The number of people living with HIV has now reached almost 40 million (UNAIDS/WHO 2006). Women and girls are especially vulnerable to HIV infection due to a host of biological, social, cultural and economic reasons, including women’s entrenched social and economic inequality within sexual relationships and marriage. Globally there were 17.7 million women living with HIV in 2006 – an increase of over one million compared with 2004. In sub-Saharan Africa, almost 60 percent of people living with HIV/AIDS in 2006 were women (ibid).
HIV/AIDS is not only driven by gender inequality, it also entrenches gender inequality (Tallis 2002) leaving women more vulnerable than men to its impact. Women in many regions cannot own or inherit property or land, and have limited access to income and resources. Even women who know their legal rights may not have access to independent legal support (ICW 2004d). Women’s unequal social, economic, and legal status is increased by a positive HIV status, and vice versa (ibid). Violations of women’s social, economic, and legal rights in turn prohibit their ability to seek care, treatment and support, and protect their sexual and reproductive health and rights.
Women and girls, including those who are themselves HIV positive, also bear the physical and psychological burden of HIV and AIDS care. Women thus carry a ‘triple jeopardy’ of AIDS: as people infected with HIV, as mothers of children infected, and as carers of partners, parents or orphans with AIDS (Paxton and Welbourn 2004). When women care for others their labour is lost, which has a major impact on their own well-being and on that of the household.
In many contexts, social and cultural values surrounding the importance of female purity mean that women and girls living with HIV and AIDS are subject to greater discrimination than men. ‘Good’ women are expected to remain virgins until marriage. For men, by contrast, multiple sexual partners and sex outside of, and prior to, marriage is generally accepted and often encouraged. These sexual double standards mean that it is women who are generally blamed for spreading HIV – by women as well as men – and are labelled ‘promiscuous’ or ‘vectors of disease’. The fact that women can infect their babies through pregnancy or breastfeeding intensifies the stigma attached to them as women (VSO-RAISA 2004). Socially marginalised groups – such as sex workers, drug users, prisoners and migrants – face additional stigma. In other cases, however, it is men who are seen as perpetrators of HIV and women as victims (ibid).
Where women are blamed, this can lead to heightened levels of sexual and domestic violence; abandonment by families and communities; forced abortion or sterilisation; dismissal from employment; and loss of livelihood opportunities. This kind of extreme discrimination, especially when combined with heavy domestic responsibilities and restrictions on access to resources, presents a powerful barrier to positive women seeking care, treatment and support for HIV and AIDS – or even to getting tested in the first place.
Yet too often, HIV interventions are not adapted to positive women’s realities, leaving them at a disadvantage when it comes to coping with HIV and AIDS. For the epidemic to be tackled effectively, the valuable skills, insights, and accumulated experiences of women and girls living with HIV and AIDS must be taken seriously by policy-makers. Their expertise can be a central force in tackling the epidemic, provided that others are prepared to listen and act on this knowledge (ICW 2004f).