and men predominated across all but the most localized scales of migration: a higher proportion of women than men migrated within county of origin. Labor-related mobility was more common among men than women, while women were more likely to travel for non-labor reasons. Labor-related mobility was associated with HIV positive status for both men and women, adjusting for age and region, but the association was especially pronounced in women. The forms, drivers, and correlates of mobility in eastern Africa are complex and highly gendered. An in-depth understanding of mobility may help improve implementation and address gaps in the HIV prevention and care continua.

Keywords: HIV, mobility, migration, gender, Kenya, Uganda, population-based

Topics: Displacement & Migration, Migration, Gender, Health, HIV/AIDS, Infrastructure, Transportation, Livelihoods Regions: Africa, East Africa Countries: Kenya, Uganda

Year: 2019

Delivering Integrated Care after Sexual Violence in the Democratic Republic of the Congo

Citation:

Bress, Joshua, Givano Kashemwa, Christine Amisi, Jean Armas, Cindy McWhorter, Theodore Ruel, Arthur J. Ammann, Denis Mukwege, and Lisa M. Butler. 2019. "Delivering Integrated Care after Sexual Violence in the Democratic Republic of the Congo." BMJ Global Health 4. 

Authors: Joshua Bress, Givano Kashemwa, Christine Amisi, Jean Armas, Cindy McWhorter, Theodore Ruel, Arthur J. Ammann, Denis Mukwege, Lisa M. Butler

Abstract:

In the eastern Democratic Republic of the Congo, ongoing armed conflict increases the incidence of gender-based violence (GBV) and presents a distinct and major barrier to care delivery for all survivors of GBV. A specific challenge is providing emergency contraception, HIV prophylaxis and treatment for sexually transmitted infections to all survivors within 72 hours of violence. To address the multiple barriers to providing this time sensitive medical care, Global Strategies and Panzi Hospital implemented the Prevention Pack Program. The Prevention Pack is a prepackaged post-rape medical kit containing antiretroviral post-exposure prophylaxis, antibiotics for treatment of sexually transmitted infections and emergency contraception. The Prevention Pack Program combines community sensitisation about post-rape medical care with the provision of Prevention Packs and the implementation of a cloud-based and Global Positioning System (GPS)–enabled inventory management system. The Panzi Hospital gender-based violence team implemented the Prevention Pack Program at Panzi Hospital and 12 rural clinics in the South Kivu Province. The data manager took GPS coordinates of each site, provided an initial stock of Prevention Packs and then called all sites daily to determine demand for post-rape care and Prevention Pack consumption. Inventory data were entered into the GPS-enabled cloud-based inventory management system. Project personnel used the consumption rate, trends and geolocation of sites to guide Prevention Pack restocking strategy. Between 2013 and 2017, a total of 8206 individuals presented for care following rape at the study sites. Of the 1414 individuals who presented in the rural areas, 1211 (85.6%) did so within the first 72 hours of reported rape. Care was delivered continuously and without a single stockout of medication across all sites. The Prevention Pack Program provided timely and consistent access to emergency contraception, HIV prophylaxis and treatment for sexually transmitted infections for rape survivors in the eastern Democratic Republic of the Congo.

Topics: Armed Conflict, Gender-Based Violence, Health, HIV/AIDS, Livelihoods, Sexual Violence, Rape, Violence Regions: Africa, Central Africa Countries: Democratic Republic of the Congo

Year: 2019

Cango Lyec (Healing the Elephant): Gender Differences in HIV Infection in Post-conflict Northern Uganda

Citation:

Spittal, Patricia M., Samuel S. Malamba, Martin D. Ogwang, Seggane Musisi, J. Paul Ekwaru, Nelson K. Sewankambo, Margo E. Pearce, Kate Jongbloed, Sheetal H. Patel, Achilles Katamba, Alden H. Blair, Herbert Muyinda, and Martin T. Schechter. 2018. "Cango Lyec (Healing the Elephant): Gender Differences in HIV Infection in Post-conflict Northern Uganda." Journal of Acquired Immune Deficiency Syndromes 78 (3): 257-68. 

