HIV/AIDS is leading cause of death of women of reproductive age: UN report

The World Health Organization's report Women and health: today's evidence, tomorrow's agenda identifies HIV/AIDS as the leading cause of death among women of reproductive age: "Globally, the leading cause of death among women of reproductive age is HIV/ AIDS. Girls and women are particularly vulnerable to HIV infection due to a combination of biological factors and gender-based inequalities, particularly in cultures that limit women’s knowledge about HIV and their ability to protect themselves and negotiate safer sex."

Here is an extract from the report:

This section is copied without footnotes or graphs. To download the full report, see below.

Women and HIV/AIDS

Globally, HIV is the leading cause of death and disease in women of reproductive age. Of the 30.8 million adults living with HIV in 2007,a 15.5 million were women. The prevalence of HIV infection in women has increased since the early 1990s and is most marked in sub-Saharan Africa.

Total number of people living with HIV/AIDS in 2007 was 33 million, including two million children younger than 15 years.

Southern Africa is most affected; in 2005–2006, median HIV prevalence among pregnant women attending antenatal care was above 15% in eight Southern African countries. Infection was acquired primarily through heterosexual transmission.

In all regions, HIV disproportionately affects female sex workers and injecting drug users, as well as the female partners of infected males.

Women’s particular vulnerability to HIV infection stems from a combination of biological factors and gender inequality. Some studies show that women are more likely than men to acquire HIV from an infected partner during unprotected heterosexual intercourse. The risk posed by this biological difference is compounded in cultures that limit women’s knowledge about HIV and their ability to negotiate safer sex. Stigma, violence by intimate partners, and sexual violence further increase women’s vulnerability. Fewer young women than young men know that condoms can protect against HIV. Furthermore, while women generally report increased condom use during high-risk sex, they are generally less likely to protect themselves than men are.

The youngest women are the most vulnerable. They not only face barriers to information about HIV – and in particular how they can protect themselves from infection – but in many settings they often engage in sexual activity with older men who are more sexually experienced and more likely to be infected.

Female drug users and sex workers are particularly vulnerable; stigma, discrimination and punitive policies only increase their vulnerability. The rate of HIV infection among female sex workers is high in many parts of the world, and a large proportion of women who use drugs also engage in sex work. In prisons, the proportion of drug users among females is higher than among males. The use of contaminated injection equipment is particularly prevalent among women, resulting in higher rates of HIV infection.

Economic vulnerability is another key factor driving HIV infection among women. Economic vulnerability is sometimes associated with migration, which increases high-risk behaviours among women who may be driven into sex work by economic necessity. On a more positive note, in recent years women have benefited from increased access to HIV prevention, treatment and care. Data from 90 low- and middle-income countries suggest that, overall, women are slightly advantaged in terms of access to antiretroviral therapy: at the end of 2008, 45% of women in need and only 37% of men in need received antiretroviral therapy. In 2008, 45% of pregnant women living with HIV received antiretrovirals to prevent mother-to-child transmission of HIV, up from 10% in 2004. Nonetheless, challenges remain: only 21% of pregnant women received HIV testing and counselling, and only one third of those identified as HIV-positive during antenatal care were subsequently assessed for their eligibility to receive antiretroviral therapy for their own health.

To download the full report or executive summary, visit this page: http://www.who.int/gender/documents/9789241563857/en/index.html