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Re: Draft NACO Gender Policy- Call for Feedback

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Dear All,

Re: /message/8588

We all are thankful to the NACO in general and to the JD(IEC),NACO in particular

for having ensured that both 'Gender and HIV policy of NACO' and now the 'Policy

Guidelines' incorporating the check list for

mainstreaming of gender equality considerations have seen the light of the day.

Being a part of the Technical Advisory Group formed by UNIFEM and its partners

for the NACO for preparation of the Gender Action Plan,I am particularly

delighted and wish to congratulate and thank the NACO team for the excellent

work that has gone into preparation and

dissemination of myriad immensely useful operational guidelines and related


I would request the members of the forum to please provide their valuable inputs

to futher enrich the document.

At this juncture I would like to point out a few typographical errors which have

crept in inadvertently and need to be corrected:-

(1) The acronym PLHA needs to be used as a singular itself as it stands for

PEOPLE living with HIV/AIDS. (vide PLHAs on pages 3 and 4)

(2)The acronym for the district units is DAPCU/DAPCUs (need to replace DPACUs on

pages 11,12,13 and 14)

(3)It is preferable to use the term SEXUALITY minorities in place of sexual

minorities (page 8 -footnote and elsewhere).

Best wishes,

Dr.Rajesh Gopal.

Dr. Rajesh Gopal, MD

Joint Director,

Gujarat State AIDS Control Society (GSACS),

O/1 Block, New Mental Hospital Complex,

Meghaninagar, Ahmedabad, Gujarat. PIN 380016

Phone (O) 079-22680211--12--13,22685210 Fax 079-22680214

e-mail: <dr_rajeshg@...>

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Dear Forum Members,

Re: /message/8588

It is heartening to learn that the NACO has finally drafted the Gender and HIV

policy and it is doubly heartnening actually that the draft 'Gender policy' has

incorporated men's role 'equally'. Recognition and understanding of men's role

and masculinity in gender programming is a very progressive step.Other wise

generally whenever the word 'gender' is used it is always in the context of

women. It is again great to read that the 'gender guidelines' also have included

the sexual minority groups in the ambit of Human rights in the draft policy.

I congratulate NACO and specially Dr. Mayank Aggarwal for taking the initiative

and bringing about a comprehensive guidelines for incorporating Gender equality

and sharing it with civil societies and individuals.

There is a particular point that can be modified:

1. There is mention of HIV/AIDS in many pages and it has been interchangebly

used, however I feel it would be good if we use as 'HIV and AIDS' and be

specific where we can use only HIV and where only AIDS.For example, in the draft

guidelines page No. 6 and page No. 10 on 'Priority setting' and else where. HIV

and AIDS are not one and the same thing and I think we cannot use it


2. Priority Setting: Page No.11,Point No. 3, apart from women's organisation

there should also be representatives from Sexual minority groups.

Rest of the guidelines is very comprehensive and well drafted.


In solidarity,

Anjan Joshi

Executive Director

SPACE (Society for People's Awareness, Care & Empowerment)

Pocket-G-6/88-89, 2nd Floor, Sector-11, Rohini, New Delhi-85

# 9818227105

E-mail: space_org@...


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Dear All,

Re: /message/8588

The draft policy guidelines for mainstreaming gender in HIV programme by NACO is

well thought and comprehensive. This analyses most of the

gender-related issues with data and evidence. This reflects the commitment of

the team members who did this commendable job. I would like to point out a

couple of things.

1. On page 5, point 3, word " flesh trade " is used. It will be good, if this can

be replaced by some other, because this usage presumes that women in sex trade

do not have agency at all.

2. In the guiding principles and policy guidelines diversity is emphasized but

in the check list gender is sited as a general category. Genders are constructed

in a complex environment of power relations. Experiences of women are varied

among different classes, occupational categories like sex workers etc.

For that reason, sites of marginalization and oppression of different genders

including transgender may not be revealed unless others engage in continuous

dialogue with them. The institutions like NACO/SACS/DPACUs/IPs should be

continuously informed by the bodies of knowledge generated through interactions

with specific groups (communities). This is an endless process.

So, the check list can be included of periodic interactions with communities or

institutionalising community participation in all processes.

The process indicators can include questions like how far the conventional

knowledge about gender and sexuality is challenged by narrations of diverse

groups. For example, masculinities also vary as compared against " normal and

ideal masculine man " whose masculinity is constructed through an image of one

who is capable of penetrating, which is high risk in the context of HIV.

