Globally, women now constitute 48% of the HIV positive population. 76% of these HIV positive women live in Sub-Saharan Africa, where women account for 59% of adults living with HIV. The rising rates of HIV infection in women and young girls is directly related to their inferior social, economic, and legal status in this region of the world. Women’s autonomy relating to sexual decisions is rarely respected. Men tend to dominate women’s sexuality in Africa’s dramatic context of poverty. While women are account for half of the HIV burden, many responses to the epidemic have failed to address the social, economic, and cultural factors that put women at an increased risk for HIV infection. The ABC program, which emphasizes Abstinence, Be faithful, and Condom use, has been adopted by many African governments but is simply not feasible for women. They are not given the choice to abstain from sex, but are often raped or coerced into having sex as a means of survival. While they may remain faithful to their husbands, they are powerless to ensure that their husbands remain faithful to them. In addition, women are not given sufficient control over sexual situations to ensure that their partners, particularly their husbands, always wear a condom. Such programs fail to address the social factors limiting women and girl’s sexual autonomy and placing them at an increased risk for HIV.
Violence against women, whether in the context of rape or sexual abuse, is a significant factor in the propagation of HIV in women. Women who have been subjected to violence are three times as likely to be infected with HIV as women who have not. Girls in Africa are also pressured into marrying at a young age. Most of these girls are married to older men who are more likely to have had exposure to sexually transmitted diseases and are less likely to use a condom.
Education efforts need to be extended to women and heavy investments should be made in methods that would allow women to control HIV prevention. Female condoms are very effective in blocking the passage of microorganisms, including HIV. However, these condoms cost on average $0.70, making them ten times more expensive than male condoms. In addition, they are not widely available and most women don’t even know about their existence. Microbicides are a very promising new method of HIV prevention that are able to block or disable the virus as soon as it enters the body and before it spreads. Even the first generation microbicides are expected to reduce HIV transmission by 40 to 60%. A 60% effective microbicide is projected to prevent 2.5 million new HIV infections over a period of three years.
Antiretroviral treatment is now available to 1.3 million people, representing a significant increase in just a few years. Still, ARVs are only available to 17% of the people in Sub-Saharan Africa who need them. Data has not shown that there are significant gender discrepancies in access to treatment, but women do encounter more difficulties in adhering to the regimens. Because women are confronted with more intense stigma and marginalization than men when infected with HIV, many chose not to return to clinics for their test results. They are also afraid that their serostatus will be disclosed without their consent, which in many cases leads to women being kicked out of their homes and losing all economic support. One study in Zambia revealed that 66% of women did not disclose their status to their partner for fear of blame, violence, and abandonment. 76% did not adhere to their treatment regimen because they were trying to hide their pills.
To design more effective AIDS programs, it is essential that more women, especially those living with HIV, be included in international AIDS conferences and meetings where programs are designed. An effective program needs to focus on education, economic empowerment, improved access to health services, and better prevention options for married women. Laws need to be developed to protect women’s rights and allow them to have a reliable legal recourse when those rights are violated. Pressure needs to be brought against social and cultural norms that legitimize child marriage and domestic violence. Programs need to be implemented that recognize the specific challenges faced by HIV positive women and improve their access to reproductive health services. Access to testing and treatment should be facilitated and promises of confidentiality respected. Thankfully, there are feasible steps that can be taken to empower women and address the issues that make them vulnerable to HIV infection.