In the early days of the epidemic, men vastly outnumbered women among people infected with HIV. In 1997, women made up 41% of all people living with HIV. Today, nearly 50% of women are infected globally – close to 60% in sub-Saharan Africa. Women are more physically susceptible to HIV infection than men -- male-to-female transmission during sex is about twice as likely to occur as female-to-male ones.
Marriage and long-term monogamous relationships do not protect women from HIV. In Cambodia, recent studies found 13% of urban and 10% of rural men reported having sex with both a sex worker and their wife or steady girlfriend. In Thailand, a 1999 study found that 75% of HIV-infected women were likely to be infected by their husbands. In some settings, it appears marriage actually increases women’s HIV risk. In some African countries, adolescent, married 15-19-year-old young women have higher HIV infection levels than unmarried sexually active females of the same age.
Prevention needs of girls and women
Despite women’s higher biological vulnerability, it is the legal, social and economic disadvantages faced by women and girls in most societies that greatly increase their HIV vulnerability. Therefore, gender-sensitive approaches are the key when designing prevention programmes. The ‘ABC’ strategy to prevent sexual transmission of HIV (Abstinence, being safer (by being faithful or reducing the number of partners), and correct and consistent condom use) is of limited value to women and girls because of their low social and economic status.
Many women are denied the knowledge and tools to protect themselves from HIV. Surveys in 38 countries found extremely low knowledge about HIV among 15-24-yearold women.
Treatment and care
Women’s immune system may respond differently to HIV. On top of the many HIVrelated diseases and ailments suffered by both sexes, HIV-positive women have a higher incidence of cervical cancer than women without the virus. Also, when women are on antiretroviral treatment, they may experience stronger side effects.
Despite these facts, when treated equally, the differences between men and women’s survival rates disappear. However, in most parts of the world, the social and economic power imbalances between men and women raise fears that women are being denied equitable and timely access to treatment options.
In many countries, prevailing gender attitudes mean women and girls are the last priority for health care. Husbands and elders often decide whether to spend family resources on
health care, or whether a woman can take time away from her household duties to visit a health centre. When male and female family members are HIV-infected, and resources are limited, addressing male treatment needs often come first.
To reflect the global distribution of HIV by sex, which is nearly 50-50, women should constitute at least half of the millions of people in developing countries expected to gain
access to antiretrovirals in coming years. Communities need to overcome barriers to women being tested for HIV, including the risk of violence they may face if they are found HIV-positive.
The care economy
When the male of a household becomes ill, wives provide care and take on additional duties to support the family, but when women fall sick, older or younger women step in to care for them and take responsibility for AIDS-affected children. The value of the time, energy and resources required to cook, clean, shop, wash or care for the family’s young, sick and elderly is called the ‘care economy’, which is vast and essential to economic life.
In developing countries, having ‘AIDS in the family’ poses strains on women in agricultural communities. In addition to their household work, many rural women play a significant role in the economic activities that put food on their families’ table and caring for the sick disrupts this work.
It is crucial to recognize and support the care economy with adequate resources and enabling policies. Ways to ease women’s disproportionate care burden in AIDS-affected households are available, many similar to those used for more generalized gender inequalities.
Possible options for resolving care economy problems include: cooperative day care and nutrition centres that assist women with their workload; nutritional and educational assistance for orphans; home care for people living with or affected by HIV, including orphans; labour-sharing and income-generating projects; and improving rural households’ access to labour, land, capital and management skills.
The Global Coalition on Women and AIDS, spearheaded by UNAIDS, seeks to improve the daily lives of women and girls in developing countries by reducing their vulnerability to HIV.
For more information, please contact Dominique De Santis, UNAIDS, Geneva, tel. +41 22 791 4509 or mobile (+41 79) 254 6803, or Abby Spring, UNAIDS, Geneva, tel. +41 22 791 4577 or mobile (+41 79) 308 9861. For more information about UNAIDS, visit www.unaids.org.