CCP staff member Lisa Mwaikambo attended RTI International’s “Ending Gender Inequalities: Addressing the Nexus of HIV, Drug Use, and Violence with Evidence-Based Action” conference last month. She shares her thoughts on how to address gender inequalities below.

Last month, I attended RTI International’s “Ending Gender Inequalities: Addressing the Nexus of HIV, Drug Use, and Violence with Evidence-Based Action” conference, which was held in North Carolina against the backdrop of recently passed local legislation, House Bill 2, that blocks cities and local governments from passing anti-discrimination measures that aim to protect gay and transgender rights. The disconnect between the conference focus and local discourse underscored the pressing need for discussions on gender, both in the United States and internationally.

Gender inequality, or the unequal treatment or perceptions of individuals based on their gender, fosters power dynamics that put individuals at greater risk of exposure to HIV, drug use, and violence as well as a number of other negative health outcomes. This is particularly true for women and girls. As a communication and knowledge management professional, I took away the following messages from the conference:

#1: Language is Powerful.

The conference kicked off with a spoken word commentary by Professor Thema Bryant-Davis of Pepperdine University. One line especially spoke to me: “Respect will trump tolerance any day.” Being a tolerant society is insufficient; we must also aim to respect each other. We can begin the process of showing each other respect by being mindful of the language that we use.

“Labels can be inaccurate, alienating, and disempowering.”

We heard heartfelt testimonials throughout the conference from individuals representing some of the most vulnerable populations. One testimonial came from a survivor of commercial sex trafficking. Kidnapped as a minor and held captive for three years, she was arrested for prostitution more than a dozen times. Yet, she was adamant that she was never a prostitute because legally, she was unable to give consent. The label assigned to her by society was, in her eyes, inaccurate, unjust and alienating.

In public health programming and research, it is imperative that we engage the population we seek to assist. In the field of strategic communication, we refer to this engagement as stakeholder participation. The communication process works best when program partners, decision makers, audience members and technical experts are actively involved in every step of the process. Since gender plays a key role in contributing to health and development issues and outcomes, it’s critical to gather gender-specific information on the current situation.

#2: If At First You Don’t Succeed, Test [Your Messages] Again.

Suaahara staff field test a health communication material about Essential Hygiene Actions (EHA) for agriculture in District of Dolakha, Nepal. © 2013 Valerie Caldas/ Johns Hopkins University Center for Communication Programs, Courtesy of Photoshare

A panel presentation on the 2016 Campus Climate Survey Validation Study (CCSVS) further emphasized the importance of word choice, even in survey instruments.

One intention of CCVS was to develop valid measures for sexual assault victimization. Three types of sexual victimization were measured: sexual assault, rape and sexual battery. However, none of these terms were used in the survey. Instead, the survey included language based on legal descriptions of unwanted sexual contact.

The project team reviewed other survey instruments on the topic and sought input from numerous academic researchers, sexual assault survivor advocates and federal scientific staff with expertise in the measurement of sexual assault. Then, the final set of constructs included in the CCSVS instrument survey underwent cognitive testing with potential survey respondents – both virtually and in-person. (Cognitive testing is used to understand how participants conceptualize what a question is asking, develop their answers, and convey them via a response.) The cognitive interview process revealed several fairly substantive issues with the instrument that required revisions. [See the CCSVC Final Report for more information on the methodology and findings.]

Just as the development of the CCSVS required an iterative process, so too does the development of social and behavior change communication (SBCC) messages and creative materials require refinement and adaptation. In SBCC, we more frequently refer to these stages as concept testing and pretesting.

#3: Demand Generation Must Go Hand-In-Hand With Service Quality Improvement.

Giving current understanding of successful HIV prevention measures, ending the AIDS epidemic is now within reach. Powerful momentum is now building a new narrative on “treatment as prevention” and the following ambitious targets have been established by UNAIDS:

• By 2020, 90% of all people living with HIV will know their HIV status.
• By 2020, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy.
• By 2020, 90% of all people receiving antiretroviral therapy will have viral suppression.

The final two targets all hinge on the first: Getting 90% of all people living with HIV diagnosed. At the conference, David Wilson of the World Bank emphasized that we need to address the interaction of service quality and demand for services. Put another way, we need to restore confidence in the public sector, which is waning in a number of countries, in order to achieve the first target and then subsequent targets.

This is an area in which CCP has demonstrated success. The Gates Foundation-funded Nigerian Urban Reproductive Health Initiative (NURHI) is a great example of a simultaneous, multi-pronged approach to increase demand for services while improving the quality of service delivery. The NURHI project is built on the premise that demand for family planning (FP) is a requirement for increased contraceptive use, and that strategies to increase demand must be coupled with improvements to service quality and accessibility.

NURHI has successfully implemented an integrated communication strategy that uses social mobilization, mass media campaigns, and entertainment education to increase demand for FP among women and men of all ages. At the same time, NURHI has improved quality of service and access to FP by:

• improving contraceptive logistics and training of health providers;
• integrating FP with maternal, neonatal, and child health (MNCH) and HIV services; and
• strengthening relationships and referrals between public and private sector providers.

While NURHI’s current focus is unmet need for family planning, these approaches could be adapted to address HIV diagnosis and care.

CCP applies these three key messages in everything that we do. Regardless of whether an intervention has gender-specific outcomes, as communication professionals, we are always aware of how gender-based social norms, cultural values, attitudes and behaviors can impact a person’s health and well-being. As a result, we consider gender at the design stage of every program – specifically as part of a situation analysis to better understand the current environment, as well as target audiences. Ultimately, we work toward transforming gender roles, norms, and dynamics for positive and sustainable change.

Please check out some of CCP-led gender projects for more information as to our approach.

This post was written by Lisa Mwaikambo, K4Health Program Officer II. In this role, she leads the Global Health eLearning Center.