To reverse the global spread of HIV/AIDS, we must break the chains of poverty and gender inequality that help the disease to spread. All over the world, greater efforts are required to address the concrete needs of women and girls and to increase the roles and responsibilities of boys and men. It is critical at this point in the global pandemic that efforts focus simultaneously on individual behaviour change and on wider social, cultural and economic change. Realistic strategies must be found that address the triple challenge of poverty, gender inequality and HIV/AIDS.

Globally there are now 17 million women and 18.7 million men between the ages of 15 and 49 living with HIV/AIDS (see Map, p. vi-vii). Since 1985, the percentage of women among adults living with HIV/AIDS has risen from 35 per cent to 48 per cent. Of particular concern are the dramatic increases in HIV infection among young women, who now make up over 60 per cent of 15- to 24-year-olds living with HIV/AIDS. Globally, young women are 1.6 times more likely to be living with HIV/AIDS than young men.

Gender and Regional Differences (1)

The overwhelming majority of people with HIV/AIDS—98 per cent of women and 94 per cent of men—live in developing countries (see Map). Of all regions, sub-Saharan Africa is the most devastated. No other region in the world approaches its HIV prevalence rates or displays such a disproportionate impact on women and girls: 77 per cent of all HIV-positive women live in sub-Saharan Africa. However, some regions, such as the Caribbean and parts of Asia, are experiencing epidemics in several countries that are spreading from particular population groups—such as sex workers or injecting drug users—into the general population, with women and girls increasingly affected.

The distinct differences in regional trends in terms of modes of transmission and burden of disease—and the cultural, social and economic environments in which these exist—must be taken into account in helping regions, nations and local communities design effective interventions.

Sub-Saharan Africa
In sub-Saharan Africa, about 23 million adults aged 15 to 49 are infected, with 57 per cent—13.1 million—of them women (see Map). Since 1985, there has been an increasingly disproportionate impact on women in this region (see Chart 2). In 1985, roughly half a million women and half a million men were living with HIV/AIDS in sub-Saharan Africa. Since then, the number of women living with HIV/AIDS relative to men has increased every year, particularly affecting young women aged 15 to 24, who are now more than three times more likely to be infected than young men. HIV is spreading predominantly through heterosexual contact, which has increased the impact on women. This is seen most clearly in Southern Africa, where more than 20 per cent of pregnant women tested were infected with HIV in most countries in the region, with prevalence rates among pregnant women in Botswana and Swaziland of almost 40 per cent. An analysis of data from antenatal clinics in eight countries shows that HIV prevalence may now be levelling off, although the numbers remain very high.

The United Nations Secretary-General’s Task Force on Women, Girls and HIV/AIDS in Southern Africa has identified three key factors that contribute to the greater vulnerability of the sub-region’s women and girls to HIV infection, each of which must be addressed:

The culture of silence surrounding sexuality;
Exploitative transactional and intergenerational sex; and
Violence against women within relationships.
All three factors must also be understood in the context of the poverty and inequalities that define the daily lives of both women and men in the region.

Asia and the Pacific
According to the United Nations, the Asia Pacific region, where more than 7 million people are living with HIV/AIDS (see Map), could become the epicentre of the global AIDS pandemic in the next decade, with China and India––the world’s two most populous nations––facing a potential AIDS catastrophe.

In East Asia 22 per cent of adults living with HIV/AIDS are women, as are 28 per cent of young people aged 15 to 24.

In South and South-East Asia more than a quarter of adults and 40 percent of young people living with HIV/AIDS are women. According to India’s National AIDS Control Organization (NACO), HIV/AIDS is no longer confined to specific groups or urban areas but is steadily spreading into the wider population and rural areas. The number of adults living with HIV/AIDS in India is estimated at nearly 4 million.

In China, where the epidemic is spreading, the gap between the rates of HIV infections among men compared to those of women is narrowing.

