Does empowering marginalize women for HIV prevention matter? A global comparative study
T. Hwang1, N. Shadravan1, L. Berkowitz2, M. Deshmukh3
1CARE USA, HIV/AIDS, Atlanta, United States, 2CARE USA, HIV/AIDS, Johannesburg, South Africa, 3CARE USA, Policy Advocacy, Atlanta, United States
Background: As women's empowerment as an HIV prevention strategy gains momentum, there is a need for grounded analysis in what is and isn't working, and why. CARE´s comparative research in Bangladesh, Burundi, Cambodia, India, Lesotho, and Peru examines “empowerment” strategies such as community mobilization through solidarity groups, and its effect on reducing women's vulnerability to HIV. This research involves sex workers, migrant factory workers and women living in post-conflict areas.
Methods: 1800 women were purposively sampled for interviews, focus groups, and semi-structured questionnaires. The participatory research explored women's definitions of empowerment, gender norms, and associations between measures of empowerment (e.g. agency, decision-making) and risk factors (e.g. condom use, HIV knowledge, access to and utilization of services. SPSS, STATA, and AtlasTi were used for quantitative and manual coding for qualitative analysis.
Results: Women's notions of empowerment reflect a tension between claiming and defending their rights as citizens and fitting in within mainstream society, and traditional gender norms. Women who participated in CARE's programs reported higher self-esteem, overall condom use, and greater utilization of STI and HIV services, and efforts to combat institutional violence than women who did not participate in programs. Findings also show that programmatic impact was not translating to the private spheres of women's lives. For example, sex workers reported high, consistent use of condoms with clients, but comparatively lower use with intimate partners due to love, trust and familiarity.
Conclusions: Solidarity groups can empower women in ways which reduce their vulnerability to HIV. However, empowerment too often equates with knowledge and self-esteem, and overlooks structural and relational factors for reducing HIV risk. To enhance impact of community mobilization, it is essential to address dynamics of intimate relationships, understand women's notions of empowerment, and engage men and boys.
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