Gender inequality and its impact on women’s risk of HIV

and access to HIV services

Dr Jantine JacobiTeam Leader, Women, Girls and Gender EqualityDirector, Global Coalition on Women and AIDS

UNAIDSjacobij@unaids.org

HIV statistics

About 16 million women are living with HIV, most of them

in Sub-Saharan Africa

Globally, women make up 50% of the global epidemic

– In sub-Saharan Africa 60 % of the people living with

HIV are female;

– Young women account for 75% of HIV infections in the

15-24 years old age group

– In Asia, the percentage of women living with HIV rose

from 19% in 2000 to 35% in 2008

young women are particular vulnerable to HIV infection

Young women are particular vulnerable to HIV infection

HIV infection rates, by age group in selected countriesWomen 15-19 (%) Men 15-19 (%)

Women 20-24 (%) Men 20-24 (%)

Botswana 5.0 2.416.0 7.4Kenya 3.5 1.07.4 1.9South Africa 6.7 2.521.1 5.1

HIV infection rates, by age group in selected countriesWomen 15-19 (%) Men 15-19 (%)

Women 20-24 (%) Men 20-24 (%)

Botswana 5.0 2.416.0 7.4Kenya 3.5 1.07.4 1.9South Africa 6.7 2.521.1 5.1

HIV infection rates, by age group in selected countries

Women 15-19 (%)

Men 15-19 (%)

Women 20-24 (%)

Men 20-24 (%)

Botswana 5.0 2.4 16.0 7.4

Kenya 3.5 1.0 7.4 1.9

South Africa

6.7 2.5 21.1 5.1

Source: Global Report, 2008, UNAIDS

HIV infections detected in Papua New Guinea, by age,

1987–2006

Source: Papua New Guinea National AIDS Council and Department of Health.Figure 29

0

500

1000

1500

2000

2500

3000

0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59Over 60Unknown

Male Female Sex not Stated

Num

ber

Age group

Unequal statusHIV infection is often related to the unequal status of women,

present in many parts of the world - similar trend for violence

Societies have collective ideas about the status of women

and men in relation to one another, including appropriate

roles, rights, responsibilities and accepted behaviors (WHO)

– These ideas vary within and between cultures

Societal norms and rules are often hierarchal and unequal

for women in general populations

Women often don’t have the same access to resources,

power and influence in comparison with men.

Clear link between gender inequality and women’s risk of HIV

Gender-based unequal power pose barriers to the adoption

of safer sex practices in relationships (USAID 2009)

Even with known risk of HIV/STIs, it is often not possible for

women to insist on faithfulness or condom use in the

relationship (Dunkle 2007)

Recent data on violence against young women in South

Africa shows that power inequity and intimate partner

violence increase women’s incidence of HIV (Jewkes 2010)

Violence affects women and girls all over the world

A multi-country study revealed that

between 15% and 71% of women

(15-49) had experienced physical

and/or sexual violence (WHO,

2005)

Between 11% and 45% of

adolescent girls report that their

first sexual experience was forced.

Swaziland: 2007 study on sexual violence against adolescent girls

25% of girls 13-17 years of

age reported experiencing

some form of sexual violence

66% of young women 18-24

years of age years of age

reported experiencing some

form of sexual violence

Source: Government of Swaziland, UNICEF, CDC

Violence during pregnancy

Data suggest that violence increases during pregnancy,

increasing risk of HIV infection for the woman and her

infant (WHO 2005, Martin 2004, Valladares 2005, Gray

2005)

10% pregnant women in Zambia, 7% of pregnant women

in South Africa, 77% of women in Ethiopia have been

physically assaulted during pregnancy (Watts and Mayhew

2004)

Mostly by the father of the baby

Gender inequality and HIV testing

Male partners influence women’s uptake of HIV testing, especially

in antenatal services (Bajunirwe 2005, Maman 2008)

Women’s perception of husband’s approval was the strongest

predictor of her willingness to accept a HIV test (Bunjunirwe

2005)

Opposition from male partners was one of the major reasons for

low uptake of HIV counseling and testing in some contexts

(Sarker 2007)

Women’s fear of a negative reaction (violence) from her partner

emerged as a key theme in a multi-study review of factors

influencing pregnant women’s HIV uptake

Disclosure and ART

Between 16-51% of women in Tanzania, South Africa and

Kenya cited fear of violence as a major barrier to

disclosure (Medley 2004)

Women may experience difficulty with adherence to ARV

prophylaxis and treatment because of concerns related to

disclosure (WHO 2009)

The highest rates of disclosure-related violence were

encountered in ANC, with violence reported to be an

obstacle to ART (WHO 2004) (Human Rights Watch 2007)

PMTCT increase: 43% in 2008 from 15% in

2005

However, in 2008, only 24% women testing positive for HIV

at ante-natal clinics were assessed for

their own eligibility for

ARVs.Source: UNAIDS, UNICEF & WHO, 2008; data provided by countries.4.13

43%

33%

23%

15%

10%

14%

24%

0

100,000

200,000

300,000

400,000

500,000

600,000

700,000

2004 2005 2006 2007 2008Num

ber o

f HIV

pos

itive

wom

en a

cces

sing

sel

ecte

d se

rvic

es

Number of HIV positive pregnant women accessing ARVs for PMTCT

Number of HIV positive pregnant women assessed for their own ARV needs

Source: UNGASS Country Progress Reports 2008.

83% of countries

report having

women included

as a specific

“sector“ in their

multisectoral

strategic

framework

Only 53% report

having a budget

attached to

programmes

which address

women’s issues

Caribbean(12)

East Asia

(3)

EasternEurope

and Central

Asia(16)

Latin America

(19)

Middle East

(4)

NorthAmerica

(1)

Oceania(7)

South and

South-East Asia(13)

Sub-Saharan

Africa(41)

Western and

Central Europe

(14)

0

20

40

60

80

100

Pe

rce

nta

ge

of

cou

ntr

ies

(%)

Women are addressed as a specific component of multisectoral HIV strategy

(Number of countries reporting)

Women are addressed as a specific component of multisectoral HIV strategy with a budget

UNAIDS Agenda for Women and Girls

Thank you

Merci