Why are women at risk?
Greater chances of infection
A HIV+ mother in Tanzania
Most HIV+ women have been infected with HIV through heterosexual sex. Physically, women are more susceptible than men to HIV infection through heterosexual sex, and this fact alone means that special attention must be paid to protecting them if they are not to be disproportionately affected by the epidemic.
Information drawn from different studies shows that during heterosexual sex, women are about twice as likely to become infected with HIV from men as men are from women. This is a major reason why women have caught up so rapidly with men when it comes to figures for the numbers of HIV+ people.
It seems very possible that, unless something is done to prevent it happening, women will soon come to overtake men in these statistics.
This may already be happening - data from the CDC in America shows that among teens, girls accounted for more than half of new HIV infections reported in 2001. Globally, women make up 60% of the 15 - 24 year olds who are HIV+.
Many millions of children around the world have already been orphaned by AIDS, and become themselves easy prey to the virus.
Why is it difficult for women to protect themselves?
Inequalities
Feminism may have been discussed in the West for several decades, but in many parts of the world its impact has not been felt at all. There still exist major inequalities between women and men in all aspects of living - from employment opportunities, availability of education, and choices in relationships. Many countries still have patriarchal rules governing women's place in sexual relationships. In some societies, women are unable to choose their sexual partners or who they marry, these choices being made for them by men in their families. In situations where the man has all the power, a woman is unlikely to be able to insist on the use of condoms, or to take measures to protect herself from HIV.
In many countries, women still have very narrow career options available to them, and often these are limited to the prescribed roles of teachers, nurses or carers. These roles, however, are crucial ones in all societies. A country which loses a large number of nurses will have great difficulty in keeping its medical services running. A country which loses many teachers will find it hard to educate the young. And both healthcare and education are absolutely vital anywhere where there is a severe AIDS epidemic.
Women are often required to work harder than men, even if they are infected with HIV. In many places girls may be taken out of school to care for family members who are infected, and a woman who is seen as the main carer for the family will also be expected to go out to work.
Women in the family
Even marriage isn't a protection for a woman in many countries. Women's infidelity is not only frowned upon but actually criminalized in certain places, whilst men's extramarital sexual relationships and use of female sex workers are seen as being almost acceptable, or to be expected. Much of the HIV prevention work in developing countries now focuses on sexual abstinence until marriage, but remaining faithful to her husband won't help a woman to stay safe from HIV if he is the one who infects her. In fact, this is one of the most common ways in which women are infected in many places.
'When I got pregnant last year, I found out that I was HIV+. When I told him about it, he just knew I was messing around with someone else. I knew I was loyal to him' DQ,33 years old
Additionally, the multiple roles women fill in society are very important ones. Women as bearers of and carers for children are crucial to social and family structure. In many countries women play a vital place in the workforce in addition to caring for their families. The loss of a mother can be devastating to a family, often depriving them of a key breadwinner and depriving children of a vital carer and teacher.
Prostitution
Another way in which women's lack of economic power enables their sexual exploitation is via prostitution. Poverty is the most common cause of prostitution, but whatever its cause, female sex workers are in a very high-risk group. Women who desperately need money to care for their children, many of them widowed by AIDS, are not in a position to insist that their customers wear condoms. This means that they are not only at risk of becoming infected with HIV, but that if they are already HIV+, they can pass the virus on to their customers. Often, these customers take AIDS home to their families.
Female sex workers are, in many countries, both frowned on socially and criminalised. It is very difficult for these women to access the healthcare services they need in order to stay healthy if they risk arrest or punishment when their profession is known. This stigmatization increases the vulnerability of a group that is already at considerable risk.
Drugs
Drug use is a social problem afflicting women just as much as men. The typical junkie is imagined to be a man, but in fact many injecting drug users are women. Anyone who becomes addicted to injected drugs is liable to sexual exploitation and vulnerable to infection from injecting equipment. Many female partners of male needle users are also infected with HIV, transmitted to him by dirty needles.
Violence against women
In many countries - especially less socially stable regions - there is a greater likelihood of women's first sex being forced or in some way coerced. Rape can be a devastating experience for any woman, and can also carry the risk of HIV infection. Sexual violence against women is more common in some parts of the world than in others. South Africa, for example, has one of the highest rates of sexual violence, coupled with a huge HIV prevalence. In some parts of Africa there is a belief that having sex with a virgin can 'cure' HIV infection - leading to the rape of young women and children by HIV+ men.
I'm a 31 year old heterosexual female that contracted AIDS as the result of rape. I repressed the events surrounding the attack until I had undergone hypnotherapy . . . It had been nearly two years since the rape and I had been HIV positive without knowing it. Enya
AIDS is also increasingly being used as a weapon in war and a tool of 'ethnic cleansing'. In parts of the world where there is a very poor security situation - Uganda, for example, and the Sudan, and Zimbabwe - there are growing numbers of reports of women being raped with the intention of deliberately infecting them with HIV. HIV infection is a weapon which can still have devastating effects long after a war is over.
