Why are women at particular risk?
Women are more susceptible to HIV for physiological, cultural and social reasons. As a result HIV has an increasingly female face in some parts of the world. In sub-Saharan Africa, more than three-quarters of young people living with HIV are female.
- For millions of women and girls, unprotected sex is not something they can avoid. Deeply embedded gender inequalities can mean women have little or no decision-making role in sexual relationships.
- The need for extra money for food, education, or to keep up appearances with friends, may lead to sex in exchange for presents, or sex with a much older ‘sugar daddy’. This transactional and intergenerational sex is one of the main ways that HIV is spread to adolescent girls.
- Violence against women has been a critical factor in the spread of HIV. This ranges from systematic rape during conflict and war, to violence at an individual level. Either way, the scale is huge.
- Even those in stable relationships may have very little access to information and may lack the negotiation skills with which to protect themselves. In many parts of the world, the number of children that a couple has is an important measure of their social status. Asking their partner to use a condom may be interpreted as a lack of trust or a sign that they themselves have been unfaithful. Also, women are often unable to say no to sex within marriage.
- Certain cultural practices put women more at risk such as polygamy and widow ‘cleansing’.
- HIV can bring prejudice and discrimination, which can be particularly harsh for women. Wives can be blamed for their husbands’ HIV infection, even if their husband has had numerous partners. Widows may be driven from their homes and left destitute. With such serious repercussions it is not surprising that many people choose to hide their HIV status.
Comprehensive, long-term strategies are urgently needed to empower women and to address their unequal social and economic status.
Do women have any alternatives to condoms to protect themselves?
Specific HIV prevention tools for women are being developed and offer some hope for the future. Female condoms are already available, but they can be expensive and still rely on negotiation with a partner. Researchers are also trying to develop other options for women that are more within their control.
Microbicides are the big hope at the moment – these creams or gels are applied internally by a woman before sex, giving them ‘invisible’ HIV protection. However, microbicides are not effective enough yet to be rolled out.
How can you prevent HIV passing from a mother to her child?
Straightforward and effective treatment can stop HIV-positive mothers passing HIV on to their children during pregnancy, labour and delivery. The same antiretroviral drugs used for treating HIV are used during pregnancy or just before or after birth – depending on the health of the mother. Their newborn babies will also usually be given antiretrovirals for their first few days or weeks. Without treatment, around 15-30% of babies born to HIV positive women will become infected with HIV during pregnancy and delivery.
Steps can also be taken to prevent HIV being passed on through breastfeeding, which otherwise can infect 5-20% of babies. If safe water is available, mothers with HIV are advised not to breastfeed but use breast milk substitutes instead. If safe water is not available, or if formula feeding is culturally unacceptable or unaffordable, breastfeeding may be less risky. In this case exclusive breastfeeding – where the baby gets no other food or water – is recommended for the first few months of an infant’s life.
What is Health Poverty Action doing to help?
- Community volunteers spread the message on HIV transmission to pastoralist women in the Bale Lowlands project in Ethiopia.
- In Somalia Health Poverty Action produces a radio programme which has recently covered the risks of mother to child transmission of HIV.
Last modified: 28/09/2011
