Over 75% of HIV infections are transmitted through sexual relations between women and men.
In countries where young people account for a high proportion of all new infections, HIV-positive young women may outnumber their seropositive male peers by as much as six times (UNAIDS).
Therefore, addressing gender roles and power dynamics between women and men, and how they impact on sexual relations and decision-making, is critical for effective prevention to ultimately halt the HIV/AIDS pandemic.
Sociocultural norms, beliefs and practices that apply to and affect women and men differently have a direct effect on vulnerability to HIV infection.
For example, girls and women are often raised to be submissive and unaware of sexual matters until marriage. They often fear reprisals from their partners and others, or being identified as promiscuous, immodest or unfaithful, if they raise issues related to sexuality and sexual health including STI/HIV prevention.
Also, while many women suffering from STIs are asymptomatic, when they do experience subsequent STI-related problems they accept it as normal.
Conversely, boys and men are often expected to be sexually knowledgeable and experienced, to be virile and healthy, and may express sexual prowess to prove their manliness through casual and multiple partners (including sex workers), infidelity, and dominance in sexual relations. This deters many men from asking questions or seeking STI/HIV/AIDS services.
Girls and women are disproportionately vulnerable to HIV. Their physiological susceptibility – at least 2 to 4 times greater than men’s - is compounded by social, cultural, economic and legal forms of discrimination.
Poverty, low social status and lack of equal economic rights and opportunities makes girls and women susceptible to sexual trafficking and exploitation, to ‘sugar daddies’ and exchanging sexual favors for necessities and goods.
Girls and women also have lower levels of education and literacy - one of the strongest determinants of sexual and reproductive health status overall.
Early marriage and vulnerability associated with their age and norms may promote respect of men’s authority in sexual matters and contraceptive use, and dictate sex as a wife’s duty, regardless of risks to herself. Thus, marriage can be a major risk factor for women who are powerless to negotiate condom use or their husbands’ extramarital behaviour. Studies indicate that in some regions, a high proportion of HIV-positive married women are most likely infected by their husbands, their only sexual partner 2.
Social values surrounding fertility and motherhood often prevent women from using condoms or HIV-positive mothers from using infant replacement formula.
Sexual violence and harmful traditional practices also expose women to HIV.
In high-prevalence countries, girls and women are bearing a disproportionate burden of care for the ill and orphaned, while struggling to maintain household income, productivity and food security, under conditions of increasing impoverishment.
To reverse the trend, tailored responses that foster gender equality are critical for success: girls and women must be empowered, and boys and men enabled to become supportive, responsible partners.
In the early stages of the HIV/ AIDS pandemic, infection was predominantly among men. This situation has dramatically changed over time. As of the end of 2001, 47% of all new infections were in women who also constitute 17.6 million of the estimated 40 million people living with HIV/AIDS. More alarmingly, young women are becoming infected at younger ages than men, and are estimated to comprise 67% of all newly infected 15-24 year olds in developing countries3.
This trend supports the strategic need to address the gender dimensions of the epidemic – especially in relation to the greater vulnerability of women and girls.