Poverty, Gender Inequities, and Women's Risk of Human Immunodeficiency Virus/AIDS

Abstract

Entrenched economic and gender inequities together are driving a globally expanding, increasingly female, human immunodeficiency virus (HIV)/AIDS epidemic. To date, significant population-level declines in HIV transmission have not been observed, at least in part because most approaches to prevention have presumed a degree of individual control in decision making that does not speak to the reality of women's and girls' circumstances in many parts of the world. Such efforts have paid insufficient attention to critical characteristics of the risk environment, most notably poverty and gender power inequities. Even fewer interventions have addressed specific mechanisms through which these inequities engender risky sexual practices that result in women's disproportionately increased vulnerabilities to HIV infection. This article focuses on identifying those mechanisms, or structural pathways, that stem from the interactions between poverty and entrenched gender inequities and recommending strategies to address and potentially modify those pathways. We highlight four such structural pathways to HIV risk, all of which could be transformed: (1) lack of access to critical information and health services for HIV/sexually transmitted infection (STI) prevention, (2) limited access to formal education and skill development, (3) intimate partner violence, and (4) the negative consequences of migration prompted by insufficient economic resources. We argue for interventions that enhance women's access to education, training, employment, and HIV/STI prevention information and tools; minimize migration; and by working with men and communities, at the same time reduce women's poverty and promote gender-equitable norms. In conclusion, we identify challenges in developing and evaluating strategies to address these structural pathways.

A global comprehensive review of economic interventions to prevent intimate partner violence and HIV risk behaviours

“…In contrast, in Stepping Stones and Creating Futures [68] there was no specific skills training, but rather the intervention focused on promoting critical thinking and reflection around livelihoods and job opportunities. There was a greater focus on younger people in these programmes, with four interventions (out of eight) targeting youth participants [10–24] and typically both women and men were included [67–69,74]. …”

“…Studies highlight the overlapping drivers of IPV- and HIV-vulnerability, particularly poverty and gender inequalities [6,8–10]. There is overwhelming evidence that gender inequalities shape men’s perpetration of IPV and women’s experience of IPV as well as their vulnerability to HIV in heterosexual relationships [3,11–14].…”

“…This exacerbates the challenges of negotiating condoms, leaving violent and controlling relationships and exposing them to controlling behaviours: all risk factors for HIV acquisition and experiencing IPV [8–10]. More recently for men, qualitative research has argued that men’s partial exclusion from the capitalist economy has led men to develop identities that draw on and deploy forms of emphasised heterosexuality (occassionaly labelled a ‘hyper-masculinity’), which include control and domination over women, including IPV as a way to control women, as well as seeking multiple sexual partners [19–21].…”

Expressão geográfica da epidemia de Aids em Campinas, São Paulo, de 1980 a 2005

“…The greater spread of HIV in women in poorer areas has been reported in several studies. 9,10,12,13,15 In addition to greater biological vulnerability to HIV infection, due to the higher prevalence of asymptomatic sexually transmitted diseases and the higher risk of infection in sexual intercourse, there are subjective situations associated with gender inequalities that women are exposed to, especially those from lower social classes. HIV transmission in women increases in populations with lower level of education and income, with limited access to health services and policies to prevent HIV infection, apart from the variables related to the previously mentioned gender inequality.…”

“…11,12 After the fi rst decades, the epidemiological profi le of the disease changed, with a trend of HIV/AIDS dissemination in heterosexual men, women and children of all social classes, particularly affecting marginalized and vulnerable populations. 6,9,10,13 In a few years, it became one of the main causes of mortality in adults. 7,13 The male:female ratio of AIDS cases was 26.7:1 in 1985, decreasing to 1.5:1 in 2008.…”