Intersections, Gender, HIV, and Infrastructure Operations: Lessons from Selected ADB-financed Transport Projects

From October 2007 to April 2008, the Asian Development Bank (ADB) conducted a five-country assessment, from a gender perspective, of the impact of selected transport projects on the spread of HIV. The assessment consisted of a desk review of ADB and government policies and regulatory frameworks in relation to HIV and to gender. Field work was carried out in selected project sites in five countries—Cambodia, the People’s Republic of China (PRC), India, Papua New Guinea (PNG), and Tajikistan. Over 370 interviews and group discussions were conducted with representatives of ministries of health, public works, transport, infrastructure, and women’s affairs; nongovernment organizations (NGOs) and other civil society actors; and construction workers, sex workers, villagers, youth, and people living with HIV.

The people most vulnerable to HIV during infrastructure construction are skilled and semiskilled male workers—including machine operators, drivers, supervisors, managers, and engineers—and young, rural, poorly educated women who move to the construction sites to sell sex. Local laborers are less at risk because they are usually drawn from the local communities and go back to their partners and families each night. Women who rent market stalls along transport corridors are also at risk of HIV if they lose their livelihood as a result of infrastructure development and consequently must migrate or look for other ways to gain an income such as paid sexual transactions. Improved transportation infrastructure results in greater mobility, particularly for young people and men, and increased travel outside the local area to seek paid work. Outside their village, young women are more vulnerable to sexual exploitation and young men are more likely to become involved in risk-taking behavior. Spouses left behind without a secure livelihood may engage in unprotected sex for money or they may be exposed to infection due to their returning partner’s risky behavior.

New roads bring more truck drivers through an area—hard-to-reach men who are often missed by HIV interventions. New roads can also increase the trafficking of drugs through previously remote areas, as well as the risk of trafficking in people, both men and women, for their labor, and women and children for sexual exploitation. In Asia, HIV particularly impacts on women because of gender differences. On the one hand, men are more likely to have multiple partners, to travel for work, and to have disposable income. They are the clients of sex workers, and many men also have sex with men. On the other hand, women are physiologically more vulnerable to infection, and their lack of social and economic power means most women are unable to negotiate safer sex. Women are generally expected to be monogamous and bear children; they have few inheritance rights in most countries; in some countries exceptionally high levels of violence toward women puts them at even greater risk of infection. Discriminatory laws and practices further disempower women. Women generally have lower levels of education and skills and are poorer than men, so they are less likely to access accurate information about HIV. Women are also more frequently and severely impoverished due to HIV; often the husband is the first in the family to get sick, assets are sold to pay for his health care, and after his death, his widow and children are left impoverished