Determinants of Health

11. Gender

Gender is part of the broader socio-cultural context. Other important criteria for socio-cultural analysis include class, race, poverty level, ethnic group and age.1

Biologically, women are more vulnerable to HIV infections from men than the other way around. Socially and economically, women’s higher rate of poverty and lack of power put them at risk, too.

Women who struggle to make ends meet might turn to survival sex for money, and might find it hard to insist on condom use. If a woman is in a relationship and is not economically independent, she has less bargaining power. As a result, it can be harder to insist on safer sex, or to ask a partner if he’s had sex with anyone else. A woman might even find it difficult to tell her partner that she is HIV positive.

This is how the gendered dynamic of poverty and income inequality plays a role in spreading HIV.

So, poverty is gendered. And poverty can lead to illness, including HIV. Is the same true for violence against women?

  • Previous sexual or physical victimization may predispose women to use substances that put them at higher risk of HIV infection.2
  • Domestic violence and childhood abuse has a strong association with the spread of HIV to women, without the use of injection drugs.
  • Some research indicates that survivors of abuse were four times more likely than others to engage in high-risk sex.3

“All their life experiences teach them that they have very little control over their futures.”4
– Kevin Sack

Gender describes socially determined roles, attitudes, behaviours, values and personality traits. It defines masculinity and femininity. As a society, we invent gender, and over time our ideas of what it is can change. Different cultures have different understandings of what it means to be male and female, and may include a sense that there are more than two genders.

Gender is powerful. Because of it, men and women often experience different levels of control and influence. Because many societies are still centred on the idea of two genders, the experiences and needs of transgender and gender queer people are often overlooked, minimized, ridiculed or ignored.

Health Canada acknowledges that “gendered” norms influence the health-care system’s practices and priorities – meaning it’s men’s needs that usually form the central notion of what (and who) is most important.

Gender and health policy

According to the International Women’s Health Coalition, HIV prevention programs need to be designed so they reflect the day-to-day conditions that women and young people face.

In its discussion paper HIV/ AIDS and Health Determinants: Lessons for Coordinating Policy and Action, the Public Health Agency of Canada makes the following conclusions about how to shape policy with gender in mind:

  • It is important not to attribute HIV vulnerability to gender. Instead, the vulnerability is a result of the discrimination associated with gender.
  • Make sure that women, Aboriginal people and other stigmatized, racialized and marginalized groups are free of discrimination, and get their fair share of opportunities in society.
  • Include efforts to address domestic violence in HIV and AIDS risk reduction and care strategies.

Prevention programs cannot succeed until women’s health and rights are placed at the very centre of HIV/AIDS strategies. All young people, male and female, must have access to full and accurate information about their own sexual health, and how their sexual health affects the sexual health of their partners. Men must learn at an early age to respect women, and women must learn at an early age to respect themselves. Education and empowerment are crucial.5

 

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1Gender Mainstreaming, Concepts and Definitions, UN Women – the United Nations Entity for Gender Equality and the Empowerment of Women, online as of June 2011
2 Women who use injection drugs: The social context of risk, Elizabeth Whynot, Canadian Medical Association Journal no. 4, 1998 – as quoted in HIV / AIDS and Health Determinants: Lessons for Coordinating Policy and Action, Public Health Agency of Canada, online as of June 2011
3 Partner violence and sexual HIV-risk behaviors among women in an inner city emergency department, N. El-Bassel et al, Violence and Victims 13 no. 4, 1998 – as quoted in HIV / AIDS and Health Determinants: Lessons for Coordinating Policy and Action, Public Health Agency of Canada, online as of June 2011
4 Epidemic takes toll on black women, New York Times Magazine, July 3, 2001 – as quoted in HIV / AIDS and Health Determinants: Lessons for Coordinating Policy and Action, Public Health Agency of Canada, online as of June 2011
5Women’s Vulnerability to HIV/AIDS: An Overview, International Women’s Health Coalition, online as of June 2011