Women’s Health: HIV/AIDS - Where do we stand?
By Blandina Steinhauslin, AILO Florence
HIV continues to be a major global public health issue, having claimed more than 35 million lives so far. In 2017, 940,000 people died from HIV-related causes globally. There were approximately 36.9 million people living with HIV at the end of 2017, with 1.8 million people becoming newly infected. People who are at increased risk of HIV infection include: men who have sex with men, people who inject drugs, people in prison and other closed settings, sex workers and their clients, and transgender people.
What about women?
Statistics
- In 2017, there were an estimated 18.2 million women living with HIV (aged 15 and older), constituting 52% of all adults living with HIV.
- HIV/AIDS is the leading cause of death among women of reproductive age (aged 15–49).
- In 2017, of the total estimated 1.6 million new HIV infections in adults globally, almost 48% were among women.
- In 2017, new infections among young women (aged 15–24 years) were 42% higher than they were among men in the same age group.
- In 2016, 6,548 teenagers and young women between the ages of 15 and 24 were infected with HIV every week, the majority in sub-Saharan Africa.
- In some regions, women who are exposed to intimate partner violence are 50% more likely to acquire HIV than women who are not exposed.
Why women and girls are more at risk
Structural factors:
- Harmful social and gender norms perpetuate the belief that girls and women are lesser than or even the possessions of men. These norms leave them disempowered, unable to influence or control decisions around sex and vulnerable to gender-based violence and HIV.
- Limited access to primary and secondary school leaves girls and young women without the basic literacy and numeracy skills they need to participate fully in their local economy and community and denies them access to higher education. Lack of education contributes to higher HIV vulnerability.
- Parental and spousal consent, stigma and health worker bias deters or prevents girls and young women from accessing HIV and health services. Without access to condoms, contraception, etc. girls and young women are unable to protect themselves from HIV and unintended pregnancies.
- Children who are or have been subject to sexual abuse are not only extremely vulnerable to HIV transmission, but often suffer psychological and developmental consequences that lead to risky behaviors, including early sexual debut, more sexual partners and substance abuse. Orphans are particularly vulnerable.
- Early marriage denies young girls and adolescent women the opportunity to continue in school, to establish economic independence and places them at risk of violence and exposure to HIV. Child brides are most in danger.
- Gender-based violence and intimate partner violence is associated with increased risk of HIV infection. Violence, or even the fear of violence, prevents girls and young women from being able to negotiate sex and condom use.
Behavioral factors:
- Age-disparate sex between older men, who are more likely to be living with HIV, and adolescent girls is a key factor to increasing infection.
- Early sexual debut, particularly before the age of 15, can place girls at high risk. Often the sexual partners of adolescent girls are significantly older and more likely to be living with HIV.
- Transactional sex—the exchange of sex for food, items or other non-monetary benefit—places vulnerable girls and women at even greater risk of being exposed to HIV.
- Sex workers and sexually exploited girls and young women are at high risk of acquiring HIV. Multiple and concurrent partners, inability to negotiate condom use and the potential for intimate partner violence are all contributing factors.
- Gaps in knowledge and limited perception of risk mean adolescent girls and young women engaged in age disparate, risky and perhaps violent sexual relationships are unaware of their potential for exposure to HIV or of the means to protect themselves through condom use.
Biological factors:
- Women are more vulnerable to HIV than men. This is due to the ability of HIV to pass through the cells of the vaginal lining, the larger surface area of the vagina compared to the penis, increased mucosal HIV exposure time, the potential for micro-abrasions and tears in the vagina and cervix, higher concentration of HIV in semen than in vaginal fluids, high concentration of HIV co-receptors in cervical cells and the high levels of activation of the immune cells in the female genital tract.
- Adolescent girls, in addition to being at increased risk for all the same reasons as women, are at even more risk because the mucosa of the immature cervix is very susceptible to HIV. Their physical immaturity and smaller size may also make adolescent girls more vulnerable to micro-abrasions and tears.
- Harmful practices, including the introduction of substances to dry the vagina or intravaginal washing with soap, further exacerbates vulnerability of girls and women. Anal sex and “virginity testing” can increase transmission.
- Poor viral load suppression in men due to lower rates of antiretroviral therapy means that they are more likely to pass on the virus to their partners.
- Other sexually transmitted infections make adolescent girls and women even more susceptible to HIV. For example, women who are infected with the HPV virus are more vulnerable to HIV, and women living with HIV progress to cervical cancer much more quickly than those not infected by HIV.
How to protect women and girls
Education:
When girls have access to secondary education, including comprehensive sexuality education, they stay in school, are less likely to marry early and the risk of unintended pregnancies and HIV acquisition decreases. They have the opportunity to explore their own values and attitudes and to build decision-making, communication and risk reduction skills about many aspects of sexuality.
Empowerment:
When women are elected as political representatives, they champion issues of gender equality, elimination of gender-based violence, health and education. When women and girls are economically empowered, such as through cash transfers, transactional sex is reduced. When programs to reduce intimate partner violence in communities are taken to scale, HIV incidence is reduced. When women have the final say over their health and childbearing, it has a direct impact, reducing the spread of HIV as well as mother-to-child transmission. When laws and policies that act as barriers to the full realization of the sexual and reproductive health and rights of women and girls are removed, gender equality can start becoming a reality.
Integrated health services:
When the full range of sexual and reproductive health services are integrated, it improves access to services for HIV-related illnesses, such as tuberculosis diagnosis and treatment and cervical cancer screening, prevention and treatment. When comprehensive post-rape care services are available, accessible and promoted, they can prevent women and girls from acquiring HIV and other sexually transmitted infections, unintended pregnancies and psychological trauma. When sexual and reproductive health services are integrated, it prevents women from dying of HIV-related cervical cancer or TB. When female-initiated HIV prevention methods are available and promoted, women and girls feel empowered and their sexual and reproductive health and rights are more easily respected and realized.
Economics:
When women participate in the economy, poverty decreases, and GDP grows. An additional year of primary education for girls results in a 15% increase in future earnings, and that figure increases with the level of education. Globally, only 55% of women participate in the labor force, compared to 80 % of men.
Bibliography:
UNAIDS: Global HIV & AIDS statistics — 2018 fact sheet
Avert: Global information and education on HIV and AIDS
amfAR: Statistics: Women and HIV/AIDS
When Women Lead Change Happens: Women advancing the end of AIDS