This is the second in a series of blog posts exploring how challenges to gender equality affect efforts to end the epidemics of AIDS, tuberculosis (TB) and malaria. The full series is available here.
The Gender Problem
Gender disparities ought not to contribute to an individual’s risk for contracting disease and create barriers to treatment, but unfortunately, in the world of HIV, women are disproportionately affected. These health impacts undercut political voice, social standing and economic opportunity for women, and justify all the more one of the four pillars of the Global Fund’s strategy: to “promote and protect human rights and gender equality.”
Unequal impact is apparent on a global scale, where HIV is the leading cause of death for women ages 15 to 44. Adolescent girls and young women (AGYW) bear the greatest vulnerabilities. Globally, AGYW comprised 60 percent of new HIV infections among 15 to 24-year-olds in 2015. In the hardest-hit countries, AGYW account for more than 80 percent of all new HIV infections.
These vulnerabilities are products of harmful gender norms that suppress female agency. Such patterns include societal expectations for women to be submissive, relationships between young women and older men, oppressive sexual relationships, as well as gender-based violence (GBV).
In many societies around the world, women’s activities are tightly controlled, which is true in many countries that also have high HIV infection rates. This unequal relationship dynamic between men and women can negatively impact health, particularly regarding transmission of HIV. However, members of key populations – both men and women – are more vulnerable to contracting HIV than the general population. For instance, in low and middle-income countries, females engaged in commercial sex are 13 times more likely to contract HIV than the general population.
Sexual relationships between AGYW and older men also play a volatile role in the HIV transmission cycle. Young girls in these relationships are at greater risk for acquiring HIV, considering that their older partner is more likely to have had previous relationships.
GBV, which has affected one-third of women worldwide, places women at a 50 percent higher risk for acquiring HIV. Among young South African women ages 15 to 24, one of four new HIV infections is thought to be violence-related. Women who are affected by GBV often face barriers in accessing health services and HIV support, not least because of reluctance to report the violence.
The Global Fund: Addressing Female Inequality
In many areas of the world, especially those with heavy disease burden, women suffer from vulnerabilities that increase their risks of contracting HIV. The Global Fund seeks to grapple with the complex health implications of gender inequality by increasing investments to address it. In 2015, $18 billion – 60 percent – of the Global Fund’s total spending was on programs benefitting women and girls. As a result, these efforts have contributed to a doubling of the number of women accessing and staying on antiretroviral therapy in Global Fund-supported countries. As inequalities persist, the Global Fund is planning to increase emphasis on supporting HIV programs and activities that address the distinct needs of women and girls.
One Necessary Focus
As highlighted above, gender norms that shape behavior have a direct impact on health outcomes. That is why men’s role in mitigating women and girls’ vulnerabilities to HIV is vital – whether to dampen the transmission cycle or increase access to treatment. Steps to strengthen men’s involvement include:
- Intervention programs that educate and promote male involvement in, for instance, efforts to decrease gender inequalities and GBV,
- Communications programs that foster awareness around social behaviors that reinforce gender inequalities,
- Voluntary medical male circumcision (VMMC), and programs targeting men to be tested for HIV.
The Global Fund has been working with grant recipients on promoting and implementing such approaches.
Additionally, the Global Fund supports programs mobilizing male leaders to encourage positive social and behavioral changes, as well as access HIV prevention and treatment. This approach is employed in a Global Fund-supported program led by the Kenya Red Cross and the Sanne Landin Children Center, which trains and deploys community health volunteers to support HIV prevention and care, where the fishing sector and commercial sex converge on the shores of Lake Victoria. The central strategy is to require men’s involvement in the program.
Moving from significant progress in combatting HIV/AIDS globally in the last 15 years to ultimately ending the epidemic requires addressing female empowerment and barriers to equality worldwide. Women and girls need agency to enjoy stable health and to thrive. However, women alone cannot eradicate the vulnerabilities to the HIV epidemic they face. There must be a role for men to help diminish harmful gender norms, to reject sexual violence (which subjects women to HIV infections), to encourage safe health practices, and to advocate for that agency of women and girls in the community. Support of women’s health has a multiplier effect by benefitting not only their own wellbeing, but that of their families, communities and countries.