Gender inequality and HIV transmission: A global analysis

E T. Richardson, S. E. Collins, T. Kung, J. H. Jones, K. H. Tram, V. L. Boggiano, L. Bekker, A. R. Zolopa Journal of the International AIDS Society, 2014; JIAS, 2014, 17: 19035 Gender inequality and HIV transmission: a global analysis

Compelling evidence indicates that improvements in gender inequality can lead to the abatement of generalised epidemics.

Worldwide, young women aged 15–24 are infected with HIV at rates twice those of young men. Young women alone account for nearly a quarter of all new HIV infections. The disproportionate HIV incidence in young – often poor – women underscores how social and economic inequalities shape the HIV epidemic.

Social forces that prevent equal access to therapies and effective care, as well as constraining women’s agency, include:

  • political and gender violence
  • poverty
  • racism
  • sexism

This study compiled HIV prevalence data from the 2010 UNAIDS Global Report and applied the 2011 United Nations Human Development Report Gender Inequality Index (GII), as well as other measures to model social factors such as faith (Muslim/ non-Muslim).

The authors found a significant correlation between having a predominantly heterosexual epidemic and high gender inequality across all models. There was no significant association between a country’s being predominantly Muslim or having a high/low circumcision rate, and its predominant mode of transmission.

Only three countries have had a generalised epidemic in the past and no longer have one: Cambodia, Eritrea and Honduras. GII data for Eritrea is not available. However, in Cambodia and Honduras, an improvement in GII of 37 and 34% respectively occurred simultaneously with both countries reducing their HIV prevalence below the 1% threshold of a generalised epidemic.

Our analysis suggests that gender inequality is an important factor in the maintenance – and possibly in the establishment – of generalised HIV epidemics and thus provides an important reminder that we may not be able to treat ourselves out of the pandemic with medications alone."


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