•    There are currently insufficient mechanisms and data to give either the Office of the U.S. Global AIDS Coordinator (OGAC) or country programs an adequate assessment of the effectiveness of gender- focused programming and its impact on societal norms and health disparities. There is a need for PEPFAR to develop an adequate approach, through both the program monitoring system and a coordinated effort of periodic evaluation and other activities, to adequately assess what efforts are being implemented and the outcomes of these efforts across the full range of its programmatic portfolio for gender-focused activities.

Overall Conclusion

•    As PEPFAR’s gender efforts have evolved and expanded, there have been positive effects of these efforts. However, the approach for how PEPFAR engages with gender-related factors that influence the HIV epidemic and response has been ad hoc. Although PEPFAR has articulated its framing of gender vulnerabilities and inequities and its overarching aims in its Gender and HIV Factsheet, it has not articulated the objectives that would need to be met in order to achieve those aims or the outcomes that would reflect success in these efforts. In addition, it does not provide guidance on intervention effectiveness or on approaches to establishing priorities for gender-focused efforts in different country settings and to developing strategic country-specific portfolios. Activities supported by PEPFAR central initiatives and through country operational planning vary widely in type and intensity of focus across the articulated gender aims and the populations that are addressed.

Recommendation Presented in This Chapter

Recommendation 8-1: To achieve PEPFAR’s stated aim of addressing gender norms and inequities as a way to reduce HIV risk and increase access to HIV services, the Office of the U.S. Global AIDS Coordinator (OGAC) should develop and clearly state objectives and desired outcomes for gender-focused efforts. OGAC should issue guidance for how to operationalize, implement, monitor, and evaluate activities and interventions to achieve these objectives.

Further considerations for implementation of this recommendation:

•    The objectives and guidance should be informed by the available evidence on how gender dynamics influence both HIV outcomes and the implementation of activities and services as well as by evidence on intervention effectiveness from the existing knowledge base, expert consultation, and experiences from pilot programs in partner countries.

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