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Women and girls left behind in the fight on HIV/AIDS

Stock Photo - Secunderabad,Ap,India-June 05,2012-Red Ribbon Express visit Secunderabad railway station, for 2 days, during Indian Railways AIDS/HIV awareness campaign. HIV/AIDS illustration.
Image credit: Image credit: reddees / 123rf

The world – including India – has made progress in reducing the burden of HIV/AIDS. Whilst continuing to have a sizeable footprint, the gains made are undeniable. However, in the quest to end HIV/AIDS as a public health menace, are women and girls being left behind?

A new report by the Joint United Nations Programme on HIV/AIDS (UNAIDS) states this to be the case, writing that “too many women and girls are being left behind in the HIV response.” The report points first of all to the promises the world has made concerning HIV/AIDS – that we not only look to bring cases down and scale up treatment, but that we consider a broader societal context. As the report describes, “HIV is more than a health issue: our efforts to end the epidemic are intertwined with our quest for social, economic and gender justice and human rights for all.” 

In 2016, the world articulated what UNAIDS called a “shared vision” to end the HIV/AIDS epidemic in-keeping with the 2030 Sustainable Development Goals. One point of emphasis was the need to push for equality between the sexes. As the Declaration read

“Globally, women and girls are still the most affected by the epidemic and that they bear a disproportionate share of the caregiving burden, note that progress towards gender equality and the empowerment of all women and girls has been unacceptably slow and that the ability of women and girls to protect themselves from HIV continues to be compromised by physiological factors, gender inequalities, including unequal power relations in society between women and men and boys and girls, and unequal legal, economic and social status, insufficient access to health-care services, including sexual and reproductive health, and all forms of discrimination and violence in the public and private spheres, including trafficking in persons, sexual violence, exploitation and harmful practices”

As such, the push for gender equality and the empowerment of women and girls was foregrounded in the Declaration. Progress has been made – fewer women and girls are living with HIV/AIDS – but more needs to be done to realise the goals of the Declaration and to ensure equity and empowerment along the lines of gender and sex. 

College students taking part in a HIV/AIDS awareness campaign in Chandigarh.

The report identifies a 39 percent reduction in cases of HIV/AIDS among women and girls aged fifteen and above since 1995. In that year, it writes, “the global spread of HIV was approaching its peak, effective treatment was not yet available and hope was in short supply. Women were acquiring HIV at alarming rates in an epidemic that began mainly among men.” An estimated 1.2 million women and girls aged fifteen or more were living with HIV in 1995. By 2018, the number had fallen to 740,000. The report notes that girls and women in the fifteen to 24 age demographic saw the largest decrease in HIV infections between 1995 and 2018, with a 44 percent drop. 

Yet these figures fall behind targets of reducing the HIV/AIDS burden by 75 percent by 2020 (compared to 2010 figures). Meanwhile, the HIV/AIDS epidemic continues to be acutely felt among women and girls. This situ is fuelled by a plethora of inequities that obstruct the path towards realising the empowerment and equality they were promised in 2016, ranging from inadequate or nonexistent legal protection against gender discrimination to a lack of autonomy over women and girls’ sexual and reproductive health. Even in the fifteen to 24 age demographic, the progress has been insufficient versus targets. As the report writes, “the world is still a long way from achieving the global target of reducing new HIV infections among adolescent girls and young women to fewer than 100,000 by 2020: in 2018, that number stood at 310,000…three times higher than the target.” 

Discrimination has long been recognised as a key impediment in the fight against HIV/AIDS. This manifests itself in the disproportionate burden of the disease that falls upon members of communities that are historically the subject of marginalisation, stigmatisation, victimisation, and prejudice. 

“Outside sub-Saharan Africa, most women at risk of HIV infection or those living with HIV belong to marginalized communities, such as sex workers, women who inject drugs, transgender women and women in prison (often referred to as “key populations” in HIV literature),” the report outlines. “They also may be the sexual partners of men who themselves belong to key populations (such as men who inject drugs or gay men and other men who have sex with men).

“While key populations represent only a small proportion of the general population, they are at much higher risk of HIV infection. Globally, more than half of new HIV infections in 2018 were among people belonging to key populations and their sexual partners.” For these groups, “gender inequality, stigma and discrimination, criminalisation, violence and other human rights violations” stand in the way of women availing the treatment and other care that they require. 

A HIV/AIDS awareness banner in Patna, Bihar.

The report is keen to emphasise that progress has been made. As a UNAIDS press release writes, “more girls are in school and gender gaps in primary schooling are closing globally, in some countries there are more women involved in political leadership and other countries have worked to protect women’s rights in legislation. HIV treatment has also been scaled up, so that by mid-2019 there were more than 24 million people living with HIV on treatment, including more than thirteen million women aged fifteen years and over.” In addition, fewer women and girls are dying due to complications of HIV/AIDS. Yet even here, there are gaps and inequities. 

“While immense progress has been achieved, AIDS-related illnesses remain the leading cause of death globally for women aged fifteen to 49 years,” the report writes. It notes that “an estimated 770,000…people globally died of AIDS in 2018. Women and girls accounted for 41 percent of those deaths.” Even as more women and girls are availing treatments such as antiretroviral therapy, many miss out. Awareness is also an issue: although the report notes that “levels of knowledge of HIV status among women living with HIV are close to the 2020 target of ninety percent”, there is still substantial variation. “Women’s knowledge of their HIV status varies widely between countries,” the report notes, “reflecting the different degrees of political will, social exclusion and intersecting forms of discrimination and criminalisation that shape their realities.” This is enhanced for key populations.

There is one element of progress made which UNAIDS identifies: averting the transmission of HIV from pregnant women to their newborn child. “Nearly 82 percent…of pregnant women living with HIV worldwide were receiving antiretroviral therapy in 2018,” the report said. “This means that approximately 200,000…infants avoided acquiring HIV in 2018 alone.” 

There is a caveat here, however. “Overall progress in preventing vertical transmission of HIV and scaling up treatment coverage has stalled in recent years,” the report states. “Slow progress in other regions [than eastern and southern Africa] means that the 2018 global target of reaching 95 percent of pregnant women living with HIV with antiretroviral therapy and sustaining them on lifelong treatment was missed.” As such, even as progress has been made, more needs to be done. In particular, efforts must be made to overcome the issues facing young mothers. 

“Pregnant adolescent girls, young mothers and women belonging to key populations encounter many additional barriers when trying to access and stay on treatment,” the report states. “Denigrating social attitudes and discriminatory practices limit their rights to access basic information and quality care, and inhibit their rights to make their own decisions, including about childbearing and breastfeeding.” 

Fundamentally, women and girls living with HIV/AIDS must have their needs recognised and responded to in the fight against the disease. Fewer Indians are living with HIV/AIDS today and the Government has issued ambitious targets to further bring down HIV/AIDS rates. As the UNAIDS report makes clear, such efforts – be it in India or worldwide – must incorporate efforts to address the concerns and needs of women and girls. Its recommendations ought to be taken onboard by stakeholders, as meaningful progress in the fight against HIV/AIDS cannot be achieved without manoeuvres towards gender parity, equity, and empowerment. 

“We’ve Got the Power: Women, Adolescents, Girls and the HIV response” can be accessed here.

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