As plans for a humanitarian fund for HIV in Myanmar are being made it is time to reconsider gender and HIV. Read on.
Inventory and review of research on gender and HIV/AIDS in Myanmar
Prepared for UNAIDS Myanmar
August 2005
Executive Summary
Myanmar is facing a generalized HIV/AIDS epidemic. Widespread poverty, underemployment and a large informal economy cause a high incidence of cross-border and internal migration, increasing the HIV-vulnerability of large segments of the population. The main HIV-transmission mode is sexual, through unsafe sex, followed by needle/equipment sharing of injecting drug users. With increasing financial support, the response to HIV/AIDS by government, UN and NGOs has moved from mainly focusing on prevention to the continuum of prevention, treatment, care and support. Recently, attention to wider socio-economic factors influencing vulnerability and ability to cope with impacts of the epidemic is increasing and some organisations now perceive HIV/AIDS as a development rather than a biomedical issue.
Gender inequality exists in Myanmar, though at a more subtle level than in some other Asian countries. While life expectancy and education opportunities are fairly equal for women and men, power relations, in the household and in society, are not and this leaves women less able to have control over their sexuality and behaviours and their vulnerability to HIV/AIDS is different to men's. This is a little understood and researched dynamic in the Myanmar context and this report aims at highlighting some of the gender concerns of HIV/AIDS in Myanmar. Socio-cultural norms prescribe suitable behaviours and expected roles of women and men. Strong barriers to acknowledging existing gender inequality exist. Due to the lack of civil society organizations in Myanmar, including the absence of a (independent) women's movement, there has not been an effective lobby on gender issues so far. Development organisations have not addressed gender issues systematically in the planning and implementation of their work until now.
Aware of the lack of information about gender-related factors which men's and women's vulnerability to HIV in Myanmar, UNAIDS planned this inventory of available research data and an initial identification of research gaps. A general framework identifying key areas and issues related to gender differences and inequality influencing HIV-vulnerability and impact was developed on the basis of a review of literature from the international context. Key areas for research on gender and HIV/AIDS are described in this report. Examples of gender mainstreaming in national HIV/AIDS policies and action plans from Cambodia and Kenya are presented.
Very little research data on gender aspects of HIV/AIDS could be found in any of the key research areas identified. Of the relatively few gender-focused studies that have been undertaken in Myanmar, 50% or more are not in the public domain and are considered too sensitive to be shared widely. Most gender-related information was found in studies of male and female youth and female factory and entertainment workers. Other (not gender-focused) studies in the fields of HIV/AIDS and reproductive health highlight some gender differences in knowledge and behaviour but do not analyse underlying causes or motivations. The link with unequal power relations between men and women is not made, nor are values, beliefs and norms analysed in detail. This makes it difficult to understand the gender dimensions of HIV/AIDS, which are rooted in values, beliefs and norms that reinforce inequality.
The large ethnic and religious diversity of Myanmar which makes for a potentially great variety of relevant values and norms, particularly about sexuality and gender relations, about which very little research information could be found. Sex-disaggregated data collection and/or analysis is lacking in many quantitative studies. Although the Myanmar government collects sentinel surveillance data for specific groups of men and women, official sex-disaggregated HIV-prevalence rates for the general population are not available. Other research/data gaps include gender-specific barriers and needs relating to access to information, products and services for sexual health and HIV/AIDS, the potential for promoting gender equality through public and institutional policies, as well as the research areas indicated below.
The priority areas in which further research on gender differences needs to be undertaken are:
o Gender norms about sexuality and power relationships in different communities (ethnic and religious) and their influence on behaviour and ability to protect oneself from HIV-infection
o Socio-economic factors influencing HIV vulnerability (gender aspects of poverty and socio-economic decision-making at the intra-household level )
o Socio-economic consequences and gender differences therein, for people infected and affected by HIV/AIDS
o Gender differences in stigma & discrimination of PLWHA
There is a clear need to advocate for and ensure a systematic assessment of gender aspects in all future research on HIV/AIDS, as well as to undertake more specific gender-focused studies.
In order to increase access to existing research data and facilitate future research, UNAIDS and other UN agencies should explore with government partners what exactly the barriers to collection and widespread dissemination of research data on HIV/AIDS and gender are, and what support is needed to lift these barriers.
Capacity building, technical feedback and information/experience sharing about identifying, prioritizing and addressing gender issues in HIV/AIDS as part of programme planning and implementation need to be expanded. This should be done in such a way that organisations can learn from each other as well as from experiences in other countries.
Specific training and technical support is needed to build and improve the capacity of Joint Programme Implementing Partners to collect, analyse and use sex-disaggregated data and to develop gender-sensitive indicators for programme monitoring and evaluation.
UNAIDS, UNICEF and UNFPA should explore the scope for supporting the collection and dissemination of data to monitor progress in meeting Myanmar's international commitments on promoting gender equality, which includes areas of reproductive health and HIV/AIDS in their wider context. Efforts should be made to involve government and non-governmental organisations in such data collection and sharing.