Authors: Patricia M. Spittal, Samuel S. Malamba, Martin D. Ogwang, Seggane Musisi, J. Paul Ekwaru, Nelson K. Sewankambo, Margo E. Pearce, Kate Jongbloed, Sheetal H. Patel, Achilles Katamba, Alden H. Blair, Herbert Muyinda, Martin T. Schechter

Abstract:

Background: As previously encamped resettle, potential for rapid HIV transmission in post-conflict Northern Uganda is concerning. Women in particular may be experiencing heightened vulnerability resulting from war-related sexual violence.
 
Setting: Cango Lyec (Healing the Elephant) Project is a cohort involving conflict-affected people in 3 districts in Northern Uganda.
 
Methods: Eight randomly selected communities were mapped, and a census was conducted. Participants aged 13–49 years completed questionnaires in Luo on war-related experiences, mental health, sexual vulnerabilities, and sociodemographics. Blood samples were tested for HIV and syphilis. Baseline data from all sexually active participants was used to determine gender differences in HIV prevalence. Multivariate modeling determined correlates of HIV by gender.
 
Results: Among 2008 participants, HIV prevalence was higher among women [17.2; 95% confidence interval (CI): 14.7 to 19.7] compared to men (10.6; 95% CI: 8.0 to 13.2, ,0.001). Among women, correlates of HIV included: war-related sexual assault [adjusted odds ratio (AOR): 1.95; 95% CI: 1.16 to 3.26]; probable depression (AOR: 2.22; 95% CI: 1.46 to 3.37); probable post-traumatic stress disorder (AOR: 2.03; 95% CI: 1.45 to 2.84); experiencing $12 traumatic events (AOR: 2.04; 95% CI: 1.31 to 3.18); suicide ideation (AOR: 1.67; 95% CI: 1.22 to 2.28); living in a female-headed household (AOR: 2.76; 95% CI: 1.70 to 4.49); first sexual partner $10 years older (AOR: 1.69; 95% CI: 1.07 to 2.67); sex for exchange (AOR: 5.51; 95% CI: 1.76 to 17.31); having 2 (AOR: 2.54; 95% CI: 1.23 to 5.23) or 3+ (AOR: 4.65; 95% CI: 2.65 to 8.18) sexual partners; inconsistent condom use (AOR: 0.40; 95% CI: 0.29 to 0.57); genital ulcers (AOR: 3.08; 95% CI: 2.16 to 4.38); active syphilis (AOR: 4.33; 95% CI: 1.22 to 15.40); and ill health without medical care (AOR: 2.02; 95% CI: 1.22 to 3.34). Among men, correlates of HIV included no condom at sexual debut (AOR: 1.92; 95% CI: 1.30 to 2.83) and genital ulcers (AOR: 4.40; 95% CI: 1.35 to 14.40).
 
Conclusion: Women are disproportionately impacted by HIV, trauma, and depression in this conflict-affected population. Trauma-informed HIV prevention and culturally safe mental health initiatives are urgently required.

Keywords: HIV/AIDS, conflict-affected people, Northern Uganda, gender, sexual violence, mental health

Topics: Armed Conflict, Conflict, Gender, Women, Health, HIV/AIDS, Mental Health, Trauma, Post-Conflict, Sexual Violence, SV against Women Regions: Africa, East Africa Countries: Uganda

Year: 2018

Women, War and Peace: The Independent Experts’ Assessment on the Impact of Armed Conflict on Women and Women’s Role in Peace-Building

Citation:

Rehn, Elisabeth, and Ellen Johnson Sirleaf. 2002. "Women, War and Peace: The Independent Experts’ Assessment on the Impact of Armed Conflict on Women and Women’s Role in Peace-Building." New York: United Nations Development Fund for Women.

Authors: Elisabeth Rehn, Ellen Johnson Sirleaf

Annotation:

Table of Contents:
Introduction: Peace – for Whom and When?
1. Violence Against Women
 
2. Women Forced to Flee
 
3. War and the Health of Women
 
4. HIV/AIDS
 
5. Women and Peace Operations
 
6. Organizing for Peace
 
7. Justice
 
8. Media Power
 
9. Prevention and Early Warning
 
10. Reconstruction

Topics: Displacement & Migration, Gender, Women, Gender-Based Violence, Media, Health, HIV/AIDS, Justice, Post-Conflict, Post-Conflict Reconstruction, Peacebuilding, Violence

Year: 2002

Pages

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