AIDS is increasingly becoming a serious threat to women, particularly in developing countries. According to the World Health Organization (WHO), AIDS-related illness is the leading cause of death and disease among women of reproductive age in low and middle income countries, particularly in Africa.
While in 1985 there were as many HIV infected men as women in sub-Saharan Africa, women’s infection rate has steadily increased and now the number of HIV infected women is larger than HIV infected men. To date, approximately three quarters of all women with HIV live in sub-Saharan Africa.
There are several reasons for this vulnerability. Women and girls are particularly susceptible to be infected due to biological, social, cultural and economic factors. The female genital tract has a greater exposed surface area than the male genital tract, making it more prone to infection with every exposure. Younger women may be even more vulnerable because they are more often victims of coercive or forced sexual relations with men who may already be infected.
Women who are victims of sexual violence are at a higher risk of being exposed to the infection. According to a South African study, women who were dominated or beaten by their partners were much more likely to be infected with HIV than women who were not. Abusive husbands were more likely to be infected with HIV than non-abusive husbands, according to a study in India involving 20,425 couples.
Women’s lower socio-economic status may also lead to high risk behaviors and make them less able to seek information they need to keep themselves safe. Globally, only 38% of young women were able to describe the ways to avoid infection and less likely than men to know that condoms can protect against the HIV infection. Particularly in sub-Saharan Africa, HIV prevalence is generally higher among adolescent girls aged 15-19 than among their male counterparts.
In addition, many young girls enter into sexual relationships with older men who are more sexually experienced, more powerful and are more likely to be infected and thus able to infect them. “We need to help young people develop the skills for mutual consent in sex and marriage and put an end to violence and sexual coercion,” stated Michel Sidibe, Executive Director of UNAIDS.
It has been shown that violence, or even the threat of it, can lead women to avoid HIV prevention, treatment, and care and support services. The problem of violence against women is exacerbated in countries at war, where in many cases rape is used as a “tool of war.” In some cases, women have been intentionally infected with HIV, so as to provoke a “slow death.”
In many societies, women are at an economic disadvantage with regard to men. In sub-Saharan Africa, for example, property is generally owned by men, and even when they are married, women don’t have as many property rights as their husbands. Lack of property also means limited economic stability and, as a result, an increase in the possibility of sexual exploitation and violence.
Major inequalities between men and women in all aspects of living persist in many parts of the world, such as employment and education opportunities and power imbalances within relationships. In those situations, gender roles limit women to positions where they lack the power to protect themselves from physical abuse and from HIV. Gender inequalities prevent women from asserting their rights and controlling the circumstances that increase their vulnerability to infection.
As a response to this situation international development organizations have stepped up their work on the promotion of women’s basic rights. Recognizing and challenging stereotypes and harmful gender roles is crucial to preventing the spread of HIV. It is important to understand, however, that programs that focus on men and the need to change their stereotypical behavior also need to be implemented. Defeating HIV and AIDS is everyone’s responsibility.
Cesar Chelala, MD, PhD, is an international public health consultant and the author of “AIDS: A Modern Epidemic,” a publication of the Pan American Health Organization.