By IPS Correspondents
BRUSSELS, Nov 23 2004 (IPS)

The poor urgently need a female-centred strategy to fight AIDS, says a landmark new report.

Women are increasingly affected by HIV and this destructive trend can only be reversed if prevention is targeted at women, says the ‘AIDS Epidemic Update 2004’ released Tuesday by the United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organisation (WHO).

Raising awareness will not be enough; boosting women’s economic opportunities and their social power should be a part of sustainable strategies, the report says.

The number of women living with HIV has risen in all regions over the past two years, the report says. In sub-Saharan Africa, the worst affected region, six in ten adults living with HIV are women. Three quarters of all 15-24 year-olds living with HIV in this part of the world are female. Young women are three times more vulnerable to HIV infection than their male counterparts.

The number of people living with HIV globally has reached almost 40 million, the highest level ever. The biggest increases this year were in East Asia (with an epidemic reported in China, Indonesia and Vietnam) and Eastern Europe and Central Asia (particularly Ukraine and the Russian federation).

Elsewhere the report shows a mixed picture. Southern Africa remains the worst-hit region, with HIV prevalence above 25 percent. But in East Africa, notably in Uganda and parts of Ethiopia and Kenya, HIV prevalence is falling.

"Obviously more resources will be needed in the future, but right now the key challenge is making the money work – ensuring that available funds are spent effectively on where they are needed most," said Dr Peter Piot, UNAIDS executive director at the launch of the report.

The most effective spending is on programmes that target women, the report says. Females are by nature more susceptible to HIV infection: male-to-female transmission during sex is about twice as likely as female-to-male transmission.

"Just as non-circumcised men have a bigger chance of catching the virus during intercourse than their circumcised colleagues, women are physically more susceptible to HIV, because the virus is more easily transmitted through the cervix," Thérèse Delvaux, an AIDS expert at the Institute for Tropical Health in Antwerp told IPS.

But social and economic realities are far more deadly than the physical makeup. In Southern Africa, many women and girls use sex as a commodity in exchange for goods, services, money, or basic necessities – often with older men.

This ‘transactional sex’ is mainly driven by poverty. "It is important to recognise that sex plays other social functions too, it is entangled in people’s need to seek trust, in their search for status and self-esteem, and in their efforts to escape loneliness and relieve boredom," the report notes. "Sex can be one of the few valorised form of capital for millions of people."

Abstinence or safer sex is not an option for millions of women, the report says. It cites a study in Zambia that revealed that only 11 percent of women believed they had the right to ask their husband to use a condom, even if he had proven himself to be unfaithful and was HIV-infected.

Another example of deadly social norms that make women vulnerable is the ‘age gap’ common among couples in Asia and Africa, the report says. Young girls often marry significantly older men (because they help their families meet essential needs) and are more at risk of infection "especially when the perception of younger women as ‘pure’ encourages men to avoid using condoms."

Research has demonstrated also that HIV infection is strongly related to violence against women, the report says. Violence at the hands of partners, sexual assault and other forms of abuse directly spreads HIV and AIDS but also "prevents many women from accessing HIV information, from getting tested and seeking treatment."

Co-author of the report Karen Stanecki told IPS that "in five to seven years there might be gels, creams, suppositories and rings (so-called microbicides which have an anti-HIV activity) that put prevention completely in the hands of women, but more research is needed."

The prevention approach – be it condoms, creams, abstinence, being faithful or reducing the number of sexual partners – will remain insufficient as long as women remain disempowered, UNAIDS and WHO say in their report. Transaction sex, the age gap, forced sex and domestic violence can be tackled by boosting the power of women.

"Strategies to address gender inequalities are urgently needed if we want a realistic chance at turning back the epidemic," said Piot. "Concrete action is necessary to prevent violence against women, and ensure access to property and inheritance rights, basic education and employment opportunities for women and girls."

The report was released in advance of World AIDS Day Dec. 1.

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