Women, girls, HIV and AIDS

Women and girls account for over half of the world's 40 million total infections. They are disproportionately affected in the developing world, where 64 percent of young people living with HIV/AIDS are female. In parts of eastern and southern Africa, more than one third of teenage girls are infected with the virus, and young women aged 15 to 19 are 2.5 times more likely to be infected than young men.

The theme of this year's World AIDS Day (and World AIDS Week here at Princeton) is "Women, Girls, HIV and AIDS." This focus was chosen because of HIV's increasing tendency to attack this population.

Women are more susceptible to HIV/AIDS for a variety of reasons. Besides being biologically more vulnerable to infection through sexual contact than males, females are often uneducated and therefore lack knowledge about HIV prevention. Due to expensive school fees, parents are sometimes forced to decide which of their children will be educated and which will stay at home. When confronted with a choice, most families in developing countries will educate a boy over a girl. Also, when family members get sick or when, due to illness, parents can no longer take care of other children, it is most often the girls in the family who are removed from school to do domestic duties and care for younger siblings and other family members.

Socio-sexual factors also fuel the epidemic within this population. Endemic rape is often overlooked and ignored, and leads to infection. According to UNAIDS, between 20 and 50 percent of all girls and young women report that their first sexual encounter was forced. Even within stable relationships, women are often subject to domestic violence and cannot ask that their partners be faithful, nor can they negotiate condom use, because of a lack of empowerment. Since they have fewer prospects for gainful employment, uneducated women are unable to leave abusive homes or even unfaithful partners who occasionally sleep with prostitutes. Dependent upon their boyfriends or husbands for food and shelter, women must continually risk infection. Contrary to popular western belief, marriage can actually be a major risk factor for young women given these circumstances. A UNAIDS report claims that in the developing world, women married by age 20 actually have higher rates of HIV than their unmarried, sexually active peers.

The virus's onslaught on women is especially damaging to developing countries. As daughters, mothers, grandmothers and pillars of villages, women provide most of the primary care to sick family or community members. Within their homes, they are often asked to perform domestic tasks and sometimes even to produce food for their households. Women also make up a large part of the nurse population. When females become infected and eventually die, they can no longer perform any of these roles, and the whole society suffers. No one cares for the sick, domestic tasks go undone, families go hungry and already depleted healthcare systems are further decimated.

Knowing what we know now — that women are disproportionately affected and that their loss reverberates throughout society — what can we do to help the situation? To truly make an impact, we must target women and girls in the fight against HIV/AIDS, with a special emphasis on eliminating gender inequalities. The abolition of school fees throughout the developing world would be an excellent first step so that more girls get educated, teaching them about protecting themselves while also empowering them to be in control of their own lives, rather than being dependent on their husbands. Next, the development of female-controlled prevention tools, like microbicides — which prevent the spread of the virus during sexual contact, but which can be applied discretely without the man's knowledge before intercourse — must be ramped up. Also, life-prolonging treatment programs must target women so that they soon make up at least half of the world's antiretroviral therapy users, in addition to focusing on HIV-positive pregnant women to prevent mother-to-child-transmission during childbirth. General tolerance of rape and domestic violence must end; men must take collective responsibility for their role in exacerbating this crisis, while law enforcement in developing countries should refuse to condone these abhorrent acts. Lastly, western-centric prevention efforts like the ABC method (Abstinence, Be faithful, use Condoms) must be adjusted to reflect developing world feminine realities, where abstinence isn't always possible, faithfulness is not always beneficial and condoms are not always a viable option.

Only when the world begins to realize that this pandemic is fuelled not only by biology, but also by gender inequality, female marginalization andcountless other social factors, will we be able to make progress in resolving the crisis.