Gender considerations along the HIV treatment cascade: an evidence review with priority actions
This brief provides policymakers and programme implementers with evidence about the impact of gender dynamics on treatment access and adherence and the gender-related gaps in treatment research and programming. It also raises questions for implementation science in order, by 2020, to achieve the global goals set out by the Joint United Nations Programme on HIV/AIDS (UNAIDS): 90% of all people living with HIV will know their HIV status, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy; and 90% of all people receiving antiretroviral therapy (ART) will have viral suppression. The brief draws from What Works For Women and Girls: Evidence for HIV Interventions and uses the World Health Organization (WHO) treatment cascade framework to identify and analyse major gender considerations in providing ART to those living with HIV in low- and middle-income countries.
The brief concludes with an argument that all ART programming must include respect for human rights. For example: "Requiring people living with HIV to disclose their serostatus to sexual partners and/or community members in order to receive treatment, care or support is a human rights violation. Similarly, coercing women to accept contraception in order to access treatment violates women's rights to make their own fertility choices." The authors note that there are few evaluated interventions demonstrating what works to overcome gender-related barrier to ART treatment. Future studies should ask questions such as "how can ART availability and accessibility be partnered with informed consent about the risks and benefits of treatment so that all people living with HIV may decide for themselves how best to stay healthy and live full, productive lives?"