The latest figures on HIV infections, as reported this week by the Joint United Nations Programme on HIV/AIDS (UNAIDS), revealed an impressive 33 percent reduction in new infections among adults and children since 2001. To continue down the road to success, future efforts must address the gender inequities that contribute to the disproportionate impact of HIV and AIDS on women and girls.
More than half of the 35 million people living with HIV are women. In sub-Saharan Africa, almost 60 percent of people living with HIV are women. Young women between ages 15 to 24 are at highest risk of and most vulnerable to HIV infection. Closer to home, black women in the United States remain at high risk for HIV infection, and HIV-related illness is now one of the leading causes of death among black women between ages 25 to 34.
Gender inequity is a key driver of the epidemic, making women more vulnerable to HIV in many ways.
Financial dependence. When women are the primary and unpaid caregivers of their families, they are financially dependent on men and often must accept situations and behavior that put them at risk for HIV. In much of the world educating girls remains a low priority, which adds to financial dependence.
Violence against women and girls. Women and girls are routinely victims of sexual coercion and violence. Some girls are forced into marriage at a young age, often to men who are much older. Even older women fear or experience violence and lack the ability to abstain from sex or negotiate safe sexual practices.
Lack of access to services. Many women do not have access to preventive health services or control of their reproductive health and rights. Unplanned pregnancies increase a woman's burden of care and support for the family. Once infected with HIV, women face even greater stigma, isolation and persecution, which affect access to treatment. Women may transmit the virus to their infants, continuing the spread of HIV and perpetuating a vicious cycle.
What can be done to reverse this situation? The short answer is that HIV prevention efforts need to target women and girls and specifically address the inequities they face. It is critical that interventions not only meet women's needs, but also receive adequate funding. Even today, many young women are not aware of their risks for HIV infection, much less the ways risks can be reduced. Therefore effective prevention programs must be multi-pronged and should include education, safe sex negotiation, life-skills building and job training for women and young girls.
Beyond equipping women and girls with affordable products, such as female condoms, we need more scientific breakthroughs in women-controlled prevention methods, such as topical microbicide gels and rings. New oral or injectable prophylactic agents that prevent HIV infection are in the works and could prove promising.
Educating girls is critical to empowering them and reducing gender inequities. Educated women are more likely to negotiate safe sex and prevent pregnancy. They are also more likely to be financially independent. We must educate communities, and especially young men, about gender sensitivity and the negative effects of violence against women and girls. Women who experience sexual violence should be counseled so they can avert long-term consequences. Stereotypical notions of masculinity and femininity and harmful myths that lead to destructive behaviors affecting women's safety and health must be dispelled. We must encourage and mentor girls and women to be leaders in their communities.
If we are going to see any real and lasting progress in combatting HIV and AIDS, we must make addressing gender inequity a top priority.
Ward Cates, Jr., M.D., M.P.H., is President Emeritus with FHI 360
Nirupama Sista, M.S. PhD is the Director of the Leadership and Operations Center for the HIV Prevention Trials Network at FHI 360