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In the past decade there have been expanding resources to address the underlying gender dimensions of HIV. This has been particularly urgent in sub-Saharan Africa as the female-to-male infection ratios in young populations has reached 3 to 1 and sometimes above. The phrase "gender and HIV" has become commonplace yet does not provide any specific guidance as to target audiences content or measurable results. It can include everything from microcredit programs for HIV-positive women to workplace programs seeking to change negative male norms to efforts to increase respect for diverse sexual and gender identities. This review mines the first generation of programs to provide an empirical foundation to inform a next generation. We examined 63 illustrative (and among the largest and best known) "gender and HIV programs." Data were obtained via programs own reports (garnered largely through interactive interviews) of how they selected their populations and targeted their interventions; whether and to what degree they conceptualize and address the distinct needs of males and females. It also inquired as to whether there were explicit links between populations of males and females in program design and in measurement of results. Pressing for clarity and answers to these questions will assist in translating the current interest in "gender" into more precise tailoring of interventions to specific age gender and partnership-status profiles. We conclude this program review with several recommendations: (1) redirecting HIV programs to primary prevention building the protective assets of those most at risk particularly the youngest of those who face the highest risk -- adolescent girls and young women deserve a larger share of resources and policy attention than they have been receiving; (2) locating populations of males for intervention guided by the needs of the most at-risk females; (3) defining gender-specific goals for females and males as separate but linked "social accounts" resulting in (a) safer and more confident girls and women who are able to claim their rights act on their own behalf and have opportunities and choices and (b) men and boys who will benefit from less rigid gender roles and who recognize the full humanity of others and treat them with respect.

First generation of gender and HIV programs: Seeking clarity and synergy