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Women and HIV Risk

The number of women and girls living with HIV is increasing in every region of the world. In Eastern Europe, Asia, and Latin America, over the past two years the rate of women and girls living with HIV has risen particularly rapidly . In sub-Saharan Africa, women and girls already make up almost 60% of adults living with HIV. The disproportionate impact of HIV and STIs on women is due both to biological and socioeconomic factors.

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In much of the world, AIDS has become a woman's epidemic. Women living with HIV now outnumber men in sub-Saharan Africa, and in many parts of the region, teenage girls are three times more likely than their male peers to become infected ( 2006 Report on the Global AIDS Epidemic. UNAIDS. World Health Organization. Geneva, Switzerland. June 2006.). Other sexually transmitted infections (STIs) contribute to the spread of HIV and represent a tremendous disease burden for women in their own right.

The disproportionate impact of HIV and STIs on women is due both to biological and socioeconomic factors.

Biological factors contributing to women's risk of HIV:

  • Women are more likely than men to contract HIV at a single exposure.
  • The cervix is a site of particular vulnerability.
  • Younger women are at even greater risk, since the cervix is physiologically less mature and therefore more vulnerable to infection.
  • Women with asymptomatic STIs may not seek treatment, which can result in serious long-term consequences such as infertility, pelvic inflammatory disease, ectopic pregnancy, infant mortality, and cervical cancer.

Social and economic inequities also contribute to women's risk:

  • The vast majority of women with HIV were infected during heterosexual sex --many by their husbands or boyfriends.
  • Women may influence but do not control the sexual and/or drug-using behaviour of their male partners.
  • Violence, coercion, and economic dependency in many women's relationships make it difficult to "negotiate" condom use or to leave a partnership that puts them at risk.
  • In many societies, women and girls are discouraged from learning about their bodies and about sex in general.
  • Often, women are socialised to leave sexual decision-making to men.
  • Gender-based social norms often encourage men to seek multiple partners, while women bear the burden of shame and stigma associated with disease.
  • Growing economic inequality and eroding social support have driven many women into commercial sex work to support their families.

And yet, 25 years into the AIDS pandemic, the favoured strategies for primary prevention of HIV continue to focus on encouraging abstinence, mutual monogamy, and male condom use. These messages have little relevance for the majority of women at risk; even less for those in resource poor settings. In spite of our best efforts, there are still millions of women who are simply unable to implement any of the current prevention strategies. As a result, infections among women and young girls are rising, and in some cases surpassing rates for men.

We must expand the range of strategies and tools available to women for protecting themselves. Education, economic and social empowerment, and the transformation of gender roles and norms that limit women's autonomy and decision-making are all critical. But these strategies are long-term. In the meantime, we can add existing and emerging prevention methods for women to our current strategies, giving women the means to protect themselves, their children, and their partners from this devastating disease.