(November 2004) The face of HIV/AIDS continues to quickly become young and female—a trend highlighted by the UN’s current World AIDS Campaign, which culminates in the 18th annual World AIDS Day on December 1.
In just the last two years, the number of women infected by HIV has risen dramatically—in East Asia by 56 percent, and in Eastern Europe and Central Asia by 48 percent. The UN campaign throws into sharp relief how the pandemic is increasingly affecting women and girls worldwide:
- Nearly 50 percent of the 37.2 million adults living with HIV are women—up from 35 percent in 1985.1
- AIDS is the leading cause of death for African-American women ages 25-34.
- Girls and young women make up over 60 percent of those ages 15-24 who are HIV-positive. In sub-Saharan Africa, that figure is 75 percent.
- Adolescent girls face HIV-infection rates up to 5 to 6 times higher than those of boys.
- In some African countries, young married women age 15-19 are more likely to be infected than single women the same age. And more than 20 percent of pregnant women tested in many Southern Africa countries were HIV-positive.
Unfortunately, women often are dangerously unaware of the risks of HIV infection and of the ways to protect themselves from it. They also routinely lack adequate access to prevention services and methods. And women who have limited social standing or economic security or who are involved in coercive or abusive relationships often cannot negotiate abstinence or use of a condom.
“Young women are especially vulnerable to HIV for both biological and social reasons,” says Lori Ashford, technical director of policy information at PRB. “They are physically more susceptible to infection than men are and they often lack the self-confidence to resist sexual advances or persuade older men to use a condom.”
AIDS as a Gender Issue
In response to these trends, many prevention programs now address HIV/AIDS not just as a public health issue, but also as a symptom of underlying gender inequality.
“Gender inequality has turned a devastating disease—AIDS—into an economic and social crisis,” says Noeleen Heyzer, executive director of United Nations Development Fund for Women (UNIFEM). “The crisis requires the infusion of serious resources into programs and policies that promote gender equality and women’s empowerment.”
Such efforts include increased access to economic opportunities and education as well as the safeguarding of women’s legal rights and equal access to health care. According to UNAIDS, men and women living with AIDS show no difference in survival rates when they are treated equally.
But in many countries, prevailing gender attitudes mean that male treatment needs often come first. Families are also hesitant to send women to clinics for fear of disrupting the “care economy” that these women provide through their household duties—duties that often include tending to other family members with AIDS.
Many observers also argue that the oft-touted ABC (Abstain, Be Faithful, and use Condoms) approach to preventing HIV infection is of limited utility when addressing women and girls.
Indeed, only 4.9 percent of married women of reproductive age use condoms—ranging from 1.3 percent in Africa to 10.5 percent in Eastern Europe.
“Abstinence is meaningless to women who are coerced into sex,” says Thoraya Obaid, executive director of the United Nations Population Fund (UNFPA). “Faithfulness offers little protection to wives whose husbands have several partners or were infected before marriage. And condoms require the cooperation of men… The epidemic won’t be reversed until governments provide the resources needed to ensure women’s right to sexual and reproductive health.”
Programs Must Reorient to Address Women and Girls
A 2004 joint report by UNAIDS, UNFPA, and UNIFEM—Women and HIV/AIDS: Confronting the Crisis—broadly outlines how donors and nations can more effectively help women and children with HIV.2 Some of its specific recommendations include:
- Making AIDS money work for women by ensuring adequately funded and staffed programs that fully respond to women and girls’ needs and circumstances in every way—addressing prevention, treatment, community-based care, education, gender-based violence, and human rights.
- Ensuring that adolescent girls and women have the knowledge and means to prevent HIV infection through population-wide, gender-sensitive communication, education, and advocacy campaigns; increased access to credit and economic opportunity; and increased access to condoms and skills in negotiating their use as well as the provision of resources and programs for men and women who are injecting drug users.
- Ensuring equal and universal access to treatment through the WHO/UNAIDS “3 by 5” campaign (whose goal is to give 3 million HIV-infected people access to antiretroviral treatment by 2005)3 as well as through expanded and strengthened health services and campaigns that address stigma, discrimination, and gender-based violence against women with AIDS.
- Promoting girls’ primary and secondary education and women’s literacy by eliminating school fees, promoting girls’ leadership and self-esteem, and expanding literacy classes.
- Recognizing and supporting home-based caregivers of AIDS patients and orphans through programs that train, protect, relieve, and support them—financially and psychosocially.
- Promoting zero tolerance of all forms of violence against women and girls through expanded counseling, health services for all victims of sexual violence, and community and media campaigns that involve men.
- Promoting and protecting the human rights of women and girls through free or affordable legal services, protection and promotion of women’s property and inheritance rights, and reform of laws that are in violation of the United Nations Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW).
“Strategies to address gender inequalities are urgently needed if we want a realistic chance at turning back the epidemic,” says Dr. Peter Piot, executive director of UNAIDS. “Concrete action is necessary to prevent violence against women, and ensure access to property and inheritance rights, basic education, and employment opportunities for women and girls.”
And PRB’s Ashford adds that many of these recommendations are not new. “Public health experts have argued for years that empowering women can have benefits for the whole society—far beyond protecting the health of individual women,” she says. “The challenge is to move from rhetoric to action.”
Robert Lalasz is a senior editor at PRB.
- For December 2004 figures on the pandemic, see UNAIDS, “AIDS Epidemic Update 2004” (Geneva: UNAIDS, 2004), accessed online at www.unaids.org/wad2004/report.html on Nov. 29, 2004.
- UNAIDS, UNFPA, and UNIFEM, Women and HIV/AIDS: Confronting the Crisis (Geneva and New York: UNAIDS, UNFPA, and UNIFEM, 2004), accessed online at www.unfpa.org/hiv/women/report/ on Nov. 29, 2004.
- For more on the initiative, see www.who.int/3by5/en/.