Gender Audit on Tanzania National Response to HIV and AIDS {Tanzania Mainland}

Transcription

1 POPULAR VERSION Gender Audit on Tanzania National Response to HIV and AIDS {Tanzania Mainland} Presented to: TACAIDS - JOINT-UN HIV PROGRAM By Margaret K. Kasembe Telephone +255 (0) 754/ February, 2009

2 TABLE OF CONTENT LIST OF ACRONYMS... V LIST OF TABLES... VI GLOSSARY OF TERMS... VIII ACKNOWLEDGEMENT... XI THE HIV & AIDS EPIDEMIC THE GLOBAL SCENE GENDER AND VULNERABILITY TO HIV AND AIDS BASIS/ JUSTIFICATION FOR THE GENDER AUDIT PURPOSE AND OBJECTIVES OF THE GENDER AUDIT KEY TASKS THE CONCEPTUAL FRAME-WORK ANALYSIS ADDRESSING KEY NEGATIVE GENDER ISSUES WHICH INCREASE HIV/AIDS INFECTION ADDRESSING GENDER CONCERNS IN PROVISION OF HIV & AIDS PREVENTION SERVICES LEVELS OF GENDER DIMENSIONS IN EXISTING NATIONAL INTERVENTIONS MAINSTREAMING OF FINDINGS FROM THE LITERATURE GENDER AUDIT AND THE SURVEY INTO THE HIV/AIDS NATIONAL RESPONSE THE GENDER AUDIT ON HIV & AIDS THE SAMPLE FOR GENDER AUDIT ON HIV & AIDS The Sample type/groups The Actual Sample Geographical Coverage THE AUDITING METHODOLOGY THE SCOPE OF THE DESK REVIEW The Survey LITERATURE REVIEW AUDIT INTRODUCTION Gender Dimensions at Infection level Gender Dimensions at Prevention Level Gender Dimensions at Care and Support Level Gender Dimensions at Treatment Level AUDITING OF DOCUMENTS BEING USED BY THE NATIONAL HIV/AIDS RESPONSE Key Gender Elements Used for Auditing The Ranking scale GENDER AUDIT ANALYSIS AND FINDINGS DATA ANALYSIS AUDIT FINDINGS The Desk Review ii

3 7.2.2 Findings from the Survey Finding on Institutional Gendered Levels RECOMMENDATIONS AND WAY FORWARD THE GENDER AUDIT IDENTIFIED SEVERAL AREAS WHICH COULD BE GENDERED SO THAT THE HIV/AIDS NATIONAL RESPONSE PROGRAMS CAN BE MORE SUCCESSFUL At National Level: At TACAIDS Level At Sector Level At UN and Donors Levels At LGAs Level At NGO Levels At Private Sector Levels OBSERVATIONS AND CONCLUSION iii

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5 LIST OF ACRONYMS ABCT AIDS ART ARV CBO CEDAW CHAC CSO EAC FBO GLIA HIV LGA M&E MDG MCDGC MEVT MLYDS MSM MTEF MVC NACOPHA NGO NHACAS NMSF RATN RFA SADC SAT SOSPA STI TACAIDS TGNP THIS TIENAI TMAP TOMSHA UN UNAIDS UNDP UNGASS USAID VCT VMAC WHO WMAC WPP Aids Business Coalition in Tanzania Acquired Immunodeficiency Syndrome Anti-Retroviral Therapy Anti-Retroviral Drug Community Based Organization Convention on the Elimination of All Forms of Discrimination Against Women Council HIV and AIDS Coordinator Civil Society Organization East African Community Faith Based Organization Great Lakes Initiative on HIV and AIDS Human Immunodeficiency Virus Local Government Authority Monitoring and Evaluation Millennium Development Goals Ministry of Community Development, Gender and Children Ministry of Education and Vocational Training Ministry of Labor, Youth Development and Sports Men who have Sex with other Men Medium Term Expenditure Framework Most Vulnerable Children National Council of People Living with HIV and AIDS Non-Governmental Organization National HIV/AIDS Communication and Advocacy Strategy National Multi-Sectoral Strategic Framework Regional AIDS Training Network Regional Facilitating Agency Southern Africa Development Cooperation Southern African AIDS Training Centre Sexual Offence (Special Provisions) Act Sexually Transmitted Infection Tanzania Commission for AIDS Tanzania Gender Network Programme Tanzania HIV/AIDS Indicator Survey Tanzania Informal Economy Networks on AIDS Initiative Tanzania Multi-sectoral AIDS Project Tanzania Output Monitoring System for HIV and AIDS United Nations United Nations Joint Programme on HIV and AIDS United Nations Development Program United Nations General Assembly Special Session on HIV and AIDS United States Agency for International Development Voluntary Counseling and Testing Village Multi-sectoral AIDS Committee World Health Organization Ward Multisectoral AIDS Committee Work Place Programme on HIV and AIDS v

6 LIST OF TABLES Table 1: Gender Related Concerns in the National Response to HIV/AIDS... 2 Table 2: Summary Gender Dimension Levels on HIV/AIDS in Audited Documents by % and Level...20 Table 3: The General Distribution of Negative Gender Based Influences to the HIV and AIDS National Response by % and by Sector...21 Table 4: Average Degree of Stigmatization by Females, Males and Youth, and Area...24 Table 5: Average Accessibility of Information on ART by Females, Males and Youth, and Area...24 Table 6: Average Proportion of Caretakers of AIDS Patients in the Homes...25 Table 7: Mitigation measures on identified Gender Based Factors as achieved by Percentages by sector...25 Table 8: Distribution of Programmes Implemented by Area and Degree of Accessibility (Male and Female)...29 Table 9: Average Accessibility Level of Preventive Measures by Education Level and Sex of Youth...30 Table 10: Average Promotion of Use of Condoms by Significant Members of Society...31 Table 11: Average Achieved Success of National Response to HIV and AIDS by Local Government Level...31 Table 12: Distribution of Gender Negative Factors Causing HIV in Institutions by Level of Impact...32 Table 13: Distribution of Institutional Mitigation Measures on Gender Factors Causing HIV...34 Table 14: Summary of Institutional Levels of Gender Perceptions by Staff...35 Table 15: Accessibility and availability of Gendered Methods, Procedures and/instruments...38 Table 16: Levels of Staff Competence in Responding Institutions...39 vi

7 LIST OF FIGURES Figure 1: Figure 2: Conceptual Analysis Framework...5 The Elderly in the caring for AIDS Patients..7 Figure 3: Institutional Gender Perceptions by Sector Figure 4: Institutional Accessibility to Available Methods / Instruments/Procedures Figure 5: Levels of Staff Competence in Responding Institutions vii

8 GLOSSARY OF TERMS Audit: Discrimination: means looking closely into a system with the aim of reviewing, checking, inspecting, examining, assessing, appraising, taking stock of the situation with the intention of finding gaps upon which improvement / renovation / rehabilitation of the system performance can be prescribed. Traditionally audits have been associated with financial accounting audits. Exclusion or denial imposed on a group of persons to access human rights entitlements. Domestic Violence: the abuse and violations physical, sexual, and psychological that take place in the family FGM/FGC: Gender: Gender Aspects: Gender Audit: This is the initiation ceremony for females in certain societies through which these females undergo the cutting of their genital organs, which ranges from total cutting, or removal of part of the genitals, as a means of graduating into certain ways of that society. The instruments used are deemed as a major cause of HIV infection. refers to the social conceptualization of man and woman based on their social differences and relations between men and women that are learnt, changeable over time, and have wide variations across cultures. They are context specific and can be modified. means the gender dimensions, components, concepts that arise from men s and women s differentiated needs. is a systematic social and quality audit that enables organizations to measure the extent to which they live up to the shared values and objectives on gender issues to which they are committed by allowing the organizations to build on existing documentation and reports, as a means of accounting for its gender mainstreaming performance in order to draw up an action plan for improving on that performance. Gender base violence (GBV): physical, sexual, or psychological violations which are inflicted by man or woman on a member of the opposite sex Gender blindness: describes social situations that do not explicitly recognize existing gender differences that concern both productive and reproductive roles of men and women. viii

9 Gender Component: (See Gender Aspects) Gender Conceptualization: the perception or realization of the differentiated and specific social needs of males and females Gender discrimination: deprivation/exclusion/denial imposed on a group of persons to access human rights entitlements. It occurs when one type of sex is treated either better or worse than the other on the basis of sex type. Gender diversity: Gender equality: Gender equity: Gender gap: ensuring and recognizing the differentiated representation of males and females in a certain situation. It is the recognition of the differentiated needs of men and women and making provisions in plans and implementation taking into account their specific social differences and roles. entails the concept that all human beings, both men and women are free to make develop their personal abilities and make choices without limitations set by stereotypes, rigid gender roles and prejudices; so that their rights, responsibilities, and opportunities do not depend on whether they are born male or female fairness of treatment /distribution for females and males according to their respective needs in terms of rights, benefits, obligations, and opportunities. Equity is the means to reach equality. the difference existing in a certain situation whereby inequality is experienced by either males or females leading to availing less levels of participation, access to resources, rights, power and influence, remuneration and benefits. Gender mainstreaming: it is a process of making women s as well as men s concerns and experiences an integral dimension of design, implementation, monitoring and evaluation of policies, programmes in all political, economical, and societal undertakings so that women and men benefit equally with the ultimate goal of achieving gender equality in all planning, implementation and monitoring and evaluation of all programs. Gender sensitivity: being aware that men and women within the society are constrained in different and often unequal ways and therefore consequently call for differentiated treatment of their conflicting need, interests, and priorities. Gender Sensitization: mobilization with intention of building awareness to gender sensitivity ix

10 Gender Stereotyping: it is the manner in which people s attitudes and practices persist to perceive men and women in a certain cultural setting. Harmful Traditional Practices: a group of acts which are institutionalized and practiced within a society as cultural beliefs and values but which undermine the welfare of a certain group/groups of that particular society. Human Rights: Marginalization: The universally agreed upon human rights with regard to the right to life, social and economic welfare, which should be enjoyed by all human beings irrespective of their sex, colour, or creed. the process of excluding/ barricading a group of persons intentionally so that they cannot access the rights and benefits entitled to them. Participatory gender audit: a situation in which staff members to a certain institution are facilitated to perform the gender audit for their own institution. Sex-disaggregated data: collection and use of quantitative and qualitative data by sex which is critical as a basis for gender sensitive research, analysis, strategic planning, implementation, monitoring and evaluation processes. Stigma: Feelings of shame, disgrace, dishonor for someone who is afflicted by an undesirable situation in the society. Stigmatization: instilling feelings of shame, disgrace and dishonor into someone. x

11 ACKNOWLEDGEMENT Gender audit is a new phenomenon so that, there isn t yet one specific way of doing a gender audit. Therefore in order to accomplish this exercise, many examples from gender audits which have been done in various countries were examined, customized, and adapted. In addition, in the course of doing this audit, views and contributions were received from members of the Steering Committee, TACAIDS Staff, Members of the Gender Macro Group, and the Joint UN Program. I wish to specifically acknowledge contributions from Dr Fatma Mrisho the Executive Chairperson of TACAIDS, Prof Ruth Meena the UN Gender Advisor, Ms Salome Anyoti the UNIFEM Program Specialist, Admassu Emebet from the UNAIDS in Tanzania, Zukiva Mihyo Researcher at REPOA and the Chairperson of the Gender Macro Group, Ms Suzan Fried, Gender Advisor HIV/AIDS Group Bureau for Development Programme, UNDP in New York I wish also to take this opportunity to acknowledge the contributions obtained from interviewing the Key Informants from the Government Ministries including the Ministry of Health, Ministry of Community Development Gender and Children, Ministry of Education and Vocational Training, Ministry of Labor, and Ministry of Lands, the Uniformed Forces including Lugalo Hospital and the Army Headquarters, NGOs including TGNP, the Private sector including ALAF, Tanzania Breweries and Ultimate Security, and the Local Councils of Ilala and Kibaha. Last but not least, I wish to acknowledge input by Ms Verah Mdai, the Gender Unit Staff at TACAIDS for her tireless efforts in the planning of interview sessions. Margaret K. Kasembe Consultant February, 2009 xi

