The Big Picture: A guide for implementing HIV prevention that empowers women and girls

The Big Picture - Implementing HIV prevention

The Big Picture - A guide for Implementing HIV prevention that empowers women and girlsThe Big Picture: A guide for implementing HIV prevention that empowers women and girls

From 2006 to 2010 STOP AIDS NOW! supported an innovative project in Kenya and Indonesia which gave equal weight to HIV prevention, gender equity and human rights. At the end of the project they asked me to set out the theory and practice of their partners’ efforts in a ‘how to’ guide. This is the result, which I co-authored with the project’s manager, Jennifer Bushee.

This guide will be particularly interesting for people working at community level who want to address the structural factors behind the vulnerability of women and girls to HIV.



This guide provides ‘how-to’ information for developing a ‘transformative approach’ to HIV prevention for women and girls. Such an approach addresses key root causes of vulnerability to HIV and seeks to reshape the beliefs, attitudes and behaviours of individuals and communities in favour of women and girls and gender equality. It also aims to empower women and girls to protect themselves from HIV infection and from the negative impact of living with HIV.

It sets out the rationale for working on HIV prevention using a transformative approach. It also shares experiences and promising practices from the Gender Development Project. It then provides 5 steps based on these for developing HIV prevention work aimed at reducing the HIV risk of women and girl through promotion of gender equality and women’s rights.

This guide will be particularly interesting for people working at community level who want to address the structural factors behind the vulnerability of women and girls to HIV.

We note that the advice in this guide is not fixed and definite; please read it as providing suggestions based on the experiences of the partners in the Gender Development Project. The advice should be adapted to fit local needs and the relevant social, political and cultural context.

We also note that this guide is not comprehensive and is not written to support the development of a whole project cycle. It gives guidance about how to think from a ‘gender transformative’ perspective, but it does not, for example, give step-by-step instructions for doing a needs assessment.

Finally, we note that this guide encourages readers to think differently about how to respond to HIV, using a holistic perspective, the so-called ‘big picture’. This approach gives you wider scope for doing HIV prevention work. It allows you to integrate HIV prevention in other work on gender and rights. It also allows you to respond more closely to the felt needs of girls and women. Crucially, the ‘big picture’ approach, over time, allows you to work in a ‘transformative’ way. This means it helps supports people to transform or change gender relations in ways that are beneficial to all, including—but by no means limited to—by reducing vulnerability to HIV transmission.

Vivre sa Différence: Les jeunes femmes, leurs orientations sexuelles et leurs droits sexuels

Vivre sa Difference sexualite

Les Jeunes femmes, leurs orientations sexuellesVivre sa Différence: Les jeunes femmes, leurs orientations sexuelles et leurs droits sexuels

Rutgers WPF a demandé aux jeunes homosexuels et hétérosexuels du monde entier quelles informations aideraient les filles et les jeunes femmes qui ont des questions sur leur orientation sexuelle.  J’ai utilisé leurs idées et leurs requêtes pour écrire Vivre sa différence. Originellement écrit en anglais.

(French translation of the publication A Different Way.)



Partout dans le monde, les idées que l’on se fait de la sexualité, de l’amour et du mariage se limitent aux relations entre hommes et femmes. Et pourtant, ce n’est pas tout ! Il existe différents types de relations, y compris des relations entre femmes ou entre hommes. Cependant, il n’y a que très peu d’informations disponibles pour aider les jeunes femmes à trouver leur voie. Nous avons rédigé ce livret pour les jeunes femmes qui :

  • se sentent peut-être différentes ;
  • veulent en savoir plus ;
  • se posent des questions sur leur sexualité ;
  • et veulent faire ce qui est le mieux pour elle.

Nous voulons donner aux jeunes femmes des informations sur les différentes orientations sexuelles. Nous espérons que cela les aidera à mieux comprendre ces questions et à faire les bons choix, en particulier si elles ne se sentent pas sûr d’elles. Ce livret pourra également être utile aux personnes qui travaillent avec des jeunes femmes, comme par exemples les enseignants ou le personnel soignant.

Nos valeurs

Nous croyons aux droits humains. Chacun devrait pouvoir en profiter. Les droits sexuels en font partie. Chacun devrait pouvoir choisir son partenaire sexuel, décider si oui ou non il souhaite avoir une relation sexuelle et être libre d’essayer et d’avoir une vie sexuelle à la fois satisfaisante et sûre.

Ces droits sexuels sont trop souvent bafoués. Par exemple, des jeunes femmes sont forcées ou poussées à avoir des relations sexuelles, ou sont obligées de se marier avec un certain homme. Pour les femmes qui se sentent attirées par d’autres femmes, la situation est souvent encore pire.