But in real life, masculinities exist and express in varying shades. Desires and

pleasures also vary like fantasies, voyeurism, touches, erotic talks and so on.

But, since these are not normalised in our culture as ways of erotic

expressions, the representation of the same, is very much limited even in our

awareness building on HIV prevention.

Even transgenders and MSMs like to be identified either as " penetrating " or as

" penetrated " . If there are groups of men sharing life styles different from

stereotypical men, who come

forward and share their experiences, norms of masculinity may be challenged.

This kind of initiatives takes us beyond ABC approach and contributes to HIV

prevention in the gender context.

Dr. Jayasree. A. K.

e-mail: akjayasree@...

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Re: Draft NACO Gender Policy- Call for Feedback


It is very heartening to know that NACO has drafted the Gender mainstreaming

policy document. We congratulate NACO, especially Dr. Mayank Aggarwal and his

team, and appreciate this attempt at holistic approach. It is particularly

encouraging to see also a clear articulation on the role of men and need to

engage them in gender discourse and mainstreaming efforts. We also welcome this

process of sharing the draft across and inviting feedback. Please find below our

additional comments/inputs. We hope that these inputs will be found useful. We

will be happy to discuss and elaborate upon them if necessary.

The second paragraph in the background section (pg. 2) articulates gender

equalities in the context of men's and women's vulnerabilities while clearly

acknowledging the role of `norms'.

We think this is a very critical perspective to be mentioned only as a passing

reference and deserves a more detailed deliberation at this point in the

document to provide the perspective. It will be critical to mention that

programs should take a gender transformative approach and not just

`gender-sensitive' or `gender-aware' approach.

This would mean that the programmatic responses should be based on nuanced

understanding of how and why gender roles and relations fuel the uneven spread

and impact of the HIV infections. At a minimum, this requires understanding that

gender and sexuality is socially defined and constructed, and that social norms

and ideologies directly affect sexual and reproductive health outcomes.

It also requires understanding how existing institutions and norms define

knowledge, behavior, motivations, and power dynamics within sexual

relationships. This understanding must be reflected into strategies and

interventions that attempt to reduce HIV risk to both women and men. This will

mark a paradigm shift from current technology based clinical approaches to a

structural approach to HIV prevention. We think this document provides

invaluable opportunity to put this approach into the center-stage of HIV

prevention, care, treatment and support.

It would also be helpful to highlight the challenges in gender mainstreaming in

the background section. Some of the challenges could include:

i) Stereotypical gender attitudes and behaviors of health service providers and

program personnel at all levels

ii)Lack of `how to' knowledge for bringing about normative changes

iii)Lack of mechanisms to hold staff accountable or motivate them to consider

and address gender issues

iv) Scare allocation of resources to monitor gender mainstreaming

v)Lack of successful M & E system for tracking progress

vi)Lack of adaptable materials, tool and methods

2. In the section – why women are vulnerable(pg. 4):

i) On pg. 4 in the third para, the first sentence should also include women's

low access to and control over resources – rewording it to " Women have poor

access to information and education, and less access to and control over

resources….. "

ii)On pg. 4 and 5 where five points are listed about global and local evidence –

a separate point after `loss of livelihoods' should be inserted on malnutrition

and food deprivation

3. In the section – why men are vulnerable (pg. 6), we suggest adding following

points to draw direct programmatic implications:

1. Young men's behavior puts women at risk - On average, men have more sexual

partners than women. HIV is more easily transmitted sexually from man to woman

than from woman to man. An HIV-infected man is likely to infect more persons

than an HIV-positive woman. Engaging men more extensively in HIV prevention has

a tremendous potential to reduce women's risk of HIV.

2. Young men's behavior puts themselves at risk - While HIV among women is

growing faster, men continue to represent the majority of HIV infection. Young

men are less likely to seek health care than young women. In stressful

situations—such as living with AIDS—young men often cope less well than young

women. In most of the world, young men are more likely than women to use alcohol

and other substances—behaviors that increase their risk of HIV infection.

3. The issue of young men who have sex with men (MSM) has been largely hidden -

Surveys from various parts of the world find that between 1%–16% of all

men—regardless of whether they identify themselves as gay, bisexual or

heterosexual—report having had sex with another man. Hostility and

misconceptions toward MSM led to inadequate HIV and AIDS prevention measures.

