Health Policy and Planning Advance Access published online on February 25, 2009
Health Policy and Planning, doi:10.1093/heapol/czp004
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Strategies for gender-equitable HIV services in rural India
1 Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
2 Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
3 Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
* Corresponding author. Division of Infectious Diseases, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Phipps 540, Baltimore, MD 21287, USA. Tel: +1-410-502-2032. Fax: +1-443-287-6440. E-mail: gsinha1{at}jhmi.edu
The emergence of HIV in rural India has the potential to heighten gender inequity in a context where women already suffer significant health disparities. Recent Indian health policies provide new opportunities to identify and implement gender-equitable rural HIV services. In this review, we adapt Mosley and Chen's conceptual framework of health to outline determinants for HIV health services utilization and outcomes. Examining the framework through a gender lens, we conduct a comprehensive literature review for gender-related gaps in HIV clinical services in rural India, focusing on patient access and outcomes, provider practices, and institutional partnerships. Contextualizing findings from rural India in the broader international literature, we describe potential strategies for gender-equitable HIV services in rural India, as responses to the following three questions: (1) What gender-specific patient needs should be addressed for gender-equitable HIV testing and care? (2) What do health care providers need to deliver HIV services with gender equity? (3) How should institutions enforce and sustain gender-equitable HIV services? Data at this early stage indicate substantial gender-related differences in HIV services in rural India, reflecting prevailing gender norms. Strategies including gender-specific HIV testing and care services would directly address current gender-specific patient needs. Rural care providers urgently need training in gender sensitivity and HIV-related communication and clinical skills. To enforce and sustain gender equity, multi-sectoral institutions must establish gender-equitable medical workplaces, interdisciplinary HIV services partnerships, and oversight methods, including analysis of gender-disaggregated data. A gender-equitable approach to rural India's rapidly evolving HIV services programmes could serve as a foundation for gender equity in the overall health care system.
Key Words: HIV, rural India, gender equity, health services, access to care, utilization
Accepted for publication 3 December 2008.