12 EXECUTIVE SUMMARY 1. Introduction This Gender Audit Report presents findings on the gender dimensions/components within the national response to HIV/AIDS in Tanzania. The gender audit was centred on the existing documents on policies, guidelines, advocacy and monitoring tools that are being used in the prevention, care, treatment and support services at national, sectoral, NGO, private and Local government levels. In addition, the gender audit received inputs from key informants on the gender concerns which are negatively impacting the HIV/AIDS national response. HIV/AIDS has impacted on the Tanzania population by lowering the life expectancy so that at birth, it is now 47 years for men and 49 years for women. Gender roles and relations powerfully influence the course and impact of the HIV/AIDS epidemic. Girls and women face heavier risks of HIV infection than men because of their diminished economic and social status which compromises their ability to choose safer and healthier life strategies. The gender related violence meted on women and girls in the form of genital cutting, or sexual violations such as rape and wife inheritance are major factors in gender-based violence, which is key to fueling HIV infection. Even though HIV/AIDS persists to be feminized, the men, and especially young boys, are vulnerable too due to social norms which reinforce the celebration of masculinity, promiscuity and irresponsible sexual behaviors among men. 2. Justification for the Gender Audit Gender inequalities are not sufficiently and comprehensively addressed in the national response HIV/AIDS intervention programs. The current survey findings indicate gender related issues continue to create many draw backs on the efforts by stakeholders of the national response of HIV/AIDS. The following concerns are showing evidence that due to the gender inequalities, women continue to be more vulnerable to the HIV/AIDS scrooge. 2.1 Even though HIV prevalence has decreased for both women and men, and across most age groups, the discrepancy remains significant amongst men and women with infection among women being significantly higher 7.7% (2003/04) and 6.8% (2007/08) while men stand at 6.3% (2003/04) and 4.7% (2007/08) xii

13 2.2 HIV infections which increased from 1,816,326 (Dec 2006) to 1, (Dec 2007) (NACP) are indicating that of all People Living with HIV in Tanzania women account for 61% (15-24 yrs), the proportion that rises to nearly three quarters compared to 2003/04 data. 2.3 Condom use for higher risk sex still low at 43% for women and 53% for men, and more significantly is the under use of Female condoms. 2.4 Age of sexual debut is at very tender age, from from 10.1% (2004/05) to 10.7% 2007/08 for women and from 10.7% (2004/05) to 10.8% (2007/08) 2.5 The proportion of reporting multiple partners within the last 12 months stands significantly higher; 25% for men while women are at 3%. 2.6 Most of the care givers in the homes are women (over 85%), including older women, however proper and adequate information on prevention is not reaching this group, thus making them vulnerable to HIV infection. 3. Purpose/ Goal To conduct a systematic gender audit on national response on HIV & AIDS in Tanzania Mainland, by reflecting on programme priorities and practices for the past three decades as well as institutional frameworks in the context of gender equality, (beyond programs to personal and institutional biases in the institutional culture) in order to come up with data and recommendations which will be used to inform and guide the national strategic direction towards gendered responses to HIV and AIDS. 2. Specific Objectives 4.1 To assess the gender responsiveness of the existing HIV and AIDS frameworks at national, sectoral and institutional levels by assessing program strengths and challenges in consistent with international guidance on human rights and gender equality. 4.2 To assess institutional frameworks (policies, action plans and strategies) in the overall development and HIV and AIDS specific, that guide priorities within the planning and budgeting processes 4.3 To analyze programmatic and institutional gender gaps and come up with recommendations for gendered improvement and inputs for upcoming national processes. 5. Conceptual Framework Analysis included the following main gender concepts: 5.1 Assessing the impact of the Key Negative Gender issues which commonly impact on HIV AIDS in Tanzania society, 5.2 Identification of the Specific Gender Related Concerns which are currently impacting on HIV and AIDS intervention programmes in Tanzania, 5.3 Assessing the strengths in the gender dimensions existing in the national interventions with regard to prevention, care and treatment, xiii

14 5.4 Highlighting the Findings from the Literature Gender Audit and the Survey conducted among stakeholders and recommending on how these should be mainstreamed as gendered interventions on HIV/AIDS. 6. Methodology The gender audit involved selected respondents from the national multi-sectoral partnership that exists in the national response to HIV and AIDS. 6.1 The audit employed two avenues of collecting data, a desk review and a survey. The desk review was aimed at assessing the inclusion of gender concepts in the existing policies, bills, and other guidelines as frameworks applicable at national, sectoral and institutional levels within the national response on HIV and AIDS. The conducted survey used two instruments which were developed in order to assess gender perceptions among the main implementers of the national HIV and AIDS response at staff and organizational levels. The information was obtained from selected key informants and other institutional respondents at sector level, NGOs and the private sector. 6.2 The Desk Review covered the bigger portion of the audit exercise (60%). The examined documents contain major HIV and AIDS policies, strategies, guidelines and implementation plans. 6.3 Non-interactive survey using questionnaires and interactive survey methods through interviews/focus group discussions / organizational team discussions ensured that all the gender issues are addressed without necessarily focusing only on women. 6.4 The three key gender elements which were used in the audit were equality, diversity, and sensitivity. Gender neutral /gender blind documents failed to respond to these three key gender elements. 7. The Gender Audit Findings The Ranking scale (Likert Scale) used is showing degree of gender compliance in the inclusion or exclusion of the gender elements (sensitivity, diversity, and equality) in each document from zero (0) to three (3) 7.1 The Literature Audit Using the Likert Scale, the main findings from the literature audit shows that average score for inclusion of gender dimensions is as follows In the national policies, is 0.81 or below 25% TACAIDS policies /plans/ strategies is 0.43 or below 25%, Sectoral policies/guidelines is 0.71 or below 25% The Local Government (Municipal Council and Ward) Levels as well as the Private sector, the documents in use for the HIV/AIDS national response are completely gender blind (0%). National Surveys, Policies & Bills... Below 25% TACAIDS Tools... Below 25% Sectoral Policies on HIV/AIDS... Below 25% xiv

15 Private Sector... 0% Local Government Authority... 0% In conclusion, it is evident that the inclusion of gender dimensions in these publications is very low. The total average score for inclusion of gender dimensions in the audited publications which are in use by the multisectoral partnership in the national response to HIV/AIDS is only 0.61 or less than 25% gendered. 8. The Survey Audit 8.1 Key Informants Findings The following tables are presenting findings from the Key informants on the impact of the negative gender influences on the HIV/AIDS national response Ten Identified Negative Gender Issues in the Community Patriarchy/ Male Dominance... 95% Domestic Violence... 95% Economic dependency by vulnerable groups Lack of decision making on sexuality % Sexual assaults and rape % Gender discrimination % Stigmatization, denial to testing secrecy of infection % Forced early marriage % Lack of information for home based care esp. for women, older women and girls as the main care-taking group % Female s lack of confidence to say No % Levels of stigmatization by area by sex Rural Areas Urban Areas Females 80% 60% Males 40% 10% Youth Boys 40% 10% Youth Girls 90% 80% Involvement in the burden of care for the aids patients in the homes Women 70% Men 2% Girls 24% Boys 4% Levels of receiving Information on ART by area and sex Rural Urban Females 10% 60% Males 45% 70% Girls 5% 15% Boys 15% 40% Acceptability of Condom Use by significant members of the society Christian religious leaders 5% Islamic religious leaders 7% Parliamentarians 90% Parents 40% xv

16 Teachers 55% Cultural Fanatic 2% Levels of achievement on the national response programming within Local Government Levels District Council 60% Ward 3% Village 1% Ten-Cell 1% NGOS within the District 80% 8.2 Institutional Survey Findings Negative Gender factors at institutional levels (Government sector, LGA, NGOs, FBOs, and Private sector) Irresponsible sexual behavior esp by men employees % Women economic dependency % Corruptive sexual habits esp during recruitment and promotion processes % Sexual harassment... 84% Patriarchy/ Male dominance/chauvinism % Traditional beliefs/ negative gender perceptions % Fear of Stigma to test % Women s lack of confidence and assertiveness % Psychological torture on HIV victims... 86% Rank and file in armed forces... 90% Restrictions not to marry for a specified time factor in the Army... 95% Gender Perceptions at Institutional levels Gov t NGO Private Armed FBO Gender Perceptions, Expertise and Vision among staff and the institution tools and framework Accessibility and availability of methods, procedures and/or instruments for gender mainstreaming within an institution Competence of staff in gender issues Culture of the organization and how it contributes to gender sensitivity within the institution Service delivery of partner organizations and other partners in gender sensitive manner within the national response TOTAL AVERAGES TOTAL AVERAGE % (50-75%) (75-100%) (All Others Below 25%) NOTE: 1. NGOS are leading because of the contributions from TGNP (75-100%) 2. Government Sector is next because of contributions from the Gender Ministry (50-75%) 3. The Armed forces have introduced gender programmes with specific emphasis on HIV/AIDS interventions (Below 25%) 4. FBOs are also putting measures to respond to the gender issues especially within the organization culture (Below 25%) 5. Institutions in the Private sector have very low gender perceptions because they are mo business oriented. (Below 25%) xvi

17 8.2.3 Accessibility and availability of Gendered Methods, Procedures and/instruments Frequency of updating the gender policies, action plans, and strategies (Below 25%) Adequate use of instruments for gender analysis (25-50%) Level of gender expertise to implement the gender audit findings... 1 (25-50%) Resources to enable your institution achieve gendered response to HIV and AIDS... 1 (25-50%) Monitoring and Gender Mainstreaming (25-50%) Outsourcing gender expertise for staff skills (25-50%) Monitoring of gender mainstreaming in institutional reports (25-50%) Access and guidance on gender and HIV standards, policies (25-50%) Capacity building opportunity on gender issues for staff (50-75%) Free flow and exchange of information amongst stakeholders (50-75%) Note: 1. Capacity building in gender for staff is adequate 2. Free flow and exchange of information among stakeholders is adequate 3. However the gender policies, action plans, and strategies need updating in order to enable staff to use their skills in gender analysis and mainstreaming which are showing very low scores. 9. Recommendations and Way Forward 9.1 At National Level: To provide Legal Guidance on the HIV/AIDS national response, the pending Bill on HIV/AIDS should be passed by Parliament Since infection of HIV is fueled by negative gender influences, a specific Bill on Gender Violations should be passed to supplement the SOSPA Repeal un-gendered sections in the existing Marriage Act (1970) which supports early marriage for girls, and therefore compromises efforts of the national response to HIV/AIDS Engender the Act No 22 that established TACAIDS to enable TACAIDS to operate within gendered mandates The Women Empowerment and Gender Policy should be revised so that it reflects the differentiated gender needs of both males and females, thus enhancing its acceptability by the males. A gendered policy could be the best strategy used by men to challenge their own masculinity and attitudes that are fueling Gender based Violence and HIV infection The National Policy on HIV/AIDS should be revised in order to carry indicators and targets that are gendered The MoH and MCDGC have comparative advantages on Health issues and Gender issues respectively. Therefore, the Government should assign them the joint role of assisting TACAIDS in engendering the HIV/AIDS national response xvii

