Social norms that promote gender inequality create harmful power dynamics between men and women. This prevents women from being able to protect their health, including from HIV. For example, they may not be able to access health services without permission from their male partner or be able to decide when they have sex.
HIV and women
- Of all new HIV infections in 2021, 49% were among women and girls.
- In sub-Saharan Africa, young women are twice as likely to have HIV than young men.
- In sub-Saharan Africa, women and girls made up 63% of all new HIV infections in 2021.
Women are disproportionately affected by HIV compared to men, with young women most at risk.
In many countries, women experience inequality linked to cultural and social norms and many experience gender-based violence. These factors make women more likely to get HIV.
To help protect them from HIV, women’s rights need to be better respected and upheld by their communities, HIV services and the law. Through international and national laws and programmes the situation is slowly changing. Many women from different communities are finding solutions to challenge and reduce the inequalities they experience.
Why are women at higher risk of HIV?
Violence prevents many women, particularly young women, from protecting themselves against HIV. Intimate partner violence is difficult for women to protect themselves from, especially where it is culturally normal for a male partner to exert violence over their female partner.
Women with HIV are often blamed for getting it and face violence because of their HIV status. This means they are less likely to get and adhere to their treatment, leading to worse health outcomes.
This means women and girls are less likely to get comprehensive sexuality education in schools and more likely to believe myths and misinformation about sex and HIV. It also means that women are more likely to be poorer than men and so more likely to be dependent on men. This means they have less decision-making power within relationships, families and societies.
Due to gender norms, women often have less power in relationships. This makes it hard for women to negotiate condom use if their partner doesn’t want to use a condom, increasing their risk of HIV.
Sex between young women and older men is common in many parts of the world. Often, these relationships are transactional, meaning the man pays or buys the woman gifts in return for sex. This type of sex is likely to be high risk and not involve a condom.
Women who are unmarried or have sex outside of marriage are sometimes denied access to health services. But even married women can face discrimination at health services because of the view that female sexuality exists to meet the needs of men.
Young women have sex. And unfortunately many young women experience forced sexual activity, including rape. Despite this, women under 18 in many countries are denied HIV and sexual health services because they are under the age of sexual consent or must have parental consent.
A lack of education leads to lack of safe jobs, cheap labour and no access to banking and formal credit. When women often have to rely on men for economic reasons it can be difficult for them to take control of their health and needs. Some women experiencing poverty or a lack of resources may have little choice but to do things that put them at risk of HIV, including sex work, intergenerational sex, early marriage, and relationships that expose them to violence and abuse.
How can HIV services meet the needs of women?
Many women with HIV don’t realise they have it until they are tested during pregnancy. Encourage all pregnant women to come to preventing mother-to-child transmission (PMTCT) of HIV services so that women who are found to have HIV can be given treatment and care to protect their own health and their baby’s.
Women who have not been pregnant are less likely to get tested for HIV than women who have been pregnant. It is important to share information about testing with all women to counter any myths that you only get tested when you are pregnant.
Because of stigma and gender-based violence, many women are reluctant to be seen attending HIV services. Integrate HIV services into other health services (such as tuberculosis or cervical cancer screening) to help women feel more comfortable accessing HIV care.
Many countries have criteria that limits who can take pre-exposure prophylaxis (PrEP). Women are sometimes overlooked for PrEP, but women’s lack of power in relationships and difficulties negotiating condom use means that PrEP is a vital HIV prevention method.
Women who are raped or exposed to HIV through unsafe sex should be offered post-exposure prophylaxis (PEP) immediately.
HIV prevention methods that are designed for women, such as the PrEP vaginal ring and internal (female condom) should be made easily available.
What systemic changes could reduce the risk of HIV for women?
There are three strands to legal reforms that would better protect women from HIV:
ensure the human rights of women to experience gender inequality and live free from violence are upheld
end the use of laws that disproportionately criminalise women because of their sexuality, sexual activity or HIV status
educate women and girls about their rights and where to seek legal aid and justice.
Gender-based violence is against human rights. Countries need to do more to educate citizens and change behaviours and social norms that discriminate against women and lead to violence.
Women from key population groups are much more at risk of HIV than other women. This includes young women, female sex workers, transgender women and women who inject drugs. Put greater legal protection in place to protect women from these groups.
Countries should make greater effort to keep girls in school. Women with more education tend to marry later, have children later and exercise greater control over their fertility. Evidence shows this all greatly reduces their risk of HIV.
Reducing poverty has been shown to reduce high-risk sexual behaviour and therefore reduce HIV risk. Cash transfers, the creation of economic opportunities, training and education can all help to improve women’s access to resources.
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