Gender, women and health

Gender inequalities and HIV

According to the latest (2008) WHO and UNAIDS global estimates, women comprise 50% of people living with HIV.

In sub-Saharan Africa, women constitute 60% of people living with HIV. In other regions, men having sex with men (MSM), injecting drug users (IDU), sex workers and their clients are among those most-at-risk for HIV, but the proportion of women living with HIV has been increasing in the last 10 years.

This includes married or regular partners of clients of commercial sex, IDU and MSM, as well as female sex workers and injecting drug users.

Gender inequalities are a key driver of the epidemic in several ways:

Aiming for two Millenium Development Goals (MDGs)

HIV/AIDS programmes that promote and invest in gender equality contribute to both MDG 6 on combating HIV/AIDS, TB and malaria and to MDG 3 on promoting gender equality and women's empowerment.

Gender norms related to masculinity can encourage men to have more sexual partners and older men to have sexual relations with much younger women.

In some settings, this contributes to higher infection rates among young women (15-24 years) compared to young men.

Norms related to masculinity, i.e. homophobia, stigmatizes men having sex with men, and makes them and their partners vulnerable to HIV.

Norms related to femininity can prevent women – especially young women – from accessing HIV information and services. Only 38% of young women have accurate, comprehensive knowledge of HIV/AIDS according to the 2008 UNAIDS global figures.

HIV/AIDS programmes can address harmful gender norms and stereotypes including by working with men and boys to change norms related to fatherhood, sexual responsibility, decision-making and violence, and by providing comprehensive, age-appropriate HIV/AIDS education for young people that addresses gender norms.

Violence against women (physical, sexual and emotional), which is experienced by 10 to 60% of women (ages 15-49 years) worldwide, increases their vulnerability to HIV.

Forced sex can contribute to HIV transmission due to tears and lacerations resulting from the use of force.

Women who fear or experience violence lack the power to ask their partners to use condoms or refuse unprotected sex. Fear of violence can prevent women from learning and/or sharing their HIV status and accessing treatment.

Programmes can address violence against women by offering safer sex negotiation and life skills training, helping women who fear or experience violence to safely disclose their HIV status, providing comprehensive medico-legal services to victims of sexual violence, and working with countries to develop, strengthen and enforce laws that eliminate violence against women.

Gender-related barriers in access to services prevent women and men from accessing HIV prevention, treatment and care.

Women may face barriers due to their lack of access to and control over resources, child-care responsibilities, restricted mobility and limited decision-making power.

Socialization of men may mean that they will not seek HIV services due to a fear of stigma and discrimination, losing their jobs and of being perceived as "weak" or "unmanly".

Programmes can improve access to services for women and men by removing financial barriers in access to services, bringing services closer to the community, and addressing HIV-related stigma and discrimination, including in health care settings.

Women assume the major share of care-giving in the family, including for those living with and affected by HIV. This is often unpaid and is based on the assumption that women "naturally" fill this role.

Programmes can support women in their care-giving roles by offering community-based care and support, including by increasing men's involvement.

Lack of education and economic security affects millions of women and girls, whose literacy levels are generally lower than men and boys'.

Many women, especially those living with HIV, lose their homes, inheritance, possessions, livelihoods and even their children when their partners die. This forces many women to adopt survival strategies that increase their chances of contracting and spreading HIV. Educating girls makes them more equipped to make safer sexual decisions.

Programmes can promote economic opportunities for women (e.g. through microfinance and micro-credit, vocational and skills training and other income generation activities), protect and promote their inheritance rights, and expand efforts to keep girls in school.

Many national HIV/AIDS programmes fail to address underlying gender inequalities. In 2008, only 52% of countries who reported to the UN General Assembly included specific, budgeted support for women-focused HIV/AIDS programmes.

HIV/AIDS programmes should collect and use sex and age disaggregated data to monitor and evaluate impact of programmes on different populations, build capacity of key stakeholders to address gender inequalities, facilitate meaningful participation of women's groups, women living with HIV and young people, and allocate resources for programme elements that address gender inequalities.

Now published: Integrating gender into HIV/AIDS programmes in the health sector: Tool to improve responsiveness to women's needs, a practical handbook for programme planners and service providers to help them integrate gender in their work on HIV testing and counselling, prevention of mother-to-child transmission of HIV, HIV treatment and care and home-based care programmes.

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Gender, Equity and Human Rights
E-mail: ger@who.int