Parfois, les informations peuvent aider. Dans de nombreuses cultures, les jeunes reçoivent de nombreux messages prêtant à confusion de la part des films, des magazines, de leurs amis, des membres de leur famille et des responsables religieux. Certaines de ces informations sont correctes. D’autres sont utilisées pour essayer d’exercer un contrôle sur les jeunes. De nombreux adultes pensent que fournir des informations aux jeunes sur la sexualité va les encourager à multiplier les relations sexuelles. C’est faux ! De nombreuses études ont montré que le fait d’obtenir des informations sur la sexualité et sur des relations saines aide les jeunes à faire de meilleurs choix.

Qu’allez-vous trouver dans ce livret ?

Le chapitre 2 est consacré à la sexualité et aux relations saines. Il peut être utile à toutes les jeunes femmes.

Le chapitre 3 explique ce qu’est l’identité de genre et souligne les différents types d’attirances ou d’orientations sexuelles qui existent chez l’être humain.

Le chapitre 4 contient de nombreuses questions et réponses sur les femmes qui se sentent attirées par d’autres femmes. Ce chapitre intéressera les jeunes en général et les jeunes femmes qui essaient de mieux comprendre leur propre orientation sexuelle en particulier.

Failing Women, Withholding Protection

HIV prevention with female condom

female condom to prevent HIV15 lost years in making the female condom accessible.

Oxfam Novib has been one of few organisations in the world investing in allowing the female condom to serve its purpose. I was fortunate to have the job of researching and writing this briefing paper for them.

They and the World Population Fund used it in their advocacy push at the 2008 International AIDS Conference. Find out more about their Universal Access to Female Condoms campaign here.



2008 marks 15 years since the female condom was invented, and, disgracefully, 15 years of failing to make them accessible to the women who need them. Despite the absence of any other female-initated form of protection, and unprecedented rises in funding for the response to HIV, female condoms remain inaccessible, and their contribution remains untapped.

The urgent need for access to female condoms is evident in the feminisation of the HIV pandemic, the large unmet need for contraception, and the pitiful progress towards meeting Millennium Development Goals 5 and 6 on maternal health and halting and reversing the spread of HIV.

Why provide female condoms, when male condoms are readily available, much cheaper, and provide a comparable level of protection?

  • Female condoms are a tool to assist women’s empowerment. Women who use female condoms report an increased sense of power for negotiation of safer sex, and a greater sense of control and safety during sex. It will be many years until women have any alternative femaleinitiated means of protecting themselves.
  • Providing both female and male condoms leads to more instances of protected sex and reductions in the incidence of sexually transmitted infections (STIs). Their additive effect, providing protection in instances which would not be protected by male condoms, makes them a costeffective form of HIV prevention.

Studies have repeatedly shown high levels of acceptability for female condoms. Some users prefer them over male condoms, as they offer more flexibility regarding the timing of putting them on and taking them off, and have a more natural feel. However, many donors and policy-makers remain sceptical that sufficient demand for them exists. Yet examination of femalecondom projects reveals significant demand, even though it is often deliberately suppressed and unintentionally undermined by stigmatisation and running out of stock. What is perceived as an issue of demand is actually one of supply. Expanding access to female condoms is held up not at the users’ end, but at the start of the chain: how much money donors and governments are willing to invest in buying female condoms, supporting female-condom programmes, and developing low-cost female condoms.

What is behind the failure to act comprehensively to create access to female condoms? Responses from donors and policy-makers to the female condom mirror the common reasons for not using a male condom: responses formed by ignorance, culture, denial, ‘poverty’, and conservatism. Added to this are overarching errors of a lack of leadership, a huge funding bias against existing forms of primary HIV prevention, failure to scale up programming, and failure to invest in strategies to lower the cost of female condoms.

Of course, some efforts have been been made in the past 15 years, which have accelerated since the launch of the United Nations Population Fund’s (UNFPA) global Female Condom Initiative in 2005. The rapid expansion of sales and free distribution in the few countries at the forefront of female condom programming demonstrates the massive unmet demand for female condoms. But there is so much more to be done. Worldwide, in 2007, roughly 423 male condoms were produced for just one female condom. Female condoms currently have a unit cost about 18 times higher than male condoms.

The levels of investment and programming needed to increase the choice of available female condoms, to lower prices and to expand production are highly feasible. Through collaborative action, donors, governments, civil society organisations and the private sector can begin the progress of achieving universal access to female condoms. Female condoms exist now, and concerted efforts to make them accessible must begin now.