Increasingly, HIV/AIDS is striking women. Today, more than 20 years into the epidemic, women account for nearly half the 33 million people living with HIV worldwide. In sub-Saharan Africa, 76 per cent of the young people (aged 15-24 years) living with HIV are female.
Despite this alarming trend, women know less than men about how HIV is transmitted and how to prevent infection. What little they do know is often rendered useless by the discrimination and violence they face, and their relative powerlessness to refuse sex or negotiate safe sex, especially in the context of marriage.
Reversing the spread of HIV must address the critical role that gender relations plays in sexual and reproductive life, and how it affects HIV prevention. Indeed, the changing face of the epidemic brings into sharp relief the gender and social inequalities that shape people's behaviours and limit their choices.
Many HIV strategies assume an idealized world in which everyone is equal and free to make empowered choices, and can opt to abstain from sex, stay faithful to one's partner or use condoms consistently. In reality, women and girls face a range of HIV-related risk factors and vulnerabilities that men and boys do not-many of which are embedded in the social relations and economic realities of their societies. These factors are not easily dislodged or altered, but until they are, efforts to contain and reverse the AIDS epidemic are unlikely to achieve sustained success.
In many places, male identity is very much linked to sexual performance: men feel pressured to have many sexual conquests to 'prove' their masculinity. Safer sex, which entails a reduction in the number of possible partners, avoiding "one night stands" and greater selectivity in sexual partnership may therefore be felt as a threat to masculinity. Young men, in particular, may feel pressured to take risks to assert their male identity.
Much sexual risk-taking by girls and young women is marked by unequal gender relations, and unequal access to resources, assets, income opportunities and social power. Far more must be done to ensure sustainable livelihoods for women and girls, particularly those living in female-headed households, if they are to be able to protect themselves against HIV infection and deal with its impact. Boosting women's economic opportunities and social power should be seen as part and parcel of potentially successful and sustainable AIDS strategies.
Violence against women is both a cause and consequence of AIDS. Research has confirmed a strong correlation between sexual and other forms of abuse against women and women's chances of contracting HIV. Male (or female) condoms are irrelevant when a woman is being beaten and raped. Moreover, forced vaginal penetration increases the likelihood of HIV transmission. In addition, the fear of violence prevents many women from asking their partners to use condoms, accessing HIV information, and from getting tested and seeking treatment, even when they strongly suspect they have been infected. Many women are in danger of being beaten, abandoned or thrown out of their homes if the HIV-positive status is known. If HIV-prevention activities are to succeed, they need to occur alongside other efforts that address and reduce violence against women and girls.
¹ This section is adapted from the "Women and AIDS" chapter of the AIDS Epidemic Update 2004 (UNAIDS, WHO). http://www.unaids.org/wad2004/EPI_1204_pdf_en/Chapter2_women+aids_en.pdf