2journals.sagepub.com/home/tai black women were under-recruited by around 35%. They also found that despite most of the global burden of HIV being in low and low-middle-income countries, most of the trials were carried out in high and high-middle-income countries. A systematicreview 5 of HIV cure research published in 2015 found that women, as well as older people and those of non-white ethnicities were profoundly under-represented.This pattern of under-recruitment is not only seen in HIV, but in many disease areas including cardiovascular disease, 7 cancer, 8 and mental health conditions. 9 Sex and gender differences 10 in the prevalence,incidence, 11 symptomatology, andprogression 12 of a range of diseases have been described, as have differences in responses to treatment. These differences in treatment responses are likely to be attributable to differences in how the body deals with a drug (pharmacokinetics) and the effect of the drug on the body (pharmacodynamics). This may affect the efficacy and tolerability of thedrug. 13 Importantly, sex 14 and gender 15 inequalities 16 in social and economic power also have a large impact on health outcomes, affecting health-seeking behaviour, access to, and utilisation of healthcare services.journals.sagepub.com/home/tai 13Visit SAGE journals online journals.sagepub.com/ home/tai
This article outlines progress in realizing the sexual and reproductive health and rights of women and girls living with HIV over the last 30 years from the perspective of women living with HIV. It argues that the HIV response needs to go beyond the bio-medical aspects of HIV to achieve our sexual and reproductive health and rights, and considers relevant Joint United Nations Programme on HIV/AIDS (UNAIDS), World Health Organization, United States President’s Emergency Plan for AIDS Relief (PEPFAR), Global Fund and other guidelines, what engagement there has been with women living with HIV and whether guidelines/strategies have been adopted. It has been written by women living with HIV from around the world and a few key supporters. Co-authors have sought to collate and cite materials produced by women living with HIV from around the world, in the first known effort to date to do this, as a convergence of evidence to substantiate the points made in the article. However, as the article also argues, research led by women living with HIV is seldom funded and rarely accepted as evidence. Combined with a lack of meaningful involvement of women living with HIV in others’ research on us, this means that formally recognized evidence from women’s own perspectives is patchy at best. The article argues that this research gap, combined with the ongoing primacy of conventional research methods and topics that exclude those most affected by issues, and the lack of political will (and sometimes outright opposition) in relation to gender equality and human rights, adversely affect policies and programmes in relation to women’s rights. Thus, efforts to achieve an ethical, effective and sustainable response to the pandemic are hindered. The article concludes with a call to action to all key stakeholders.
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