Fact Sheet No 242
WOMEN AND HIV/AIDS
Facts and figures
33.6 million people living with HIV/AIDS, 14.8 million of whom are
- 5 million adults newly infected in 1999, 2.3 million are women
- 2.1 million died of AIDS in 1999, 1.1 million of whom were women
- 12-13 African women currently infected for every 10 African men
- Half a million infections in children (under 15), most of which
have been transmitted from mother to child
- 55% of adult infections in sub-Saharan Africa are in women, 30% in
SE Asia, 20% in Europe and USA.
Modes of transmission
The AIDS epidemic in women is overwhelmingly
heterosexual – almost entirely so in Africa and South and South East
In other areas, a proportion of women are infected
- sex with a bisexual or drug injecting partner
- their own injecting drug use
- heterosexual sex without these factors
- blood transfusion (in developing countries where blood is not
Why are women more vulnerable to HIV infection?
- Larger mucosal surface; microlesions which can occur during
intercourse may be entry points for the virus; very young women even
more vulnerable in this respect.
- More virus in sperm than in vaginal secretions
- As with STIs, women are at least four times more vulnerable to
infection; the presence of untreated STIs is a risk factor for HIV.
- Coerced sex increases risk of microlesions.
- Financial or material dependence on men means that women cannot
control when, with whom and in what circumstances they have sex
- Many women have to exchange sex for material favours, for daily
survival. There is formal sex work but there is also this exchange
which in many poor settings, is many women’s only way of providing
for themselves and their children.
Socially and culturally
- Women are not expected to discuss or make decisions about sexuality
- They cannot request, let alone insist on using a condom or any form
- If they refuse sex or request condom use, they often risk abuse, as
there is a suspicion of infidelity
- The many forms of violence against women mean that sex is often
coerced which is itself a risk factor for HIV infection
- For married and unmarried men, multiple partners (including sex
workers) are culturally accepted
- Women are expected to have relations with or marry older men, who
are more experienced, and more likely to be infected. Men are
seeking younger and younger partners in order to avoid infection and
in the belief that sex with a virgin cures AIDS and other diseases.
Why must the response be gender-based?
Three main reasons:
1. Unequal gender (social, economic, and power)
relations are driving the epidemic
2. Women are disproportionately affected by the
- They are highly vulnerable to infection
- They bear the psychosocial and physical burden of AIDS care
- They suffer particular discrimination; are often blamed for
3. Sex differences in pathology. Clinical management,
for too long based on research undertaken on men, must be tailored to
women’s particular symptomatology, disease progression, HIV related
What will make a difference?
Physical and material independence and security for
women which is independent of the "protection" of a man or men
- Women must be empowered so that they are able to control their own
lives and in particular their sexual relations
This implies a profound shift in social and economic
power relations between men and women. It cannot be achieved tomorrow
but action must start today, through:
- Increased educational and employment opportunities for girls and
- Public education campaigns on the harmful - fatal, in the case of
AIDS - effects of unequal gender relations.
Microbicides: our best hope
The development of a prevention method which is
cheap, safe and effective and under women’s control, is essential.
- In the absence of a vaccine, this is a method likely to have an
immediate and significant impact on the alarming rate of new
infections in women.
- A massive investment in international research and development of
a microbicide is required.
- An issue which must be dealt with is the desire for children. A
microbicide for preventing both pregnancy and STIs including HIV
(dual protection), and a microbicide which is not also a
spermicide must be developed.
Proven effective interventions
There are a number of proven interventions (see key
interventions) which together, comprise key strategies to control the
spread of the epidemic. They are particularly important for women.
Treatment and prevention of sexually transmissible
- women are more vulnerable to STIs; the consequences are more serious
- many STIs are asymptomatic in women, so go untreated
- syndromic management of STI in women is more difficult than in men
- stigma associated with STIs is greater for women (suggests
promiscuity), so they are often afraid or unwilling to seek care.
Women and children are the chief recipients of
transfusions; women - during and after delivery. The following action is
- Antenatal care and adequate nutrition to reduce some of the need
- Appropriate clinical use of blood to avoid unnecessary transfusion
- Screening of all blood as the ultimate aim.
Education for prevention including the use of condoms
Condoms, male and female, are currently the only
protection methods available.
They need to be more widely accepted, available and
- Education to promote their use
- Increasing access through free distribution, subsidies, or social
marketing so that they are really affordable.
It has been shown that even in the most favourable
circumstances, condom use (male and female) is low. The acceptability of
these methods remains problematic. The female condom is if anything more
cumbersome than the male condom and considerably more expensive.
Furthermore, women cannot control their use. Impact will continue to be
low if people’s preferences and therefore their actual use of methods,
are not given due attention.
Women as carers
- Women are responsible for the health care of all family members.
- Care is only one of the many productive and reproductive activities
of women which include farming, food preparation, collection of
firewood and water, child care, cleaning, etc.
- Care is provided free but has a cost! During illness, women’s
productive labour is lost; this has serious impact on long term
wellbeing of the household.
- Care doesn’t end with death of husband/child/sister. Care of
orphans lies with grandmothers and aunts.
- Women carers are often HIV positive themselves.
Making men more responsible
- Little attention has been paid to men’s participation in efforts
to protect women
- Men are hard to reach and educate but some are concerned about
sexual health – their own and their partners
- Raising awareness of their own risk has been shown to change certain
- Interventions must be aimed at men (as well as at women) if women
are to be protected.
For further information, journalists can contact :
WHO Press Spokesperson and Coordinator, Spokesperson's Office,
WHO HQ, Geneva, Switzerland / Tel +41 22 791
4458/2599 / Fax +41 22 791 4858 / e-Mail: email@example.com