RESUMEN
Based on an adapted version of the conceptual framework used by the Guttmacher-Lancet Commission on Sexual and Reproductive Health and Rights (SRHR), this study sought to analyse to what extent seven global agencies, five of which belong to the UN family and the other two closely linked, incorporate women's autonomy and freedom of choice in accessing services into their SRHR policies, and how they operationalize these in their global SRHR programmes that target women and adolescent girls. Twenty-nine SRHR-related policy documents published in 2013-2020 and 17 independent evaluations of global SRHR programmes in the same period were analysed. They were found to fall short of considering women's individual autonomy and choice as the two core principles of SRHR. By ignoring autonomy and choice, global SRHR programmes missed the opportunity to incorporate activities that could enhance the emancipatory empowerment of women and girls to improve their sexual and reproductive wellbeing. The study identified concrete aspects on which global agencies, in view of their respective mandates, could have pronounced themselves more explicitly and might have been more effective in implementing SRHR programmes. In light of the international gender equality and women's empowerment discourse this suggests that donor countries could hold global agencies more accountable, bilaterally or jointly, for their SRHR performance, in particular their active endorsement and application of SRHR core principles.
RESUMEN
INTRODUCTION: The female condom is the only evidence-based AIDS prevention technology that has been designed for the female body; yet, most women do not have access to it. This is remarkable since women constitute the majority of all HIV-positive people living in sub-Saharan Africa, and gender inequality is seen as a driving force of the AIDS epidemic. In this study, we analyze how major actors in the AIDS prevention field frame the AIDS problem, in particular the female condom in comparison to other prevention technologies, in their discourse and policy formulations. Our aim is to gain insight into the discursive power mechanisms that underlie the thinking about AIDS prevention and women's sexual agency. METHODS: We analyze the AIDS policies of 16 agencies that constitute the most influential actors in the global response to AIDS. Our study unravels the discursive power of these global AIDS policy actors, when promoting and making choices between AIDS prevention technologies. We conducted both a quantitative and qualitative analysis of how the global AIDS epidemic is being addressed by them, in framing the AIDS problem, labelling of different categories of people for targeting AIDS prevention programmes and in gender marking of AIDS prevention technologies. RESULTS: We found that global AIDS policy actors frame the AIDS problem predominantly in the context of gender and reproductive health, rather than that of sexuality and sexual rights. Men's sexual agency is treated differently from women's sexual agency. An example of such differentiation and of gender marking is shown by contrasting the framing and labelling of male circumcision as an intervention aimed at the prevention of HIV with that of the female condom. CONCLUSIONS: The gender-stereotyped global AIDS policy discourse negates women's agency in sexuality and their sexual rights. This could be an important factor in limiting the scale-up of female condom programmes and hampering universal access to female condoms.