Gender inequality key foundation for generalised HIV epidemics

02 July 2014
An HIV ribbon

Gender inequality is a major contributor to maintaining and establishing generalised HIV epidemics, according to a new short report published in the International AIDS Society Journal. The report calls on programmes to combat gender inequality as an integral part of public health policy formation and combatting generalised heterosexual HIV epidemics.

The authors used the 2011 United Nations Human Development (UNDP) Report Gender Inequality Index (GII), which looked at the differences in achievement between men and women across three dimensions: empowerment, reproductive health and the labour market. They found that a major contributing factor to generalised HIV epidemics was having a concurrently high gender inequality index. The argument still stood after other social and economic variables were included, such as the democracy index, male circumcision rates, and GNI per capita. The only exception to the rule was the Middle East and North Africa (MENA) region, where a high gender inequality was associated with low HIV prevalence rates. However it is believed that cultural factors play a major role here. Elsewhere, countries with a severe gender inequality index were up to 15 times more likely to have a generalised HIV epidemic than those with near equal gender imbalances. It is well known that the HIV epidemic disproportionately affects woman around the world.

Every minute one young woman becomes infected with HIV, with sub-Saharan Africa reporting the percentage of young women aged 15-24 living with HIV being twice that of young men. Gender-based expectations increase a woman’s vulnerability to HIV and are a major contributor to heterosexual generalised epidemics, as the study shows. Cultural expectations about sex, and a woman’s role in society may prevent them from accessing HIV prevention and sexual reproductive health services. Legal structures may also impact upon a woman’s vulnerability to HIV.

The authors call for structural interventions to reduce gender inequality, such as abolishing school fees for girls, enforcing domestic violence and rape laws, abolishing child marriage and increasing participation of women in the labour market. Interventions like this will go a long way to combat HIV in countries where there are generalised heterosexual epidemics.

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