Until now the mode of transmission in Asia has been mainly through injecting drug use and sex work. As a result, the prevalence of HIV/AIDS in most countries of the region has been restricted to groups with high-risk behaviour and has not spread to the general population. However this could change quickly. For example, injecting drug use and sex work are so pervasive in some areas of China that the epidemic could rapidly spread outside these groups to the wider population. Three Asian countries—Cambodia, Myanmar and Thailand—are already dealing with serious epidemics. All three have made efforts to prevent the spread of HIV by targeting high-risk groups, and to some degree they have succeeded.

However there is also evidence that HIV transmission between spouses has become a more prominent cause of new infections.

Factors affecting the spread of HIV/AIDS among women and girls in the region are poverty, early marriage, trafficking, sex work, migration, a lack of education, and gender discrimination and violence. Breaking the culture of silence is critical. As in many regions, both industrialized and developing, complex social and cultural barriers have made talking about sexuality or insisting on protection from HIV so difficult that even educated middle class women say they are unable to protect themselves, while poor women have even less power to do so.

Eastern Europe and Central Asia
HIV prevalence has grown rapidly in this region. In 1995 relatively few cases were recorded but, by the end of 2003, about 1.3 million people were living with HIV/AIDS in the region (see Map). Over a quarter of a million people became infected in 2003 alone. The worst affected countries were the Baltic States (Estonia, Latvia and Lithuania), the Russian Federation and Ukraine, with serious outbreaks in Belarus, Kazakhstan and Moldova as well. Overall, women account for 33 per cent of people with HIV/AIDS in the region, and young women account for 28 per cent. Evidence suggests that their rates are increasing compared to men’s. For example, in 2002 in the Russian Federation, 33 per cent of newly diagnosed infections were among women, compared to 24 per cent a year earlier.

The social and economic upheaval that took place in the former Soviet Union in the 1990s has brought declining socio-economic conditions and increasing inequity throughout the region. The resulting sense of hopelessness among those left out of new market economies is fuelling HIV transmission through injecting drug use and unsafe sex. Because most drug users are young and sexually active, sexual transmission is also becoming a significant mode of HIV transmission.

Latin America and the Caribbean
Some 2 million people between the ages of 15 and 49 are living with HIV/AIDS in Latin America and the Caribbean, with 36 per cent women in Latin America, and virtually half (49 per cent) in the Caribbean.Young women are 2.5 times more likely to be infected than young men in the Caribbean. HIV prevalence has reached rates of 1 per cent or higher in the general population in at least 12 Caribbean and Central American countries (the Bahamas, Barbados, Belize, the Dominican Republic, Guatemala, Guyana, Haiti, Honduras, Jamaica, Panama, Suriname and Trinidad and Tobago).

In the Caribbean, the main mode of transmission is heterosexual; however in Puerto Rico, injecting drug use appears to be the main source of the epidemic. In South America, HIV is transmitted mainly through injecting drug use and from relations between men, with subsequent heterosexual transmission to other partners. In Central America infection appears to be occurring through sexual transmission, both heterosexually and among men involved with men. Among the factors helping to drive the spread of HIV in the region overall is the combination of unequal socio-economic development and high population mobility

Middle East and North Africa
HIV prevalence in the Middle East and North Africa is still very low. The exception is southern Sudan. In addition, HIV infections are increasing among injecting drug users in Bahrain, Iran and Libya, and to a lesser degree in Algeria, Egypt, Kuwait, Morocco, Oman and Tunisia. However, infections among this group could spread quickly to the general population.

For example, a study in Iran showed that half of injecting drug users were married and a third had reported having extra-marital affairs.

Already, young women aged 15 to 24 are more than twice as likely to be living with HIV/AIDS as young men, although this figure is somewhat skewed due to the high levels of infection in young women in southern Sudan.

In countries of this region, social and cultural norms limit the discussion of sexuality and reproductive and sexual health issues, and many countries have not developed prevention programmes. Part of the challenge facing the region is the need to defuse the stigma and blame that are so often attached to vulnerable groups, and to widen the general public’s knowledge and understanding of the epidemic.

More Information: http://www.unfpa.org/hiv/women/report/chapter1.html