18 9.1.8 The Government should allocate to the MoH and MCDGC a specific budget line for the engendering activity The Government through the Ministry of Justice should expedite the process of passing the two acts mentioned above: One on Gender Based Influences and the other (which is pending) on HIV/AIDS The Government should assign to MCDGC and Ministry of Justice to work jointly on the process of engendering the framework tools (including the bills to be passed) for the national response to HIV/AIDS is achieved The Government should enlist the assistance of Donors and the UN to fund the process of engendering the national response to HIV/AIDS in the country. 9.2 At TACAIDS Level Using the findings from the Gender Audit, revise/rewrite the tools in the framework in order to include the required gender dimensions with respect to the services provided by the HIV/AIDS national response Establish and dedicate a Gender Unit which will coordinate gender issues which are pertinent to the HIV/AIDS national response Recruit gender experts for the unit Engender the prevention, care, treatment and support services rendered by the HIV/AIDS national response by engendering the NMSF, TOMSHA, NHACAS and all the other tools Ensure that the TOMSHA as a monitoring tool fully captures information about the gender dimensions of the HIV epidemic in Tanzania by developing targets and indicators to measure the gender related outcomes and impact of the HIV/AIDS national response Provide adequate gender training (Gender analysis, appraisal, and mainstreaming skills)to all staff working for the HVI/AIDS national response to build their ability to engender the program design and implementation of activities which support the equal rights and differentiated gender needs of women/girls and men/boys Link the TACAIDS Gender Unit expertise to the Gender/HIV Focal Persons at sectoral, NGOs, and private sectors so that a solid knowledge base on gender can be built so that staff working on issues of HVI/AIDS are able to talk at same levels where the HIV/AIDS national response is concerned Solicit for funding from Government and development partners for engendering the HIV/AIDS national response framework tools in use by TACAIDS and its partners Increased collaboration with LGAs and NGOs in order to have better grass root outreach for the HIV/AIDS national response xviii

19 9.3 At Sector Level The Government should encourage each ministry to develop specific strategies on the HIV differentiated gender needs and issues of men/boys and women/girls being served by their mandates Sectoral policies should be developed with the view to address all gender related issues within the sector, but especially those issues related to the national response to HIV/AIDS Collaboration and support to NGOs working within the sector s mandate in order to increase grass root level outreach on issues related to the national response on HIV/AIDS Collaboration with TACAIDS as the national authority on the national response to HIV/AIDS should be at high level, esp the MoH and MCDGC so that the areas of health and gender are well integrated into the national response to HIV/AIDS 9.4 At UN and Donors Levels In response to the 2005 Paris Declaration on Aid Effectiveness, assess and support effectively the attainment of the required levels of gender equality, sensitivity and diversity with regard to the HIV/AIDS national response services rendered by the stakeholders in the country Donors should provide technical assistance and funding for gender mainstreaming of the audited gender related findings into the national response to HIV/AIDS as soon as possible Increase financial assistance to TACAIDS for training and capacity building in gender expertise for its staff as well as staff of other stakeholders for the national response to HIV/AIDS, Funds for the Establishment of the Gender Unit within TACAIDS Funds for the Recruitment of Gender experts for the Gender Unit Funds for the revision and engenderment of the tools in use for the HIV/AIDS national response which have been produced by the stakeholders at all levels Fund the engendering of the intervention process of HIV/AIDS national response al all levels (national, institutional, LGAs, private sector, and NGOs) Allocate and sustain specific funding in the MTEF for the engendering of the HIV/AIDS national response Support research into consequences of negative gender influences and vulnerability to HIV/AIDS as identified by the findings from the gender audit Support the monitoring of gender mainstreaming of all programmes being implemented on HIV/AIDS by the national response Support collaboration of stakeholders of HIV/AIDS national response at all level of operation xix

20 9.5 At LGAs Level Review and engender the locally produced policies related to the HIV/AIDS national response Identify gender differentiated concerns in all HIV/AIDS programmes for women, men, boys, and girls as well as taking into account the early sex debut for girls Formulate and train engendered HVI/AIDS Committees at the Council, Ward, and Village in order to enhance the implementation of gendered HIV/AIDS interventions All LGA sources should be budgeted and distributed appropriately through the HIV/AIDS Committees To enhance better collaboration with NGOs,FBOs, and CSOs, the HIV/AIDS Committees should include members from sectors and should be adequately gendered in composition 9.6 At NGO/FBO Levels Implement and scale up specific interventions to address the gender dynamics of the HIV/AIDS national response programmes at grass root levels Advocate more robust gendered surveillance on infection, prevention, care and support on women, men, boys and girls with much attention on their transactional and intergenerational sexual activities Effectively participate and collaborate in addressing gender concerns with key partners of the HIV/AIDS national response from national levels to grass root levels Together with the other stakeholders, participate effectively in using the gender audit findings in the engendering process of the national framework Advocate the full integration of gender into the national response to HIV/AIDS using the findings from the gender audit NGOs should work with the Government and the Donor community to ensure that their planned activities on engendering the HIV/AIDS framework are adequately funded Together with Government, donor community, TACAIDS and other partners in the national response framework, continue to advocate for the integration of gender dimensions in the HIV/AIDS national response Organize campaigns to change harmful or disempowering norms about masculinity, femininity, and sexuality in order to speed up change of mind-sets in our society. 9.7 At Private Sector Levels Revisit the existing HIV/AIDS policies and engender them as per findings of the gender audit Integrate gender dimensions in the whole approach to programme design and implementation with regard to HIV/AIDS in the private sector workplace as well as the surrounding communities xx

21 9.7.2 Effectively collaborate in engendering the prevention, care and treatment in terms of equal accessibility and sustainability of these services for both males and females, in the HIV/AIDS national response with other partners through the Aids Business Coalition in Tanzania (ABTC) ================= xxi

22 THE HIV & AIDS EPIDEMIC 1.1 The Global Scene HIV and AIDS is the most devastating disease to have emerged in recent history. According to the latest (2008) WHO and UNAIDS global AIDS estimates, 33.0 million are living with HIV worldwide; 2.7 million people were newly infected in 2007 and 2.0 million died of AIDS in Although the number of new HIV infections has fallen from 3 million (in 2001) to 2.7 million in 2007 overall in several countries, the epidemic is not over in any part of the world. 1.2 Gender and Vulnerability to HIV and AIDS Gender roles and relations powerfully influence the course and impact of the HIV/AIDS epidemic. Gender-related factors shape the extent to which men, women, boys and girls are vulnerable to HIV infection, the ways in which AIDS affects them, and the kinds of responses that are feasible in different communities and societies. Gender-based inequalities overlap with other social, cultural, economic and political inequalities and affect women and men of all ages. These inequalities increase the vulnerability of women and girls to HIV/AIDS. Girls and women face heavier risks of HIV infection than men because of their diminished economic and social status which compromises their ability to choose safer and healthier life strategies. Hence men have been known to use their economic, social and cultural advantages to impose their desires on their spouses, girl-friends and contacts; and women are driven by economic need to engage in transactional sex, thus increasing their vulnerability to sexually transmitted diseases, and in particular to HIV and AIDS. 1 Women are often infected at an earlier age than men. Early marriages for girls plus early sexual debut for girls have resulted to early HIV infection for girls. In Tanzania, 12% girls have their first sex at 15 years of age, whereas for boys it is only 7%. 2 In addition, the violence meted on women and girls in the form of genital cutting, or sexual violations such as rape and wife inheritance have increase what is now known as gender-based violence. There is growing evidence that a large share of new cases of HIV infection is due to gender-based violence in homes, schools, the workplace and other social spheres. 1 TGNP, SAT & RATN (2004) A Training Manual on Gender, Policy and HIV & AIDS 2 TGNP and Macro International Inc. (2007) Women s Health in Tanzania. Dar es Salaam 1

23 In short, HIV/AIDS persists to be feminized so that reversing the spread and negative impact of HIV on women and girls therefore demands that women s rights are realized and that women are empowered in all spheres of life. However, the men, and especially young boys, are vulnerable too due to social norms which reinforce negative masculinity and greatly increase men s lack of understanding of sexual health issues, while at the same time celebrating promiscuity and irresponsible sexual behaviors among them. 2.0 Basis/ Justification for the Gender Audit According to the recent results of the Tanzania HIV & AIDS and Malaria Indicator Survey 2007/08 issued by the National Bureau of Statistics, it indicates the following major gender related concerns for HIV and AIDS. These findings link to many other research elsewhere in the world and support that when gender inequalities are not sufficiently and comprehensively addressed in the intervention programs, it then becomes difficult to address men and women specific gender needs, so that gender gaps continue to manifest themselves as inequalities. The following is evidenced by the given TORs for this study: 3 Box No 1: Gender Related Concerns in the National Response to HIV/AIDS Even though HIV prevalence has decreased for both women and men, and across most age groups, the discrepancy remains significant amongst men and women with infection among women being significantly higher 7.7% (2003/04) and 6.8% (2007/08) while men stand at 6.3% (2003/04) and 4.7% (2007/08) HIV infections which increased from 1,816,326 (Dec 2006) to 1, (Dec 2007) (NACP) are indicating that of all People Living with HIV in Tanzania women account for 61% (15-24 yrs), the proportion that rises to nearly three quarters compared to 2003/04 data Condom use for higher risk sex still low at 43% for women and 53% for men, and more significantly is the under use of Female condoms Age of sexual debut is at very tender age, from from 10.1% (2004/05) to 10.7% 2007/08 for women and from 10.7% (2004/05) to 10.8% (2007/08) The proportion of reporting multiple partners within the last 12 months stands significantly higher; 25% for men while women are at 3% Most of the care givers in the homes are women (over 85%), including older women, however proper and adequate information on prevention is not reaching this group, thus making them vulnerable to HIV infection Concerns are conclusively showing that women and girls are more affected by HIV AIDS due to existing gender inequalities even in the provision of interventions. Coherent national policies, legal reforms, strategies and plans marked by high-level 3 TACAIDS (2008) Terms of Reference for the Gender Audit on the National Response to HIV/AIDS in Tanzania 2

24 political commitment for steps that tackle the gender dimension of the epidemic in a variety of ways could hold the answers to the reduction of this scrooge in Tanzania. Thus the need for gender audit in interventions plans and programmes is nigh. 3.0 Purpose and Objectives of the Gender Audit 3.1 Purpose/ Goal To conduct a systematic gender audit on the national response on HIV & AIDS in Tanzania Mainland, with regard to programme priorities and practices for the past three decades as well as institutional frameworks in the context of gender equality, (beyond programs to personal and institutional biases in the institutional culture) in order to come up with data and recommendations which will be used to inform and guide the national strategic direction towards gendered responses to in the national intervention to HIV and AIDS. 3.2 Specific Objectives To assess the gender responsiveness of the existing HIV and AIDS frameworks with regard to program strengths and challenges in the area of gender in consistency with international guidance on human rights and gender equality To assess institutional frameworks (policies, action plans and strategies) in the overall gender context on development and HIV and AIDS specific, that guide priorities within the planning and budgeting processes To analyze programmatic and institutional gender gaps and come up with recommendations for gendered improvement and inputs for upcoming national processes. 3.3 Key Tasks A desk audit review was conducted on key documents on the national HIV and AIDS such as policy, strategy and programme documents, and identifying the existing gender gaps Interviews were conducted with key informants from selected entities which included HIV and AIDS gender coordination authorities in the government sector ministries, NGOs, private sector, and LGAs Interviews and consultations were also conducted with gender technical committees ie: The Gender Macro policy Group, the UN inter Agency Group on Gender and Gender and HIV and AIDS Focal persons in relevant Ministries and District Council (Ilala and Kibaha) as guided by TACAIDS. 3

25 3.3.4 Finally, a comprehensive report has been produced using the analysis of the audit findings in order to extract the current status of gender mainstreaming, challenges, and gaps. 4

26 Fig. 1: Conceptual Framework Analysis Key Negative Gender issues as contributing Factors to HIV/ AIDS national intervention on Infection, Prevention / Care/Treatment New impact on Gendered Interventions influencing/mitigating on negative contributing Factors Formulated Gendered HIV/AIDS Specific Gender Related Concerns impacting on HIV/AIDS in the national response programs in Tanzania HIV & AIDS New impact from Gendered audited approach to HIV/AIDS Prevention Care & Treatment Interventions Level of Engendered mitigations in existing national interventions on HIV AIDS (Policies, Guidelines) Review and Mainstreaming of recommended gendered interventions from audit into the national response framework policies and guidelines Findings on gender dimensions from Literature and Survey Audit 5