4. From a developmental perspective, there is evidence that styles of

interaction in intimate relationships are " rehearsed " during adolescence -

Viewing women as sexual objects, delegating reproductive health concerns to

women, use of coercion to obtain sex and viewing sex as performance generally

begin in adolescence (and even before) and may continue into adulthood. While

ways of interacting with intimate partners change over time, context and

relationship, there is strong reason to believe that reaching boys is a way to

change how men interact with women.

5. Men need to take a greater role in caring for family members with AIDS, and

to consider the impact of their sexual behavior on their children - The number

of men affected by AIDS means that millions of women and children are left

without their financial support. Caring for HIV-infected persons is mostly

carried out by women. Both young and adult men need to be encouraged to take a

greater role in this care giving. Young men who are fathers must consider the

potential of their sexual behavior to leave their children HIV-infected or

orphaned due to AIDS.

6. Finally, there is a pragmatic and cost-effective reason - Boys and younger

men are often more willing and have more time to participate in group

educational activities than do adult men.

4. In the table on Risk and Vulnerability to HIV(pg. 7),

i) Along with Men and Women, another column could be added for MSM/TG. For the

first row on behavior, it could say – multiple sex partners; for the second row

on social norms – high concurrence of partners, marriages between men, sexual

domination (panthi), silence and invisibility, violence and culture of silence;

and for the third row on economic factors – financial insecurity compounded by

poor system level support

ii) In the column of women, row on social norms it should be `culture of

silence' `in place of `culture of violence'

5. In section 3 – Policy guidelines (pg. 8) –

i) Heading - All HIV prevention and care interventions will be based on:(pg. 8)


a) Point 2 (pg. 8) should add on – emphasis should remain on dissolving over

time the barriers of gender divide between men, women and transgender, and

moving towards a continuum of femininities and masculinities.

b)Point 3(pg. 8) could be said as – `ensuring men's role as equal partners' in

place of `recognition of men's role as equal partners'

c)Adding a 5th point – application of positive deviant approach

ii)Heading - All HIV prevention and care interventions will ensure:(pg. 8) –

a) Point 6(pg. 9) should include key populations along with sexual minorities

B) Point 7(pg. 9) should include `….training on gender and sexuality issues….'

in place of training on gender issues alone

6. In the section on suggested checklist, heading A on Priority Setting (page11)

– point 3 should include `…..gender specialists and representatives of women and

men…..' in place of `…..gender specialists and representatives of women …..'

Dr. Deepmala Mahla, dmahla@...

Ms. Pranita Achyut, pachyut@...

Mr. Ajay Singh, aingh@...

Dr. Priya Nanda, pnanda@...

Mr. Dipankar Bhattacharya, dbahttacharya@...

Dr. Ravi Verma, rverma@...

International Center for Research on Women (ICRW)

42, 1st Floor, Golf Links,

New Delhi - 110 003

Phone : 91-11-24654216/17, 24635141

Fax : 91-11-2463-5142

e-mail: <dmahla@...>

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Re: /message/8588

First of all let me thank NACO, especially the IEC team who have done such a

comprehensive guideline for mainstreaming HIV and AIDS.

I would like to bring your attention to one crucial but sensitive area, which

reinforces women's vulnerability. The role Religion plays in subjugating women,

ascribing a secondary status, should be addressed in a country like India where

people are religious and religious values play a very important role in

day-to-day lives.

Portions from various scriptures are widely used to portray a negative,

subordinate status to women. Any discussion on equality

and mutuality in sexual relations can be made meaningful only when we

address the role of religion.

The principles of A and B (of HIV prevention) which is mostly derived from

religious teachings stay invalid when it comes to a contradicting gender

conditions and practices.

Some of the stereotypes like women are easy to be tempted-cause of

evil-their role is to please men and to serve them- no right to negotiate-no

role in decision making-Women are always under the protection (control) of men-

unclean- cover their heads and be silent -They should forgive, tolerate- etc

illustrates the clear role that religion plays in underlining such beliefs.

The examples mostly come from my own experience as a Christian woman. But each

religion has enough of these learning to place women in a vulnerable position.*

*Most of these stereotypes are evolved from religious teachings, which is

reinforced by culture.

