HIV hits women hardest

Posted: 28 November 2002

For the first time in the 20-year history of the AIDS epidemic, more women than men have been infected with HIV, according to the AIDS Epidemic Update 2002, produced by UNAIDS. Globally, women now account for just over 50 per cent of those infected with HIV.

The report, released in November 2002, paints a dismal picture of the continuing spread of the disease. "It's once more a sad story: 42 millionpeople living with HIV today, five million new infections in 2002 and 3.1 million (who have) died from AIDS this year," said Dr. Peter Piot,executive director of UNAIDS.

The virus is spreading most rapidly in eastern Europe, where nearly every country is experiencing a major outbreak. It has also marched swiftly across central Asia and into China, where it was almost non-existent a fewyears ago.

But there are signs of hope. The AIDS Epidemic Update, an annual report by the World Health Organization and UNAIDS, says prevention programmes appear to be working in the few areas where they have been set up.

"There are a number of countries where we have strong empirical evidence declining, and in each case they are declining among young people," Piot said.

He cited South Africa, where HIV infections among pregnant teenage girls fell 25 per cent between 1998 and 2001. In Uganda, the number of new HIV infections has been dropping every year for the last 10 years, he said.

The epidemic has worsened an already dire food crisis in southern Africa. With more than 14 million people now at risk of starvation in Lesotho, Malawi, Mozambique, Swaziland, Zambia, and Zimbabwe, HIV/AIDS was now reaching beyond the loss of life and health care costs traditionally associated with the disease. In Botswana, Lesotho, Swaziland and Zimbabwe,national adult HIV prevalence rates have risen higher than thought possible and now exceed 30 per cent.

"We can prevent 29 million new HIV infections this decade if we implement a full prevention package globally by 2005. Over the past two years the international community has come to recognise what is needed, in terms of resources and political leadership, to combat the pandemic," UNAIDS Executive Director, Dr Peter Piot said in a statement.

"But we cannot say that in either category we are anywhere near where we need to be to have a significant impact on the epidemic," he added.

Why women are vulnerable

In a separate report from the Worldwatch Institute, on the Feminization of Aids, Radhika Sarin said that more than 18 million women are living with HIV/AIDS. In 1997, women accounted for 41 per cent of all adult cases. That proportion had risen to nearly 50 per cent by 2001 and continues to grow. Half of all new HIV infections occur among 15 to 24-year-olds, and young women are especially vulnerable.

In Sub-Saharan Africa, women account for 58 per cent of adult HIV/AIDS cases, and infection rates among young women are at least twice those among young men. In some parts of Kenya and Zambia, one in four teenage girls is infected compared with one in 25 teenage boys.

Of the 2.3 percent of the population infected in the Caribbean (the world's second most-affected region), women account for 52 per cent of adult cases and 55 per cent of infected 15 to 24-year-olds. On some Caribbean islands, the infection rate among girls aged 15 to 19 is five times greater than among same-aged boys as a result of sex between young women and older men.

Biological, economic, and social factors all contribute to women's vulnerability. Women have a large surface area of reproductive tissue that is exposed to their partner's secretions during intercourse, and semen infected with HIV typically contains a higher concentration of virus than a woman's sexual secretions. Young women especially are at greater risk because their reproductive organs are immature and more likely to tear during intercourse. Women also face a high risk of acquiring other sexually transmitted infections, which multiply ten-fold the risk of contracting HIV when left untreated.

The economic dependency of women on their sexual partners and husbands often means they have little bargaining power when it comes to negotiating condom use. Many live in fear of being abandoned or beaten if they resist their husbands' sexual demands. In times of extreme hardship, women may rely on "sugar daddies" to support them in exchange for sex; others turn to prostitution.

The stigma of infection is also a barrier to seeking care because gender-based social norms and sexual customs prevent women from learning about reproductive health. Often, sexual coercion and gender inequities are tolerated, and double standards make it acceptable for men to have multiple sexual partners.

More than 13 million children under the age of 15 are "AIDS orphans," having lost a mother or both parents to the disease. These orphans face economic and social hardships, malnutrition, and illness, and are usually taken out of school. While grandparents and other relatives may take them in, many are often left to fend for themselves.

Where women participate in agricultural production, food security at the household and community level is being seriously threatened by the spread of AIDS. Communal agricultural output in Zimbabwe, for example, has been cut in half over the past five years, largely due to AIDS.

Female condom

Currently, the female condom is the only safe and effective woman-controlled HIV prevention option available. It is now nominally available in over 75 countries, but unlike other reproductive health commodities there has been relatively little public sector investment in this method by governments or international donor agencies, making it costly and relatively inaccessible. A microbicide applied in the vagina could prevent infection and still allow couples to have children, but no such product currently exists. The need is compelling and efforts are under way to develop one.

Ultimately, the real key lies in improving the status of women through education, economic empowerment, open communication, and the elimination of violence and sexual coercion. But the impact of AIDS is making it increasingly difficult to implement even the most basic of strategies to halt its spread, such as providing education.

Already, affected countries are losing growing numbers of teachers to AIDS. In the Central African Republic, 85 per cent of teachers who died between 1996 and 1998 were HIV-positive, dying an average of 10 years before they were due to retire. Without a swift and concerted response to the epidemic, the burden of disease is likely to increase.

Radhika Sarin is a Staff Researcher at the Worldwatch Institute and author of of Worldwatch Paper 161: Correcting Gender Myopia (September 2002.

Sources: Associated Press, BBC, UN News Centre, IPPF and Worldwatch Institute.RELATED LINKS: AIDS Epidemic Update 2002AIDS Passes 20-Year Mark, Vital Signs 2002