27 4.0 The Conceptual Frame-Work Analysis The analysed concepts include the Key Negative Gender issues which commonly impact on HIV AIDS globally, the Specific Gender Related Concerns which are currently impacting on HIV and AIDS intervention programmes in Tanzania, Strengths in gender dimensions in existing national interventions with regard to prevention, care and treatment, Mainstreaming of Findings from the Literature Gender Audit and the Survey conducted among stakeholders. 4.1 Addressing Key Negative Gender issues which increase HIV/AIDS Infection Socio-Economic related Gender issues Cultural Harmful Traditional Practices related to Gender Issues Violence and related Gender Issues Discrimination, Rights, and Empowerment Gender related issues 4.2 Addressing Gender Concerns in Provision of HIV & AIDS Prevention Services Attainment of Gender (Context of Human Rights in HIV and AIDS) in Infection Addressing Gender in Social Oriented Issues to HIV AIDS Prevention Addressing Gender in Care and Treatment Addressing Gender in Institutional Administrative Issues Addressing Gender in Infrastructure Issues 4.3 Levels of Gender Dimensions in existing National Interventions Audit results on key documents indicating percentages or level of gender diversity, gender sensitivity, gender equality and equity in the existing policies, strategies, guidelines and plans Audit results indicating percentages or levels of gender perceptions with regard to gender sensitivity, equality and equity, and diversity at institutional levels 4.4 Mainstreaming of Findings from the Literature Gender Audit and the Survey into the HIV/AIDS National Response Arriving at recommendations / proposals of engendering the audited key documents by including /mainstreaming gender dimensions/components/aspects through reviews and re-writing of these key national, sectoral and institutional documents (policies, guidelines, strategies and plans) on the national HIV/AIDS response 6

28 Fig 2: Addressing Gender in Care and Treatment...The national interventions (care, treatment and support) with regard to HIV and AIDS are not reaching the elderly who are mainly old women. Despite the fact that many elderly women in the society are currently taxes with the responsibility of looking after their children as aids patients in the homes as well as their orphaned children after they die The need to address these gender issues related to HIV/AIDS home care are crucial Source: Civil Society Focus. Issue No 02 March-June, 2008 Old women in this group picture are expressing their concern on the omission of clear national interventions for the elderly in the HIV and AIDS programmes at all levels. 7

29 5.0 The Gender Audit on HIV & AIDS 5.1 The Sample for Gender Audit on HIV & AIDS The gender audit involved selected respondents from the national multi-sectoral partnership that exists in the national response to HIV and AIDS. The proposed sampling design for the audit and every element of the design (with factors leading to suitable decisions taken) are described in the following paragraphs. The salient features of the design are: The Sample type/groups The selected/determined sample types or groupings, enabled the generation of reliable data on gender auditing on the national intervention on HIV and AIDS. The main areas which were audited include the current efforts being injected in the prevention, care, treatment and support services to males and females, through the Multi- Sectoral Committee at Government sector levels, CSOs level, private sector level, HIV and Gender Networks and Working groups, Faith Based Organizations, Armed Forces, plus the HIV Multisectoral approach at Local Government level (Committees at Councils, Wards, and Village levels). The design is envisaged to provide estimates of gender related characteristics which influence HIV infection, prevention, care, treatment and support with Coefficients of Correlation (CCs) expressed through the use of the Likert scale The Actual Sample a) Government Sector Ministries: Education, Lands, Community Development Gender and Children, Labor and Youth Development b) Other Government Sector institutions such as the Armed Forces(Military) Hospital c) Main Collaborators among CSOs: TGNP, NACOPHA, and TNW+ d) Collaborators within the Private Sector: ALAF, TBL, and Ultimate Security e) HIV and Gender Networks and Macro Working Groups f) TACAIDS at institutional level g) Faith Based Organizations : Christian and Moslem h) Local Government Multi-sectoral HIV/AIDS Committees in Ilala District at: Council Level (1) Ward Level (1)Village level(1) This sample included 9 females and 12 males as respondents to the Key Informant questionnaire from the above institutions. 8

30 5.1.3 Geographical Coverage According to the Tanzania HIV/AIDS and Malaria Indicator Survey , the HIV prevalence shows that Iringa recorded the highest prevalence among the regions (16.8%) for women and (12.1%), Dar es Salaam recorded second by (10.2%) for women and (7.3%) for men. The lowest record for the Mainland Tanzania is Kigoma at (1.5%). However, due to proximity and time constraints, the audit was focused on Dar es Salaam in order to represent those areas with high HIV prevalence rates. 5.2 The Auditing Methodology The audit employed two avenues of collecting data, a desk review and a survey. The desk review was aimed at assessing the inclusion of gender concepts in the existing policies, bills, and other guidelines as frameworks applicable at national, sectoral and institutional levels within the national response on HIV and AIDS. The conducted survey used two instruments which were developed in order to assess gender perceptions among the main implementers of the national HIV and AIDS response at staff and organizational levels. The information was obtained from selected key informants and other institutional respondents at sector level, NGOs and the private sector The Scope of the Desk Review The gender audit scope was limited within the following categories: national level policy documents on HIV and AIDS, administrative and key technical documents such as the various institutional policies and action plans on HIV/AIDS intervention, information on promotion/advocacy documents, technical cooperation documents, and the gender specific documents such as the Women and Gender Development Policy. The Desk Review covered the bigger portion of the audit exercise (60%). The examined documents contain major HIV and AIDS policies, strategies, guidelines and implementation plans. The examined documents have been able to provide the audit with: - Quantitative and verifiable evidence on the level of gender dimensions in the documents being used to address HIV/AIDS nationally - Identified gaps that will assist the engendering of these documents - Established benchmark for gender mainstreaming in future documents. Each document was listed by title and the contents were audited carefully in order to assess the gender component and voices of women as well as men, girls as well as boys 9

31 into the given information, documentation and products. The questions addressed were on how differently the subject or issue affects males and females, why it affects them that way, and what has been put in place as mitigation factor. The audited documents are those produced by TACAIDS, the Government sector (MDAs) LGAs, NGOs, and other stakeholders. a) At national Level: which include national policy documents, national strategies and implementation frameworks, acts and bills addressing HIV/AIDS in Tanzania. b) At institutional levels (MDAs) NGOs, Private Sector, and Armed Forces: the audit examined the various sectoral policies, strategies and plans. c) At LGA levels: the audit examined the policies, guidelines, and implementation plans for the district, councils, ward, and village levels The Actual Documents that were Audited National level Policy Documents which include: - The National Policy on HIV/AIDS (2007) - The Government of Tanzania Bill Supplement No 9 (September 2007) on HIV and AIDS (Prevention and Control Act, Tanzania HIV/AIDS Indicator Survey (THIS) - Mwongozo wa Kudhibiti Ukimwi katika Utumishi wa UMMA / Guidelines for HIV and AIDS Interventions at the Work Place within the MDAs TACAIDS Guidelines on HIV and AIDS Interventions - The Second National Multi-Sectoral Strategic Framework on HIV and AIDS ( ) - TACAIDS MTEF Consolidated Budget (Recurrent and Development 2007/ /2010) - National HIV and AIDS Communication and Advocacy Strategy (NHACAS) - Tanzania Output Monitoring System for HIV and AIDS (TOMSHA) - Operations Plan for Tanzania Multi-Sectoral HIV Monitoring and Evaluation System ( ) - Essential Minimum Package for HIV and AIDS Planning and - Budgeting within LGAs (2007) - TACAIDS Annual Reports 10

32 Sectoral Documents - Policy documents the Ministry of Education and Vocational Training - Policy documents from the Ministry of Labor, Employment and Youth Development - Policy documents from Ministry of Community Development, Gender and Children Others Documents of Regional Importance - East African Community: Second EAC Regional Workshop on Mainstreaming Gender and HIV/AIDS Interventions into various Regional Development Sectors and Strategic Plans Report (June, 2008) Documents from the Private Sector The audit examined the institutional policies on HIV/AIDS which have been developed at company level by ALAF Limited and Ultimate Security, as guides on the implementation of the HIV/AIDS intervention in these companies The Survey Non-interactive survey using questionnaires and interactive survey methods through interviews/focus group discussions / organizational team discussions ensured that all the gender issues are addressed without necessarily focusing only on women. In addition, these discussions were meant to promote organizational participation and ownership of the audit exercise Criteria. The degree of involvement in the HIV and AIDS intervention was the main criteria for eligibility for inclusion in the study and this was used to identify the correct intervening sector, or institution which was eligible for filling the questionnaire, undertake an interview which involved all the actual samples (See no 2 above), focus group discussion which was achieved at ALAF Tanzania, or institutional team discussion such as what took place at the Ultimate Security Headquarters and Tanzania Breweries Limited Key Informants. Interactive questionnaires were used on the key informants. The information centered mainly of the gender related concerns that negatively impact on the national HIV/AIDS response. Main areas included in the survey tool are those reflected in the given Conceptual Analysis Framework for this study as shown in figure 1 above Institutional Respondents. The non-interactive questionnaire was employed on institutions in order to audit the staff and organizational gender perceptions, visions, and understanding of the importance of gender issues in the organization s work towards combating HIV and AIDS in Tanzania. Furthermore, this 11

33 survey tool also examined the actual gender conceptualization in the administrative operations within the organization. The need to establish whether on not the institution had gender sensitive staff operating in a gendered environment using gendered policy framework was paramount in determining the institutional contribution on the success of the national intervention HIV/AIDS programme in Tanzania Mainland. 6.0 Literature Review Audit 6.1 Introduction As already discussed in sections above, HIV and AIDS have severe socio-economic impacts on males and females. However, women and girls bear the brunt of the epidemic due to their vulnerability to infection, and also as the main care giver during illness, and main family supporters when the breadwinner Incase of a man) is gone. Therefore, it becomes highly imperative for all interventional frameworks in the form of policies strategic and action plans, to address the key gender inequalities underlying the epidemic and make frequent reviews on progress made in addressing these issues. Policies and strategic plans on HIV/AIDS are the foundations for any meaningful and sustained response to the epidemic. Policies are key tools in directing implementation focus and resources. 4 All African leaders were party to the Declaration on the Commitment on HIV/AIDS at the UN General Assembly on HIV/AIDS held on June, 2000, during which all the countries were urged to have developed by 2003, multisectoral national strategic plans and financing on HIV/AIDS, with joint efforts from the Government, NGO Sector, Private Sector, Donor community, PLWHA, researchers and academicians. The involvement of all key stakeholders and the need for establishing multisectoral task teams on gender and HIV 5 were seen as paramount to the success of national HIV and AIDS response programmes. Other commitments aimed at addressing the existing compromises in the provision of prevention, treatment, care and support were identified as those related to gender based concerns which were fueling the infection of HIV especially among vulnerable groups (women, girls, boys, disabled). According to UNAIDS, key findings from assessments conducted in five regions between are helpful in identifying some of the major challenges in expanding gender equality and equity in national AIDS programmes. 6 Practically all assessments call for the prevention programmes to pay 4 TGNP, SAT & RATN (2004) A Training Manual on Gender, Policy and HIV & AIDS 5 UNAIDS (2007) 20 th Meeting of the UNAIDS Programme Coordinating Board, June, 2007, Geneva, Switzerland 6 UNAIDS (2007) 20 th Meeting of the UNAIDS Programme Coordinating Board, June, 2007, Geneva, Switzerland 12