Addressing the role of religion may be a sensitive issue, but I strongly believe

that we cannot do justice to mainstream gender if we do not critically study and

bring perspectives from religion that uphold women and accept their subjectivity

and dignity. India is a secular country, which does not mean that it is a

country without religions but ours is a country where different religions co

exists with harmony. Hence, it should be made mandatory for all religious groups

to uphold and accept women with dignity and human worth and hence we can

celebrate mutuality and self respect in all

relationships especially sexual relationships.

There are many efforts to address stigma and discrimination from an

interfaith platform in national and international level. But mainstreaming of

gender has to be an integral part of such efforts also.

Hence, I request NACO to address gender biases in religion also as an important

area to mainstream gender in HIV and AIDS.


Anshi(Sheila) Zachariah

AIDS Desk-National Lutheran

Health and Medical Board,

94, Purasawalkam High Road,

s, Chennai 600 010

Ph. 26432454/26480933


e-mail: <anshe.david@...>

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Dear Members,

Re: /message/8588

This is regarding the NACO Policy Guidelines on mainstreaming gender

in HIV/AIDS. My views are given below.

Mainstreaming Gender in Prevention of HIV/AIDS. A policy document on

mainstreaming gender in HIV/AIDS, cannot over look the fact of the poor status

of women in several parts of the country, especially their low literacy level

which denies them access to any written material on HIV/AIDS; poor health status

especially the reproductive part of it, which not only denies them the

opportunity of gaining any knowledge to take action in preventing vaginal or

urinary tract infections or any other sexually transmitted diseases, their

symptoms and cure.

There are major obstacles in accessing health care facilities - lack of time,

money for transport and a total indifference by the family to their needs to

access health care facilities for general gynaecological check ups.

In addition to all these factors, the prevalent child marriages are a

big obstacle in the prevention of HIV. Then the issues of rape and

sex with unmarried girls by their relatives is yet another factor. It

is surprising that the feminist movement in the country has also not

bothered about containing the epidemic.

It is known that the strategy used so far is man-oriented and none of the

prevention programmes is woman-oriented. There are different risks to women in

different situations – rural and urban, married and unmarried, caste and family


Poverty leading to malnutrition, sexual practices, traditional commercial sex,

increasing polygamy owing to adverse sex ratios and the Nata system must be

considered while deciding on mainstreaming gender. Male migration owing to

famines and with animals is yet another reason.

Therefore, major programmes for mainstreaming gender should include

devising solutions to the social problems being faced by women. A

woman-centric approach should include a much higher investment in the

rural areas on the expenditure on sex education programmes and not on

pregnancy and child birth alone.

Till today not enough care and support has been provided to women

living with HIV/AIDS. There should be a special fund for women for

the purpose. A much more effective surveillance management is

required. All the information should be conveyed to women through TV

and radio or by group discussions.

In the field of prevention there is a need to intensify research on

microbiocides. Female condoms are still not available in the urban areas let

alone in the rural areas. Most of the programmes for women should emphasise that

if their vaginal walls are strong they have a lower chance of catching the


This requires much more attention to personal hygiene especially during

menstruation. Highly subsidized sanitary napkins or even free napkins should be

available to women in the rural areas.

The need for rehabilitation of women suffering from HIV/AIDS is also essential.

They must be provided with proper jobs to live and special provision for extra

nutrition for HIV positive women should be made at Anganbaris like those for

pregnant and lactating women.

The biggest problem is the double burden of widowhood and their own positive

status and responsibility of repaying huge debts to meet the cost of treatment,

hunger and discrimination.

The policy for women should include special ration quotes at PDS and free

medicines for opportunistic infections. The policy should also include pensions

for such widows without the rider of a son and provision of work on the national

rural employment guarantee scheme.

It is also necessary that the policy should include construction of short stay

homes in every city where the ARV center is located, a community care center in

every district, a strong law which prevents and penalizes all those who

discriminate against women with HIV/AIDS and setting up of link centres for

every ARV centre for collection of medicines to avoid traveling long distances

to the ARV centres.

NACO should take on board Departments like WCD, Education, Rural Development and

Panchayati Raj and Labour in its strategy of mainstreaming gender along with

NGOs and the Civil Society.

Dr Sudhir Varma, IAS(Retd), PhD,

Director, Social Policy research Institute, Jaipur.

e-mail: <sudhir_varma30201@...>

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