Women's Vulnerability to HIV/AIDS: An Overview
In January 2002, U.N. Secretary General Kofi Annan announced that for the first time, women represented half of HIV-positive individuals worldwide, and more than half in sub-Saharan Africa. HIV/AIDS had become a generalized epidemic in many African countries, moving from high-risk groups such as sex workers and injection drug users to the general population, largely because of pervasive gender inequality. The Secretary's rallying cry to the international community stressed that effective HIV prevention programs had to address the realities of women's lives.

The combination of gender inequality and severe poverty is lethal to women in the developing world, and creates the following risk factors for HIV:

• Lack of comprehensive reproductive health services and information for women and girls. If the world community is serious about preventing transmission of HIV/AIDS in women, comprehensive reproductive health services should be a logical starting point for increased funding. But women's health education and services continue to be woefully underfunded. In India, for example, 70 percent of women and girls live in rural areas, and the only way many will learn about HIV and prevention is when they seek pre- or post-natal care, but these services are not considered priorities for HIV/AIDS funds in India or elsewhere.

• Economic disempowerment. Pressure to provide an income for themselves or their families leads many girls to engage in "transactional sex" with older men ("sugar daddies"), who give them money, school fees, or gifts in exchange for sex.

• Lack of basic education. Of the 121 million children not in school worldwide, 65 million are girls, and the highest concentrations are in sub-Saharan Africa.  AIDS is adding to the problem because girls are leaving school in increasing numbers, much more often than boys, to care for sick relatives. Education gives girls the skills they need to access information, enter the labor force, and rise above the poverty that makes them all the more vulnerable to infection.

• Migrant husbands. Many women, especially those in rural areas, are infected by husbands who work as miners, truckers, or soldiers and engage in unprotected sex while away from home. For example, in Cameroun, the HIV prevalence of men who have been absent from home for more than 31 days is 7.6 percent, compared to a rate of 1.4 percent among those who stayed home.

• Ignorance and stigma around HIV/AIDS. The unwillingness of too many governments and community or religious leaders to talk frankly about sex prevents the dissemination of accurate information about HIV/AIDS and fosters the spread of wildly inaccurate information. Often, the effects are especially harmful to women and girls. For example, the myth that having sex with a virgin can cure AIDS only increases the number of young girls becoming infected.

• Child marriage. It is still common in many parts of the developing world for young girls to marry before they are 18; 60 percent of girls in Nepal, 76 percent in Niger, and 50 percent in India will be married by that age. All too often, they marry older, sexually experienced men who may already be infected, or who may be unfaithful, or both. These young girls often know very little about sex, HIV, or how to protect themselves. Because they are so young, they have little power in the relationship, and so are unable to negotiate condom use. Additionally, girls and young women who are married are more likely to drop out of school, underscoring the need for innovative interventions to reach them.

• Violence. One in three women worldwide will be raped, beaten, coerced into sex, or otherwise abused in her lifetime. A woman who experiences sexual violence is at a physically greater risk of contracting HIV, and if she is in an abusive relationship, she is rarely able to negotiate terms to protect herself from infection.

Policy Implications
Prevention programs cannot succeed until women's health and rights are placed at the very center of HIV/AIDS strategies. All young people, male and female, must have access to full and accurate information about their own sexual health, and how their sexual health affects the sexual health of their partners. Men must learn at an early age to respect women, and women must learn at an early age to respect themselves. Education and empowerment are crucial.

A balanced, scientifically based approach is fundamental to curbing the HIV epidemic, as is a balance between prevention and treatment. As Uganda has shown, approaches like Abstinence-Be Faithful-Use Condoms (ABC) can be effective, but only if all three elements are emphasized and local conditions are considered. Abstinence is not an option for a young married woman whose husband is HIV-positive, but abstinence-only prevention programs operate from the erroneous assumption that most women and girls have control over their sexual lives. In order for HIV prevention efforts to be effective, they must be based on the realities of women's lives.