34 greater attention to the specific gender-based vulnerabilities of women and men, including gender inequalities and cultural and social norms that put people at risk. At the 2006 United Nations High Level Session on AIDS, all member states of the United Nations including Tanzania, pledged: - To eliminate gender inequalities, gender-based abuse and violence - To increase the capacity of women and adolescent girls to protect themselves from the risk of HIV infection, - To provide health care and services, including, inter alia, sexual and reproductive health, 7 Reinforcing the above commitments are other agreements which were previously ratified and domesticated by the Government of Tanzania, such as the Convention on the Elimination of Discrimination Against Women (CEDAW) (1979) which is the key basis for legal reforms and other steps aimed at countering the violation of women s human rights and protecting women who are infected and affected by HIV/AIDS. Gender mainstreaming has been taken as the approach towards bringing the contributions, perspectives and priorities of both women and men to the centre of attention in all areas of societal development. Furthermore, Governments and institutions have designed and implemented initiatives to achieve the Beijing Platform of Action (PfA) (1995) plus its objectives of gender equality and empowerment of women, in the same context as the CEDAW. In 1998, the SADC Heads of State signed an Addendum to the SADC Declarations on Gender and Development: The Prevention and Eradication of Violence Against Women and Children which was later on, 2000, reinforced by the formulation of an Action Plan. In Tanzania, the National Plan of Action covers Violence against women plays a crucial and devastating role in increasing the risk to women and girls of HIV infection. Violence can be physical such as rape or psychological such as the promotion of fear that might prevent disclosure by a positive partner to a negative partner or prevent negotiation of safer sex. Violent or forced sexual encounters increase the risk of abrasions to the vaginal wall, facilitating entry of the virus. Violence against women and girls is underpinned by women's unequal power in their relationships with men. Women with limited economic security may be more likely to stay in a violent relationship. Violence may also result as men attempt to live up to stereotypes of masculine behavior, which may in turn lead to unsafe sex and/or non-consensual sex. Many women are married at a young age to older men, and the power inequities inherent in these relationships can lead to violence or the threat of it. The risk of violence and sexual abuse is high among girls who are orphaned by AIDS, many of whom face a heightened sense of hopelessness along with a lack of emotional and 7 UN (1979) CEDAW 8 URT (2001) A National Plan of Action for the Prevention and Eradication of Violence against Women and Children : Stop Gender-Based Violence 13

35 financial support. Fear of violence prevents women from accessing HIV/AIDS information, being tested, disclosing their HIV status, accessing services for the prevention of HIV transmission to infants, and receiving treatment and counseling, even when they know they have been infected. This is particularly true where HIVrelated stigma remains high. 9 At the East African Community: Second EAC Regional Workshop on Mainstreaming Gender and HIV/AIDS Interventions into various Regional Development Sectors and Strategic Plans, Repot (June, 2008) sex differences in HIV epidemiology, gender inequalities, promoting gender equalities in HIV programming, human rights, gender and HIV were given much emphasis in the discussions, including the marriage of gender and HIV/AIDS! Meanwhile there is widespread consensus that the need to address the gender dimensions has become more urgent with the emergence of HIV and AIDS, so that most countries have policies and strategies for coping with HIV and AIDS in the light of gender issues. 10 In Tanzania the concerns shown in item 2.0, are pushing the stakeholders to revisit the prevention, care and treatment services rendered in the HIV/AIDS national response in order to assess the gender dimensions included therein. This includes revisiting the contents of the main documents such as the Act No 22, which established TACAIDS as the infrastructure to oversee the HIV/AIDS national response in Tanzania. The Act, the Tanzania Commission for AIDS Act (2001) plus the specific policy on HIV/AIDS, the National Policy on HIV/AIDS (2001) as the main governing instruments, are to a large extent, gender blind. Consequently other stakeholders have no basis that guide the process of engendering their own institutional policies, strategies, and implementation plans Gender Dimensions at Infection level The pandemic requires the transforming of relations between women and men to eliminate gender inequality and reduce the risk of infection UN Secretary- Kofi Annan Gender norms and inequalities influence all aspects of the HIV/AIDS epidemic. According to USAID/IGWG gender greatly impacts on vulnerability to HIV infection. Norms of femininity dictate upon women and girls decisions on their sexuality. The gender norms of femininity inhibit knowledge and assertiveness and decrease ability to negotiate for safe sex. Women and girls are not supposed to be knowledgeable about TGNP in collaboration with SAT and RATN (2004) A Training Manual on Gender, Policy and HIV & AIDS 11 Audit findings on the cited documents. (For details see Annex 1) 14

36 sex and generally have limited access to information, so that they remain poorly informed about sex and cannot discuss with their partners Norms on masculinity inhibit knowledge and support for shared decision making with sex partners, and promote aggression and risk taking by men. Unlike for women and girls, norms for masculinity dictate that men should be knowledgeable, experienced and capable of taking the lead in sexual relationships. Male identity is very much linked to sexual performance; they feel pressured to have many sexual conquests to prove their masculinity. 13 Multiple partners for men are celebrated, encouraged, and condoned. 14 Masculine norms on aggression and dominance are what lead to genderbased-violence which is key to HIV/AIDS infection and spread Patriarchy/Male dominance Findings from all key informants of this gender audit are supporting that Patriarchy/Male dominance is the highest source of gender related problems in the areas of infection, prevention, treatment and support in the HIV/AIDS national response. In short, social constructions of masculinity, intimate partner violence, male dominance in relationships, and HIV risk behaviors in men, must be examined in a more holistic manner in order to arrive at effective interventions. A researcher in Uganda arrived at the conclusion.women are becoming infected with HIV because the state is failing to protect them from domestic violence argues that many women are victims of marital rape. Women were also powerless to protect themselves from infection and are unable to access HIV/AIDS services because their husbands physically attacked, threatened, and intimidated them, and did so with impunity MSM For the males who have sex with other males (MSM) traditional norms of femininity and masculinity contribute to the phobia, silence, denial, stigma against MSM and therefore affect access to accurate power to negotiate for consistent and nonstigmatizing information on prevention and care increases the vulnerability before HIV infection among MSM, transgender, and third-sex individuals. 16 Meanwhile, violence may also affect MSM. Within MSM relationships, gender norms often dictate that one partner is dominant and the other is submissive. The submissive partner has less power and therefore may face the threat of violence from the powerful partner USAID/IGWG (2004) How to Integrate Gender into HIV/AIDS Programs: Using Lessons Learned form USAID and Partner Organizations 13 UNAIDS/WHO (2004) Women and AIDS in AIDS Epidemic Update 14 USAID/IGWG (2004) How to Integrate Gender into HIV/AIDS Programs: Using Lessons Learned form USAID and Partner Organizations 15 Human Rights Watch (2003) Just Die Quietly: Domestic Violence and Women s Vulnerability to HIV in Uganda 16 USAID/IGWG (2004) How to Integrate Gender into HIV/AIDS Programs: Using Lessons Learned form USAID and Partner Organizations 17 ibid 15

37 For a national response to mitigate on the HIV infection and spread, the guidelines need to carry a well gendered intervention that is able to address each group s specific gender needs. The current guidelines for the national response are not well articulated to address these specific gender needs. 6.3 Gender Dimensions at Prevention Level Intimate partner violence plays an equally damaging role at the prevention level. Findings indicated a link between intimate partner violence and being HIV positive that women with violent or controlling male partners are at increased risk of HIV infection. They suggest that abusive men are more likely to have HIV, or other STIs (sexually transmitted infections) from another source. Abusive men are also more likely to impose risky sexual practices on partners Gender based violence at Prevention level Despite the overwhelming evidence that increasingly HIV/AIDS is striking more women, women know less than men about the how the disease is transmitted and how to prevent the infection. 18 And what little they know is rendered useless by the discrimination and violence they face from their partners, which makes them powerless to refuse sex or negotiate safe sex especially in the context of marriage. The use of condom is irrelevant when women are being beaten and raped. The fear of violence prevents many women from asking their partners to use condoms, access information on HIV, getting tested or seeking treatment even when they strongly suspect that they are infected. Furthermore, the limited mobility due to male and community norms preclude women from leaving households, thus having difficulties in accessing health services without the permission or approval of their partners. 19 And as with the male condom, women may fail to insist upon the use of the female condom as this could be viewed as a sign of infidelity or luck of trust MSM With regards to MSM, violence against them by communities, the police and other activists, drive MSM underground making it very difficult to reach them with HIV prevention measures on information and support for safer sexual practices. 20 Therefore if HIV-Prevention services are to succeed, they need to occur along other efforts that address and reduce violence against the vulnerable including MSM, women and girls. 6.4 Gender Dimensions at Care and Support Level 18 UNAIDS/WHO (2004) Women and AIDS in AIDS Epidemic Update 19 USAID/IGWG (2004) How to Integrate Gender into HIV/AIDS Programs: Using Lessons Learned form USAID and Partner Organizations 20 ibid 16

38 6.4.1 Gender differences show much negative impact at the care and support of the AIDS patients in terms of resources spent on the aids patients, and time spent caring the sick. Women and men tend to put greater emphasis on men s health needs and devote household resources to meeting the man s needs. 21 In actual fact, HIV/AIDS and poverty have added more burdens on women and poor people in all households which have AIDS patients and AIDS orphans The primary burden of care often limits women s and girls access to productive resources including time for cultivation (especially those women residing in the rural areas) or attending school for girls. The burden of caring for ill family members in the homes which has been made to rest mainly with women and girls involves increased household chores like walking long distance several times to fetch water for cleaning clothes and washing the sick, extra cooking for sick, and being there for them. As the impact of the AIDS epidemic grows, girls tend to drop out of school in order to help their mothers or to cope as individuals, with the tasks of caring for siblings and ill parents and AIDS orphans Equality and freedom to a good life should not end at the signing of an international agreement. Tanzania has domesticated and issued many policies which are addressing women s, girls boys and men s gender specific needs. However the burden of caring for the aids ill patients has been stereotyped as a woman s role and therefore imposes another burden on women, including old women (see photograph on pp 24) All the policies, acts, strategies and plans for the implementation of the national response to HIV/AIDS are silent on this gender related aspect. 6.5 Gender Dimensions at Treatment Level Even though the UDHR stipulates everyone has right to enjoy in scientific advancement and its benefits, women infected with HIV/AIDS encounter many gender related problems in accessing the treatment service in national HIV/AIDS intervention program. In addition, gender inequality in the health sector in many African countries is reflected by malnutrition among women and girls, fertility and maternal mortality due to inequality in family decision making, poverty and other gender equality issues Stereotyping fuels stigma and discrimination because gender norms assume that when a woman contracts HIV/AIDS, she is promiscuous. Gender norms blame and shame women for being vectors responsible for the spread of HIV. Therefore programs on PMTCT unintentionally tend to exacerbate the stigmatization on women. Since the women are tested first in such cases, they are viewed as responsible for bringing HIV to their spouse. Consequences of stigma faced by HIV positive women are 21 USAID/IGWG (2004) How to Integrate Gender into HIV/AIDS Programs: Using Lessons Learned form USAID and Partner Organizations 17

39 often harsher than those meted on men, for they may often enough lead to much GBV or being thrown out of the matrimonial homes. In many countries including Tanzania women who are HIV positive, find themselves discriminated against when trying to access care and support. Men are more likely than women to be admitted to health facilities. Family resources are more likely to be devoted to buying medication and arranging care for ill males than females Gender norms also blame and shame MSM as responsible for HIV due to their perceived immoral sexual ways. In fact MSM face double stigma due to the sexual orientation and positive sero-status within the family, community, and also from health care settings Auditing of Documents being used by the National HIV/AIDS Response Taking into account the identified gender dimensions from international documentation with regard to HIV and AIDS, and also based on the strength of the Government of Tanzania commitment to the international and regional declarations, commitments and conventions on gender and HIV/AIDS, the gender audit exercise examined the existing literature/documents produced at national, sectoral, and institutional levels in order to measure their compliance to the accepted gendered interventions in HIV/AIDS. As these policy and action plans were deemed to be the main principal sources of information for use by all stakeholders of the national HIV and AIDS response programme, they composed almost 60% of this gender audit. Consequently, the gender audit put much emphasis on the desk review and audited of most policy and action/strategic plans/ documents that are in place concerning this national intervention (policies, action and strategic plans, programmes and projects documents) as mentioned in the methodology section Key Gender Elements Used for Auditing The three key gender elements which were used in the audit were equality, diversity, and sensitivity. Gender neutral /gender blind documents failed to respond to these three key gender elements. Incorporated images, photographs and drawings were examined to determine whether or not they communicated messages that promote gender equality rather than perpetuate stereotypical roles. Ideal diversity was generally portrayed by showing men and women in equal position or status. Sensitivity in gender was assessed as emanating from the portrayed gender equality and diversity. Gender sensitivity was also measured by the language in use. The use of gender sensitive language enhances everyone s visibility (men, women, girls, and boys). 22 Aggleton, P and R Parker (2002) world AIDS Campaign : A Conceptual Framework and Basis for Action: HIV/AIDS Stigma and Discrimination. UNAIDS: Geneva, Switzerland 18

