Whenever I watch my two-year old daughter playing with her 20 month-old male cousin, it is interesting to observe the ways in which they are already learning their gendered roles of "girl" and "boy." One of the most notable things regarding the issue of gender is the sometimes subtle ways in which it shapes our worlds, determining which behaviours are appropriate for whom on the basis of sex. In the area of reproductive and sexual health, accommodations must be made to take account of the impact of gender socialisation and the ways in which it shapes the sexual identities, roles and behaviours of girls and boys; women and men. However, given the often covert nature of socialisation, certain gendered behaviours are often left untouched, resulting in reproductive health policies that fail to meet the specific needs of women, and of men.

Faced with the global crisis of the HIV/AIDS pandemic, many reproductive health care planners have given voice to the need to incorporate an in-depth account of the dynamics of gendered relationships into their policies and programmes (PDF). Seemingly simple questions such as "how do women and men negotiate sexual relationships?" and "how is power assigned amongst women and men?" come sharply into focus, bringing with them the realisation that these issues are not easily answered, and are not so simple after all.

The complexity of gender, and its impact on sexuality, and by extension reproductive health care policies was underlined for me in a conversation I had recently with a pregnant adolescent female. The teenager was enrolled in a local programme that offers young women an opportunity to continue with their education if they become pregnant, while providing them with family planning counselling. On the surface, here was a young woman who had been given the tools to manage her sexual life. However, during the course of our conversation, she admitted not only to thinking that her partner would be unfaithful; but more importantly, that she did not feel like she could refuse to have sex with him if he would not use a condom.

Herein lies one of the key concerns in gender planning: the issue of power. Amidst socio-cultural patterns which still draw parallels between masculinity and dominance, and femininity and submissiveness, how effective are policies that focus solely on equipping people with tangible tools to protect their sexual health, without simultaneously challenging the imbalanced nature of gender relationships?

In 2002, the National HIV/AIDS Commission of Barbados held a Training of Trainers HIV/AIDS workshop (PDF) aimed at equipping educators from a cross-section of the civil service with the "necessary knowledge and skills to train their work colleagues about HIV/AIDS and its impact on various facets of the society." Among the issues that were looked at during the workshop were the socio-economic impact of HIV/AIDS and HIV/AIDS in the workplace. The issue of gender however was not raised as one of the central areas. Despite the undeniable benefits to be derived from efforts such as this one, their long-term effectiveness comes into question given the glaring absence of an analysis of gender dynamics.

Jamaica, in its National HIV/AIDS Policy (PDF) identifies gender as one of the contributing factors to the spread of HIV, noting: "gender roles and inequities such as female subservience in sexual decision-making influence behaviour choices that spread HIV. The policy calls for the use of gender-sensitive approaches to the construction of messages geared towards the public, noting the need to contextualise these approaches given the society's prevailing social and cultural norms.

Against a cultural backdrop in which manhood is still widely associated with the ability to "conquer," impregnate and sexually please large numbers of women; and womanhood is associated with sexual submissiveness, fecundity and the ability to appear sexually attractive to men; how do we develop policy that takes these, and other socio-cultural realities into account?

The challenge is to go beyond paying lip service to the role of gender, and to engage in multi-layered investigations of how women and men in the Caribbean come to create and understand their sexual identities. These analyses must take into account issues of race, nation, class, sexual orientation and religion. In a very real sense, we must ask "what can it mean to be a working-class Indo-Guyanese woman? … A middle-class African-Barbadian man?" It is undeniably difficult to create an overarching policy that will equally meet the needs of each individual. However, it is a start to develop policy from a needs-based approach. If some men feel that their manhood is tied to their promiscuity, we should work with them to rework this social construction of masculinity. If some women feel like they cannot tell their partners "no," then we should start from there and build with them to create spaces in which they can empower themselves to make wise sexual decisions.