Women and children
A young HIV+ girl in Latin America
Another way in which the HIV/AIDS epidemic spreads is through childbirth. UNAIDS/WHO data says that at the end of 2004 there were an estimated 2.2 million children (under 15 years) who were living with HIV, many of whom were infected with HIV at birth. A large number of these children will not live to adulthood. There are drugs which can reduce the chances of a child becoming infected with HIV at birth from about 40% to around 2%, but in many parts of the world these drugs are unavailable. A mother who is HIV+ can pass on the infection to her child through her breast milk, but again, suitable substitutes for breast milk, and the education to understand their importance and how to use them are not being supplied to women in many countries.
Increasingly, governments are beginning to make an effort to supply the drugs needed to prevent mother-to-child transmission from occurring, which is a positive step, but whilst it is very important that the child's life is saved, the mother must not be forgotten. UNAIDS estimates that there are 15 million AIDS orphans in the world, and a great deal of money, planning and energy is being put into finding the best ways to care for them. The best way to ensure the well being of children affected by HIV/AIDS is simply to ensure the well being of their families, something that unfortunately sometimes doesn't receive the prioritisation it deserves.
The focus on preventing HIV transmission to babies is an important and necessary one, but it can lead to a narrowed perspective. It's equally important to help women who don't have children as well as those who do. Often, especially in resource-poor countries, many women live in areas where there is little or no medical infrastructure, and where they come into contact with HIV testing and care services only through antenatal care. This is inadequate, as it excludes women who are not pregnant. There is a clear need for HIV testing to be more inclusive.
Women in Africa
Just under two-thirds of all people infected with HIV are living in Sub-Saharan Africa, 57% of whom are women. Around 76% of young people here who are infected with HIV are female.
In South Africa, up to 20 per cent of HIV positive women were infected within a year of losing their virginity. This suggests that women now represent the major part of the growing epidemic. In places where heterosexual sex is the most common form of transmission, women will soon come to overtake men unless something is done to prevent this.
Women around the world
A young HIV+ woman prays in a hospice
Even in the United States, there is still much more to be done to protect women. There has been criticism that sex education in schools in the USA is based on the idea that sexual fidelity until marriage is the best way to prevent STD infection. This won't protect a women if she is infected by the man she marries, and it leaves her vulnerable and ignorant if she changes her mind, and has sex before marriage. The US government is still resistant to the distribution of free condoms, which are absolutely vital if women are to be protected from HIV/AIDS. 80% of the women infected with HIV in the US are African-American or Hispanic, ethnic groups which are also unfairly burdened with poverty and poor education.
HIV+ women
HIV+ women suffer from the same conditions associated with AIDS as men do, but they also experience separate conditions, such as severe pelvic inflammatory disease, which increases the risk of cervical cancer. Women also react differently to antiretroviral therapy, and may sometimes need different treatment from men. There is no one treatment method that will perfectly suit the needs of both men and women.
What needs to change?
Gender roles around the world pin women into positions where they lack the power to protect themselves from HIV infection and where, if they are infected, they lack opportunities to receive treatment. Feminism still has a long way to go before it can even equalise the risk women are at from HIV compared to men. Negative assumptions about women's roles and discrimination against them must be challenged and women must be empowered to help themselves and to protect themselves.
Women who have been raped need to have access to post-exposure prophylaxis - medical techniques which can reduce the chances of HIV infection if the victim of a rape is treated quickly. In many (mainly African) countries with high levels of sexual violence against women and high HIV prevalence, this treatment is not freely available to women.
Women need to have a way to protect themselves from HIV. Too many women do not have the power in heterosexual relationships to insist on condom use, and are vulnerable to infection from their partners. There are plans underway to develop a microbicide, a gel or cream which can be applied vaginally, without a partner even knowing, and which would kill HIV, preventing infection. Tests have been being done for a number of years, but medical experts say that even if all goes well, such a gel is still at least 5 years away.
There are many issues surrounding the development of microbicides . It will be at least five years before any such product becomes available for use due to the duration of the safety-testing that needs to be done first. If such a product can be shown to be both safe and functional, it will then have to be made palatable to consumers from different countries and cultures. Firstly, there is the issue of pregnancy. Women in developing countries may want a microbicide that prevents HIV infection but which allows pregnancy to occur, whilst other women may want to be protected against both HIV infection and pregnancy. Given that a number of faith-based organisations espouse anti-contraception views, it seems likely that a microbicide which does not prevent pregnancy will be more easily accepted.
Protecting women from HIV is not solely women's responsibility. Most HIV+ women were infected by unprotected sex with an infected man. Preventing infection is the responsibility of both partners, and men must play an equal role in this. If no HIV+ men had unprotected heterosexual sex, the number of women newly infected with HIV would plummet.
Violence against women, discrimination, gender-based inequalities, prostitution - these are all social issues which undeniably need to be changed, but which might take decades to alter. Women who have HIV need to be treated immediately, and women who don't have the virus need to be able to protect themselves. If, in the short term, it is impossible to empower women to be able to insist on condom use, then efforts must be made to find an alternative solution.
Many women may not think they are at risk for HIV infection. There is still, in some places, a myth that HIV infection is something that happens to other people - to men, to injecting drug users, to people from other ethnic groups. This falsehood needs to be cleared up, and countries around the world need to empower women to be able to protect themselves.
Steve Berry
Last updated August 15, 2005