40 Evidence of use of gender-sensitive language was evidenced by the use of sexist terms, for example, chairman instead of chairperson or guidelines that emphasized on the He/him to represent both man and woman. The sensitivity on the substance and content of text was shown by the given messages which captured the difference on impact of policies or planned activities and processes on men, women, girls and boys. Consequently, the audit examined the given text in the framework documents in order to determine if the aspects of both males and females are represented. Any data used in the text was also examined to see whether or not it was disaggregated on gender basis as opposed to being only sex disaggregated. In addition, the audit examined the text and messages to determine the gender responsiveness by looking into relations between the sexes, including power relations, describing women, men, boys and girls gender related experiences and specific gender mitigations as portrayed in the frameworks used for the national response to HIV and AIDS in Tanzania The Ranking scale The Ranking scale (Likert Scale) used is showing degree of gender compliance in the inclusion or exclusion of the gender elements (sensitivity, diversity, and equality) in each document from zero (0) to five (5) as follows: 0- Low, 1- Moderate, 2- High, 3- Very High For more details on the audited documents (See Vol. 2) 7 Gender Audit Analysis and Findings 7.1 Data Analysis The study captured both quantitative and qualitative data. Pre-coded questionnaires generated both quantitative and qualitative data. However post coded methods were applied to all open ended questions. Review of documented information from discussions was also captured as data for the audit. The end analysis used the discussions, the quantitative and qualitative data, plus the triangulation of these findings in order to arrive at conclusions. Microsoft Office Excel was used in analyzing the data. The Likert Scale was used in getting average scores for the different aspects from various statements given on personal and organizational basis. 19

41 Individual and institutional responses ranged from Therefore, the average scores varied from 0-3 as well, but with certain chances of falling between whole numbers. Therefore, there was need to identify the lower and upper boundaries of the average scores. The boundaries were determined as follows: to (Low) or % to (Moderate) or % to (High) or % to (Very High) or % These boundaries were applied to findings from both the literature review and the survey. 7.2 Audit Findings The Desk Review Using the Likert Scale, the main findings from the literature audit shows that average score for inclusion of gender dimensions in the national policies, is 0.81 or below 25% TACAIDS policies /plans/ strategies is 0.43 or below 25%, Sectoral policies/guidelines is 0.71 or below 25%. However in the Local Government (Municipal Council and Ward) Levels as well as the Private sector, the literature in use for the HIV/AIDS national response is completely gender blind. The total average score for inclusion of gender dimensions in the publications which are in use by the multisectoral partnership in the national response to HIV/AIDS is 0.61 or less than 25% of the used scale in the audit exercise. The obtained weighting indicates that the inclusion of gender dimensions in these publications is very low. Table 2: Summary Gender Dimension Levels on HIV/AIDS in Audited Documents by % and Level Type & Level of Documents National Surveys, Policies Bills & Summary of Gender Levels Audit Number of Documents Audited Average Score Remarks The national policies which were audited include the National HIV/AIDS Policy, the pending HIV/AIDS Bill, both of which were completely gender blind. However, the Tanzania HIV Survey Indicator (THIS) showed much gender diversity, equality, and sensitivity in content and approach. 20

42 TACAIDS Tools Sectoral Policies on HIV/AIDS Most of the documents in use by TACAIDS including the Act No 22 that established TACAIDS, MTEF and the NSMF are very low in gender sensitivity. The other tools in use such as TOMSHA and NHACAS indicate very low levels of gender aspects. Others such as the Essential Minimum Packages for HIV and AIDS is gender blind Audit documents include those from Ministry of Labor and Youth Development, Ministry of Education and Vocational Training, UTUMISHI, and Ministry of Community Development, Gender and Children. Apart from those from the Gender Ministry, others were very low on gender aspects. Private Sector 2 0 The examined documents from Ultimate Security Ltd and ALAF Ltd are all gender blind Local Government Authority 2 0 The prevailing policy on Gender Development at Municipal level and Ward Levels in Ilala District, is showing much gender blindness in the section on HIV/AIDS As discussed above in each of the given types, the high score shown (0.81) for the National policies is actually coming from the THIS which obtained (2) or 50%- 75% from the audit, whereas there those like the pending Bill on HIV/AIDS or the policy on HIV/AIDS both got below 25%. In the sectoral policies, the score of (0.71) is actually contributed by the MCDGC as the Ministry responsible for Gender Development in Tanzania. Whereas other sector ministries got scores below 25%, MCDGC had 50%-75%from the engendering of the prevailing policies and strategies. The Private and LGAs both scored 0% Findings from the Survey Key Informant Questionnaire The respondents have been able to demonstrate the following gender audit aspects Table 3: The General Distribution of Negative Gender Based Influences to the HIV and AIDS National Response by % and by Sector Identified common Negative Gender Influences on HIV Infection & Prevention Responses from key informants showing percentage of gender based negative influences Government CSO Uniformed Local Private Faith Based Average Sector Forces Government Sector total % % % % % % % Economic dependency Domestic Violence Gender discrimination Lack of land and property ownership esp by women and children Lack of decision making on sexuality

43 Forced early marriage Illiteracy and lack of HIV awareness and information Stigmatization, denial to testing secrecy of infection Patriarchy/ Male Dominance Cultural Harmful Practices Sexual assaults and rape Female s lack of confidence to say No Lack of information for home based care esp. for women, older women and girls as the main care-taking group Total Average Total , a) Interpretation and Discussion Using the Likert Scale, the average scores from 76.5% - 95% are very high. This is showing evidence that the identified negative gender related influences have very serious impact on the national response to HIV/AIDS with regard to infection, prevention, care and treatment. Also the average total score for each type of institution are very high (90.1%-99.3%) because all these institutions recognize them as the major negative gender related issues impacting on the HIV/AIDS National response. In order to address these, it calls for processes designed for combating infection of HIV to take into account specifically the negative gender related influences and include these in each area of intervention: b) HIV Infection Level Interventions must take into account the gender dimensions which are fueling the HIV infection in the country especially among the risk groups of women, girls, boys, MSM, and the elderly with much reference to old women who look after their children when they become aids ill patients and these children s orphans when they die. Patriarchy/ Male Dominance is the major source of infection in all the above mentioned groupings. However, for the reproductive ages, findings from the key informants identified Economic dependency and Female s lack of confidence to say No, Domestic Violence, Gender discrimination, Lack of land and property ownership especially by women and children, Lack of decision making on sexuality, Stigmatization, secrecy of infection and denial to 22

44 testing, Cultural Harmful Practices (FGC for girls, Forced early marriage, Widow inheritance, Circumcision for boys) and Sexual assaults and rape as main contributors and counters of efforts to reduce infection as expected by the HIV/AIDS interventions in the national response. Findings also show that Lack of information for home based care esp. for women, older women and girls as the main care-taking group need to prevail in all interventions on Care for the aids ill patients so that infection from this level can be avoided. Interventions must take into account the gender dimensions which are fueling the HIV infection. Fig c) HIV Prevention Level Findings are showing high percentage on Domestic Violence, Gender discrimination, Lack of land and property ownership especially by women and children, Lack of decision making on sexuality, Stigmatization, secrecy of infection and denial to testing, Widow Inheritance, Illiteracy and lack of HIV awareness and Sexual assaults and rape especially at marital level are having adverse effects on the effort. Discussions with medical doctors confirmed these fears and more. It came to light that married women are scared of using condoms as preventives devices due to fear of domestic violence, fear of being discriminated and even divorced for having tested positive. When married women know for sure that their spouses are infected, they cannot protect themselves because they believe to be the men s properties and therefore cannot say NO to unprotected sex. On refusal to have sex with an infected husband, the responding doctors say that there have been report of frequent marital rape cases. In short they have no say over their own sexuality. Widow inheritance has resulted into many HIV infections. In most cases the big carrot is disinheritance of land and property from widows and orphans of an aids victim. Findings show that despite much awareness creation condemning widow 23

45 inheritance, there are many incidences of widow inheritance that are taking place and need to be addressed in order to increase HIV/AIDS prevention. d) HIV/ AIDS Treatment Level Interventions at treatment level are diversely affected by Domestic Violence, Gender discrimination, Stigmatization, secrecy of infection and denial to testing, Illiteracy and lack of HIV awareness and information. Findings are showing high scores on the part of women and girls and therefore the need to address these concerns in the national response interventions is crucial. Stigmatization is more felt by women and young girls than boys and men, in both the urban and rural areas. However, there are incidences when the males are also overwhelmed by testing positive. Findings from doctors were able to substantiate the fear of being stigmatized which has sometimes led married spouses to decide on sharing ARV dosage simply because one of them (especially the man) refuses to be tested for fear of stigmatization. Stigmatization and denial to go for voluntary testing is also an issue at places of work, so that it is only counseling efforts that men are able to participate in the treatment programme. Table 4: Average Degree of Stigmatization by Females, Males and Youth, and Area 24

46 Victims of Stigmatization Area Rural Urban % % Females 80% 60% Males 40% 10% Youth Boys 40% 10% Youth Girls 90% 80% Females Males Youth Boys Youth Girls 25

47 Table 4: Average Degree of Stigmatization by Females, Males and Youth, and Area Other gender related problems domestic violence and discrimination whereby infected women, especially pregnant women through the PMTCT programme, have been scared of making their infected situation known to the family, for fear of discrimination and violence from the spouse and in-laws, and probably eviction from the marital home. Such women are taking the ARV drugs secretly. However, the problem comes after the arrival of the baby when they are advised not to suckle the baby. Some have opted to suckle and infect the baby rather than disclose their secrecy on their HIV condition. Illiteracy and lack of information especially for the vulnerable and high risk groups is adversely affecting the treatment area of the HIV/AIDS intervention efforts. This is coupled by the illiteracy situation of the affected groups especially those from the rural areas where information does not freely flow like in the urban areas (See table below). The use of radios, TV, banners, posters, fliers etc are limited. 26

48 Fig : Average Accessibility of ART by Females, Males and Youth, by Area Table 5: Average Accessibility of ART by Females, Males and Youth, by Area Recipients of ART Area Rural Urban % % Females 30% 60% Males 45% 70% Boys 25% 40% Girls 5% 15% e) HIV/AIDS Care and Support i) Lack of information for home based care is one of the main gender related concern. Findings show that older women who are not sexually active have been infected with HIV/AIDS through the care of their aids-ill children just because they did not put on protective gear while attending to the patients. Socially it is deemed disrespectful and a sign of less love to handle your loved ones especially your own child with protective gear. Findings are showing that such emotions have resulted in some elderly women getting infected with HIV/AIDS. Due to ignorance and emotions lack of appropriate information to these women continue to cost them their lives. 27

