methodology
1) Conceptual frameworkHalf of all people infected by HIV/AIDS in the world are women, mainly affected by HIV/ADS epidemic due to their lack of Sexual and Reproductive Rights. In fact, the growth of the epidemic among women and girls is helped by the explosive combination of poverty, migration, violence, lack of information and unsafe sex practices in a context of the expansion of fundamentalism and conservative morality.5 HIV/AIDS has had a devastating impact on women and girls, whose vulnerability to the infection is exacerbated by economic and social inequality.
In our view, no process for debating and designing responses to HIV/AIDS can be productive, credible or successful without a comprehensive approach on Sexual and Reproductive Rights. However, despite the recognition that it is impossible to face women’s HIV/AIDS vulnerability without an active process of empowering women themselves, and despite acknowledging that sexual and reproductive health and rights are key issues for that process, until 2006 government and civil society UNGASS reports have not provided sufficient information about the current situation of women’s and girl’s in order to improve the countries’ responses to HIV/AIDS by strengthening sexual and reproductive policies and services. This lack of information probably reflects the low priority of gender issues on the national and international HIV/AIDS agendas and in resource allocation.
2) Data-gathering instrument construction
In elaborating the data-gathering instrument an effort was made to identify those paragraphs of each chapter of the Declaration of Commitment whose objectives required action in the field of sexual and reproductive health. After they had been identified, those points that were considered to be crucial for civil society were defined, that is, those actions which if they failed to be implemented with quality and wide outreach, would jeopardize the effective achievement of the goal.
That set of critical points was what guided the elaboration of the indicator matrix. The matrix was constructed on the basis of a search for qualitative data with relevance for the analysis of those policies, plans, or programmes necessary to make the satisfactory achievement of the goals in question feasible as well as operable.
In gathering information the following sources were used:
• Interviews with key informants – programme administrators, researchers and NGO leaderships;
• Interviews with service users;
• Analysis of official documents, literature produced by NGO and academic production in regard to each one of the themes addressed;
• Observation of service providing.
Operational definitions for policy analysis
This monitoring tool was developed on the basis of the importance of civil society’s opinions on the policies regarding sexual and reproductive health and their concrete implementation, considering their adequateness, reach, coverage, effectiveness and civil society participation. The analysis of the respective services was done in the dimensions of access, quality, and care, as defined below:
Adequacy: Does it provide the answers for the problems considered critical by civil society?
Reach: Does it include all different types of people affected by the problems the policy tries to solve?
Coverage: Does it reach people most affected by the problem?
Effectiveness: Does it happen in practice? Does it have a budget? Are there trained human resources for its implementation? Does it have a communication strategy for reaching civil society?
Civil Society Participation: Are there, indeed, representatives from civil society, especially the epidemic’s most affected populations, involved in designing, monitoring, and evaluating the proposed actions?
Access: Do people who need services get them easily, or are there challenges?
Care: Do people feel well received, respected, and respected in their rights?
Quality: Do people get their needs met?
Most vulnerable women
Women living with HIV; incarcerated; partners of MSM; drug users; married; affected; girls living with HIV; girls living on the streets; transsexual women; young women; women and girls who are sex workers; girls who are orphans due to AIDS; indigenous women; immigrants and indigenous women who migrate; women affected by migration; mobile populations (national and international); bisexual and lesbian women; women and girls victims of sexual exploitation; women and girls victims of violence and sexual violence; women and girls with special needs.
Data analysis was oriented by the identification of the main strong points for promoting advances in the sexual health of women living with HIV/AIDS to prevent the epidemic amongst women, and the main gaps and deficiencies related to the articulation of sexual and reproductive health and HIV/AIDS, considering the socio-political and health environment that surrounds the implementation of actions of sexual and reproductive health and the national response to the epidemic.