49 Table 6: Average Proportion of Caretakers of AIDS Patients in the Homes Caretakers Average Participation % Women 70% Men 2% Girls 24% Boys 4% Total participation 100% ii) Other main participants are women and girls and sometimes boys. Again findings are also showing that there have been as number of cases where these groups have been infected simply because they lacked information and protective gear. iii) With regard to economic support, the most afflicted are women and children, and the elderly people who look after the aids patients and later their orphans. The need to fill the economic vacuum created by medical bills, and nutrient needs was viewed by the respondents as a gender issue. Patients receiving ARV treatment need good nutrient. However, findings are showing that if the patient is a man, the family struggles to give him good nutrient. But when the patient is a woman, or child, or an elderly person, this privilege is usually unavailable. The government has already realized this so that, for those working in the government sector, provision for equal support for men and women employees has been achieved. However, the proportion of those employed in the government is small against those in the private and informal section. Therefore planned interventions need to look seriously into this gender dimension. Table 7: Mitigate measures on identified Gender Based Factors as achieved by Percentages by sector National Efforts mitigating achievement against Gender Based negative influences on HIV and AIDS Respondents from various Sectors Govern ment Sector CSO Uniformed Forces Local Government Private Sector Faith Based % % % % % % % National Policy on HIV and AIDS TACAIDS establishment Specific Budget and enabling environment for implementing interventions on HIV/AIDS Specific sectoral policies on HIV and AIDS Advocacy/ Education on human rights esp women s rights Economic empowerment for Total 28

50 women and youth Counseling Services by medical and social welfare staff Training of Peer Educators Mainstreaming Gender and HIV in Schools Uhuru Torch Messages Curriculum Seminars and Workshops with topics targeting specific groups (women, youth, girls, men) Land ownership for both spouses Customary rights of occupancy Issuing specific laws on land ownership, sexual offences Interpretation and Discussion of Data: Mitigation Measures for Infection, Prevention, Care and Treatment Levels a) National Mitigations i) Issuing specific laws on land ownership, sexual offences scored 71% in all institutions as they realize the importance of having legal back up in supporting mitigation measures. Respondents also recognize that sexual offences, especially those related to assaults like rape, and defilement, and also those related to harmful cultural practice such as early marriage and widow inheritance, and other situations where victims have no decisions on their own sexuality need specific laws in addition to the existing Act on Sexual Offences (Special Provisions) of ii) Customary Rights of Occupancy 68% and Land and Property Ownership 67% scored high as mitigation measures because land and property ownership especially among the vulnerable groups such as women, youth (boys and girls) was seen by the respondents as significant mitigations in making available to women and the youth the economic independency that is usually lost after the death of the bread winner in the family through HIV/AIDS. Economic dependency among women and the youth fuels HIV infection. iii) TACAIDS establishment received 61.8% as mitigation measure in the national response to HIV/AIDS. All key informants recognize the significance of having an umbrella institution that is steering the course of the national response to HIV/AIDS. iv) National Policy on HIV and AIDS score moderately, 53.6%. Even though the National Policy on HIV/AIDS provides the general framework for collective and individual response to the HIV/AIDS pandemic, the audit assessed this policy and 29

51 found there was little provision for gender responsiveness to be visible in the national response to HIV/AIDS. Findings from most key informants are in support that there was low gender dimension level so that they conclusively pointed out that the policy is not adequately gendered to offer mitigation on the negative gender aspects impacting on HIV/AIDS. In the literature audit, this policy was found to be gender blind, and scored only 0.3% or below 25% by the Likert scale. v) Specific Budget and enabling environment for implementing interventions on HIV/AIDS are showing a score of 44% achievement as mitigation measures. Poorly gendered policies are resulting into poorly engendered programmme designs and plans which are poorly funded for gendered aspects. Findings from the audit indicate non-engenderment on the given strategic objectives, statements, the stakeholders analysis matrix, institutional perspectives, the performance review for , the mid-year performance review 2006/07, the draft work-plan for divisions and units, recurrent budget 2007/ /2010 by the GOT, and development budget by TMAP, Global Fund, DCI, DFID, UNDP, GLIA, CIDA, UNFPA and World Bank showed that MTEF. The failure to reflect gender aspects in the budgeting plans is also reflected in the MTEF which shows no specific fund for capacity building in gendered interventions. Without adequate capacity in the area of gender, the institutional plans cannot receive funding for gender aspects so that the mentioned gender aspects in the MTEF continue to remain just- add-ons! b) Mitigation at Other Levels i) Specific sectoral policies on HIV and AIDS scored 54.3%. These sectoral policies do not exist in each ministry. All MDAs are using the specific guidelines on HIV/AIDS which have bee issued by the Civil Service Sector Ministry Utumishi. In the literature audit, this document scored below 25% of engenderment. ii) The Ministry of Community Development, Gender has issued many documents including a specific policy on gender development, the Policy on Community Development (1996) the Women and Gender Development Policy (2000) and the National Plan of Action for the Prevention and Eradication of Violence Against Women and Children ( ). All these documents have a collective average score of 25-50% engenderment. Despite containing many gender dimensions, the documents especially those issued in 2001, miss the opportunity of linking the negative gender 30

52 aspects related to inequalities and violence against women, to the HIV/AIDS national response with regard to infection, prevention, care and treatment. As the gender-mother-ministry, using the prevailing Women Empowerment and Gender Development Policy, it is failing to attain gender visibility in its own programmes let alone the other sector ministries. iii) Training of Peer Educators 75.1% scored highest as one of the best mitigation measures being employed to mitigate on gender related negative impact on HIV/AIDS. All sectors including the private sector have a selected group of workers who have been trained as peer educators on HIV/AIDS intervention. The workplaces are finding time for the workers to undergo training after the realization of the need to reduce staff deaths due to HIV/AIDS infection. This education further extends to cover employee s families plus the surrounding communities in the case of ALAF. iv) Advocacy/ Education on human rights especially women s rights scored 59.6%. The advocacy tools in use whether the national ones NHACAS or institutional ones, all seem to contained low gender aspects. Probably this is because they are formulated based on non-gendered policies and action plans. NHACAS scored below 25% engenderment. v) Seminars and Workshops with topics targeting specific groups (women, youth, girls, and men) scored 64.8% as mitigation measures in the HVI/AIDS response. Using seminars and workshops enables all groups of people within the communities to get informed on HIV/AIDS. Uhuru Torch Messages Curriculum scored only 37%. Findings show a general consensus during the Uhuru Torch Mobilization, much HIV infection takes place despite the campaigns on the use of condoms. vi) Counseling Services by medical and social welfare staff 63.8% was also identified as a significant mitigation measure for those who have fear of testing, or making their HIV situation known by the sexual partners or employers at workplaces. It is only after a voluntary test has taken place, also a declaration has been made on the HIV situation of an individual, that further infection of HIV can be contained. Therefore, counseling is an important mitigation measure in the prevention of HIV/AIDS. vii) Mainstreaming Gender and HIV in Schools scored 57.5%. Using the developed ministerial guidelines on the mainstreaming of crosscutting issues including gender and HIV, the education sector has failed to realize the link between gender and HIV, so that findings are showing that this has been so achieved moderately by 57.5%. However, the audit found out that the mainstreamed gender aspects in the education sector are mainly concerned with equality at enrolment levels. 31

53 viii) Economic empowerment for women and youth scored only 49.3%. As a mitigation measure, the key respondents scored it very low probably because most of the initiatives for economic empowerment for the vulnerable groups have in most proved to be not sustainable. During discussions, especially with the NGOs, they as one of the mains link of the national response at grass root level were very skeptical of the manner in which these initiatives are designed and implemented so that the various women and youth groups, especially those living with HIV fail to realize the intended empowerment. Findings from the Local Government Authorities also gave same evidence. c) Accessibility to Mitigation Measures The following paragraphs contain findings on the accessibility of the mitigation measures which are currently in place. The level of engenderment is shown in the approach and reach of the mitigation measure in use: Table 8: Distribution of Programmes Implemented by Area and Degree of Accessibility (Male and Female) Implemented Programmes which are mitigating on negative Gender factors in the communities Degree of Accessibility and Type of Mitigation Women Rural Women Urban Male Rural Male Urban S F I S F I S F I S F I Condom distribution x x x x Advocacy by stakeholders x x x x Role models on testimonials x x x x Campaigns against HIV x x x x Targeted seminars for peer educators Establishment of HIV Committee at Council, Ward and Village levels x x x x x x x x Counselling x x x x Voluntary Testing encouragement Economic empowerment programmes x x x x x x x x Education through theatre x x x x Mobile VCT Training in life skills for women, girls, boys, and disabled x x x x 32

54 Community meetings on HIV/AIDS x x x x Total Grand Total group Average scores Key: S = Sufficient; F = Fairly; I = Insufficient Based on the Likert Scale: (Average score key: Low = or (0-25%); Moderate = or (25-50%); High = or (50-75%); Very High = or (75-100%) Discussion Table No 7 is showing the degree of Accessibility and Type of Mitigation for women and men in the rural and urban areas indicates unequal accessibility between the rural and urban areas. Even though Mitigations are indicating some degree of sufficiency in the urban areas, however using the Likert scale, all the average scores for female and males in both urban and rural areas are below 25%. Responses for Sufficient, Fairly, and Insufficient, are showing scores from all of which fall below 25%. However looking at the findings, they are supported by respondents statements that the national response to HIV/AIDS has not yet reached the optimum level in both the rural and urban areas. This means combating negative gender influences on HIV/AIDS needs more input on the identified mitigations measures for both males and females living in the rural and urban areas. Table 9: Average Accessibility Level of Preventive Measures by Education Level and Sex of Youth Education Level Condom Accessibility Information on HIV/AIDS Girls Boys Girls Boys % % % % Primary education 0% 10% 45% 45% Secondary education 2% 15% 60% 60% Tertiary education 30% 60% 80% 80% i) Accessibility to Condoms and information on HIV/AIDS as preventive measures for youth by education levels in Table 8, is showing that the higher the level of education level the more access to condom use and information. This is further confirmed by the fact that school girls pregnancies are much higher in primary schools, which is definitely a result of unprotected sex TGNP and Macro International Inc. (2007) Women s Health in Tanzania. Dar es Salaam 33

55 Table 10: Average Promotion of Use of Condoms by Significant Members of Society Findings from the audit in Table 9 have also revealed that opinions from key informants show that there is little agreement on the use of the condom by the influential persons in the society. ii) Religious leaders are strongly opposed to the use of condoms. Some of them are a major source of misconceptions regarding the HIV/AIDS. Talking to a priest revealed that most of the Christian leaders enforce abstinence among their believers rather than condom use (5%). The Moslem Leaders (7%) on the other hand could not agree that polygamy and frequent separations could be one of the major sources of spreading HIV/AIDS. iii) Parents (40%) and teachers (55%) are a bit wary of encouraging the use of condoms. They are prepared to talk to the children and youth rather than introduce the use of this protective gadget. iv) The Cultural fanatic (2%) (Zaramo) was of the opinion that ngoma or dance festivals especially among the Zaramos must go on well into the night, if possible the whole night. That is how it has always been. Instituting condom use during such nights will not work because no one would be able to use them anyway! These dances are the most coveted functions among the Zaramos, even though they could also be the main sources of HIV/AIDS infections. Further research into this is needed to justify this. The Parliamentarians on the other hand were seen to be the main supporters of the condom campaign. Respondents are optimistic that, the Parliamentarians will gain more ground with the passing of the Act on HVI/AIDS. 34

56 Table 11: Average Achieved Success of National Response to HIV and AIDS by Local Government Level Local Government Level Success % District Council 60% Ward 3% Village 1% Ten-Cell 1% NGOS within the District 80% Findings in Table 10 are also showing the levels of programme achievement by the various stakeholders at District, Ward, Village, Ten-Cell as well as the NGOs working at these levels. There is action mainly at District Council Level (60%) and NGOs (80%). Key informants were agreeable that funds are received at district levels for the HIV/AIDS interventions. However, little funds trickle down to the other levels within the district. NGOs were very vocal that despite their excellent contribution to the HIV/AIDS national response, they are disregarded by the district authorities, so that they are not given funding and sometimes they are not even invited to the HIV Committee Meetings. Fig : Average Achieved Success of National Response to HIV and AIDS by Local Government Level From the level of gender perceptions findings have shown more gender knowledge at NGO levels. Therefore, this constant exclusion of NGOs from the district 35

57 implementation levels are retarding the development of gendered interventions in the district, ward, village and Ten-cell HIV/AIDS programmes. Table 12: Distribution of Gender Negative Factors Causing HIV in Institutions by Level of Impact Negative Gender related Institutional Factors Level of Impact by Percentages CSO Government Uniformed Forces Local Government Private Sector FBO % % % % % % Interpretations (Using the Likert Scale the findings are showing 80- over 90% which is very high) Irresponsible sexual behavior esp by men employees Women economic dependency Corruptive sexual habits esp during recruitment and promotion processes The average occurrence of 88.6% of irresponsible sexual behavior on the part of men as a vice is very high in all institutions, being highest in Faith based institutions and the Private sector. It is lowest in CSO Women economic dependency rates at 86.6%. It is highest in Faith based, Private sector, and Local Government responses Corruptive negative gender habits are at average of 86.8% in institutions esp in the Private Sector, the Uniformed Forces and the Local Governemnt Sexual harassment Sexual harassment is rated at the average of 84% but highest in the Private Sector, and Local Government Patriarchy/ Male dominance/chauvinism Traditional beliefs/ negative gender perceptions Women s lack of confidence and assertiveness Fear of Stigma to test esp. for women employees Patriarchy is very high by 88.1% but highest in Private Sector, Faith Based and uniformed forces Traditional beliefs accounts for 89.3% with the highest being in Private sector and Faith Based institutions Lack of confidence in women is 94.1% average but highest among all the vices Employees by average 80.3% have tendencies of fear of stigma Psychological torture on % of infected employees 36

58 Negative Gender related Institutional Factors Level of Impact by Percentages CSO Government Uniformed Forces Local Government Private Sector FBO % % % % % % Interpretations (Using the Likert Scale the findings are showing 80- over 90% which is very high) HIV victims undergo psychological torture before counseling takes place Rank and file in armed forces Restrictions not to marry for a specified time factor in the Army Rank and file causes negative gender impact on HIV and AIDS esp with regard to infection and prevention Restrictions on army recruits not to marry for six years is a cause for HIV infection for about 95% Total Average Total Vices identified to impact on HIV/AIDS are showing very high averages of occurrences in the Private sector and Faith Based Based on the Likert Scale: (Average score key: Low = or (0-25%); Moderate = or (25-50%); High = or (50-75%); Very High = or (75-100%) Fig Distribution of Gender Negative Factors Causing HIV in Institutions by Level of Impact Discussion From the above table, the responses from key informants at institutional levels are showing that the negative gender factors impacting on HIV/AIDS have very high 37

59 significance in all institutions. They are highest in the Private Sector where the institutional autonomy has no boundaries and regulations which monitor risk behaviors. In the Faith Based organizational responses, findings are showing significant high occurrences due to the religious beliefs which influence some believers to engage in risk obtaining situations such as polygamous behaviors, frequent separations, irresponsible family lives. With regard to the Uniformed Forces, the rank and file has significant negative impacts on the lows ranks. The regulations imposed on the young recruits forbidding them not to marry for six years is encouraging risk behaviors in the army. Table 13: Distribution of Institutional Mitigation Measures on Gender Factors Causing HIV HIV AND AIDS INSTITUTIONAL INTERVENTION EFFORTS MITIGATING FACTORS REMARKS Irresponsible sexual behavior esp by men employees Women economic dependency Peer education Disciplinary action Women support groups Income generation schemes Ministries have developed strict disciplinary measures for violators The efforts are targeted on those women who are living with HIV. Also for empowerment purposes Corruptive sexual habits Recruitment Committees/Panels Ministries have developed strict disciplinary measures for violators. This part of the HIV/AIDS intervention Sexual harassment at recruitment/promotion phases Patriarchy/ Male dominance/chauvinism Traditional beliefs/ negative gender perceptions Promotion Committees/Panels Performance reports Advocacy and sensitization Advocacy efforts by NGOs such as TGNP Advocacy and sensitization Advocacy efforts by NGOs such as TGNP Ministries have developed strict disciplinary measures for violators. This part of the HIV/AIDS intervention The Army has developed special gender modules for army personnel. This part of the HIV/AIDS intervention The Army has developed special gender modules for army personnel. This part of the HIV/AIDS intervention Women s lack of confidence and assertiveness Women empowerment seminars Existence of the national Women Empowerment and Gender Policy Affirmative actions and sensitization efforts especially by NGOs like TGNP Also efforts by the Ministry of Community Development, Gender and Children Fear of Stigma Psychological torture on HIV victims School Girl pregnancies Advocacy and sensitization Counseling Counseling Advocacy and sensitization Mainstreaming of gender issues in School Curriculum Counseling is done at pre-testing, after testing and during treatment so that the patients do not stop treatment mid-way. The need for counseling especially women and men who fear to tell their spouses is very crucial in the prevention of further infection. Educating the children esp. girls is empowering them in making decision on 38

60 HIV AND AIDS INSTITUTIONAL INTERVENTION EFFORTS Feminized teaching of social sciences Rank and file MITIGATING FACTORS Mainstreaming of gender issues in School Curriculum Existence of Governing Orders in the Army REMARKS their own sexuality Teachers both males and females are now being allocated the role of counseling even if they teach sciences In addition to the Standing Orders, Disciplinary Committees within the Army Restrictions not to marry for a specified time factor in the Army Continuous Advocacy, Peer education and condom distribution as mitigation against HIV infection for the young people in the army This is currently a major concern which is having adverse effects on the HIV/AIDS intervention efforts Discussions Mitigation measures in use, as shown in Table 12 above, are very much similar in many institutions. However, there are those institutions, especially sectoral ministries which have instituted punitive actions to the extent of expelling a worker who is found to be leading an irresponsible sex life. Other ministries have identified the high risky groups (for example workers, who due to their nature of work have to spend many days in the field) the sector ministries have instituted measures such as condom distribution and much sensitization on gender and HIV/AIDS for such groups of workers Finding on Institutional Gendered Levels Using the Likert Scale, findings from institutions on Institutional Gender Perceptions, Expertise, and Vision are indicating a range of 0.48 or below 25% to 2.26 or % within the NGO sector. The Private Sector is very low (0.48 or below 25%), followed by the Armed Forces (1.28 or 25-50%), Faith Based Institutions (1.32 or 25-50%), the Government (1.8 or 50-75%), and the highest being NGO (2.26 or %). The major key informant in the NGO sector was TGNP Table 14: Summary of Institutional Levels of Gender Perceptions by Staff Type Organization Government NGO Private Armed Forces FBO Remarks Gender Levels within Institutions Gender Perceptions, Expertise and Vision among staff and the institution tools and framework Gender perceptions, expertise and vision are very high in the NGO and in the Government sectors.the level is high enough in Armed Forces where they have initiated specific HIV and gender programs for better perception and awareness among the ranks. It is Moderate within FBOs, and lowest within the Private sector. 39

61 Type Organization Government NGO Private Armed Forces FBO Remarks Gender Levels within Institutions Accessibility and availability of methods, procedures and/or instruments for gender mainstreaming within an institution Competence of staff in gender issues Accessibility and availability of methods, procedures and instruments for gender mainstreaming within an institution in very high within NGOs. It is high in the Government sector and the Armed Forces is moderate. It is very low within the FBOs and the Private sector Staff Competence in gender issues is very high within NGOs. It is high within the government and FBOs. It is moderate within Armed Forces, and very low in the Private sector. Culture of the organization and how it contributes to gender sensitivity within the institution Gender integration within the Organization Culture is very high within FBOs, NGOs, and Government sectors, but moderate within the Armed Forces and the Private sector. Service delivery of partner organizations and other partners in gender sensitive manner within the national response NGOs have the highest collaboration. The government scored high, and so did the Armed Forces. FBOs score moderate and the private sector scored the lowest. i) Discussion on Institutional Gender Perceptions Table no 13 above and figure 3 below are able to show the responses on the general understanding by staff on the various aspects of gender dimensions within an organization. This includes the gender perceptions in policies and guidelines used by the staff. Accessibility of the instruments in use to enable staff to realize the gender perceptions and visions and the staff gender skill in using these instruments in gendered programme design and implementations. Also the gender aspects in the staff s co-existence within the institutions are very important not only having amicable existence for male and female staff, but having these values reflecting on the service delivery and collaboration with other partners in achieving the goals of the national response to HIV/AIDS. 40

62 Fig 3: Institutional Gender Perceptions by Sector 41

63 ii) Discussions on Accessibility to Gendered Instruments and Procedures Findings in Table 14 above and Figure 4 below are showing that there are high levels (1.53 or 50-75%) achievement of free flow and exchange of information among stakeholders. Also the capacity building of staff in these organizations on gender issues is equally high probably due to the many gender oriented seminars being organized nationally for staff. This indicates that much sensitization on gender issues has been achieved. Access by organizations to guidance on gender and HIV standards, guidelines and policies is moderate (1.38 or 25-50%) This is probably because findings indicated that most of the instruments such as the Women Empowerment and Gender Policy (2000) are not well known even by other Government Sectors, let alone the private and informal sectors. Fig : Summary of Institutional Gender Perceptions Gender Perceptions Accessibility & availability Competence of staff Organization Cullture Service delivery Government Sector NGO Sector Private Sector Armed Forces Faith Based Organizations Findings are also showing moderate achievements by institutions in the monitoring of gender mainstreaming and where need be, outsourcing required gender expertise to assist in gendering the programming processes. This is probably because gender issues have not yet received the deserved priority by the HIV/AIDS programme planners and implementers. The adequacy of instruments for gender analysis for institutional processes is indicated as low leading to the inability of updating gender policies and plans. 42

64 However, other findings are indicating confidence by institutions that the institutions have the resources and ability to incorporate the audit findings in the institutional frameworks. Figure No 4: Institutional Accessibility to Available Methods / Instruments/Procedures on Gender Issues Accessibility to Methodologies and Procedures Free flow and exchange of information amongst stakeholders Access and guidance on gender and HIV standards, policies Monitoring and Gender Mainstreaming Series1 Level of gender expertise to implement the gender audit findings Frequency of updating the gender policies, action plans, and strategies Table 15: Accessibility and availability of Gendered Methods, Procedures and/instruments Organizational Aspects Total Organizational Aspects Total Average Scores Frequency of updating the gender policies, action plans, and 0.69 strategies Adequate use of instruments for gender analysis 0.84 Level of gender expertise to implement the gender audit 1 findings Resources to enable your institution achieve gendered 1 response to HIV and AIDS Monitoring and Gender Mainstreaming

65 Outsourcing gender expertise for staff skills 1.23 Monitoring of gender mainstreaming in institutional 1.23 produced reports with regard to HIV and AIDS Access and guidance on gender and HIV standards, policies 1.38 Capacity building opportunity on gender issues for staff 1.53 Free flow and exchange of information amongst stakeholders

66 Fig : Levels of Staff Competence in Gender Issues by Responding Institutions iii) Discussions Findings in Table 15 above and Fig 5 below are showing levels of staff confidence ranging from 0.76 to Using the Likert scale the findings are indicating high abilities of staff in integrating and incorporate gender dimensions in programmes and also in their ability to advise other staff on gender issues. The use of mainstreaming tools and sharing gender mainstreaming experiences is moderate. However the level of knowledge on the gender tools being used for gender mainstreaming in the HIV/AIDS national response, is lowest (0.76) Fig. No 5: Levels of Staff Competence in Responding Institutions Staff Competence Levels Level of knowledge on tools Timely use of advisor's information Use of mainstreaming tools in institution Sharing gender mainstreaming experiences Ability to incorporate gender dimenisons Level of gender mainstreaming skills Ability to advise other staff on gender issues Ability of integrating gender in programs 45