The feminization of AIDS. (Up Front).

More than eighteen million women are living with HIV/AIDS. In 1997 women accounted for 41 percent of all adult cases. That proportion had risen to nearly 50 percent by 2001 and continues to grow. Half of all new HIV infections occur among fifteen to twenty-four year-olds, and young women are especially vulnerable.

Sub-Saharan Africa is the hardest hit region, with 9 percent of the population infected. In several African countries, the share of the population that is infected is in the double digits. Women account for 58 percent of adult HIV/AIDS cases, and infection rates among young women are at least twice those among young men. In some parts of Kenya and Zambia, one in four teenage girls is infected compared with one in twenty-five teenage boys. Of the 2.3 percent of the population infected in the Caribbean (the world's second most affected region), women account for 52 percent of adult cases and 55 percent of infected fifteen to twenty-four year-olds. On some Caribbean islands, the infection rate among girls aged fifteen to nineteen is five times greater than among same aged boys as a result of sex between young women and older men.

The HIV/AIDS epidemic is growing fastest in Eastern Europe. Ukraine, heavily stricken with 250,000 infected, has a rising rate of HIV transmission through sexual activity. In the Russian Federation, reports of new infections have been doubling annually since 1998. The actual number of Russians living with HIV/AIDS is estimated to be four to five times higher than the reported figure of 173,000 in 2001. Mass unemployment, economic insecurity, and disintegrating public health systems leave young people in the region especially vulnerable. Many have fallen victim to intravenous drug use and commercial sex work, which both contribute to the spread of HIV and other sexually transmitted infections (STIs). Surveys in some cities in the Russian Federation show that most sex workers are between the ages of seventeen and twenty-three and that condom use is erratic at best.

Biological, economic, and social factors all contribute to women's vulnerability. Women have a large surface area of reproductive tissue that is exposed to their partner's secretions during intercourse, and semen infected with HIV typically contains a higher concentration of virus than a woman's sexual secretions. Young women especially are at greater risk because their reproductive organs are immature and more likely to tear during intercourse. Women also face a high risk of acquiring other STIs, which multiply ten-fold the risk of contracting HIV when left untreated.

The economic dependency of women on their sexual partners and husbands often means they have little bargaining power when it comes to negotiating condom use. Many live in fear of being abandoned or beaten if they resist their husbands' sexual demands. In times of extreme hardship, women may rely on "sugar daddies" to support them in exchange for sex; others turn to prostitution. The stigma of infection is also a barrier to seeking care because gender-based social norms and sexual customs prevent women from learning about reproductive health. Often sexual coercion and gender inequities are tolerated, and double standards make it acceptable for men to have multiple sexual partners.

More than thirteen million children under the age of fifteen are "AIDS orphans," having lost a mother or both parents to the disease. These orphans face economic and social hardships, malnutrition, and illness, and are usually taken out of school. While grandparents and other relatives may take them in, many are often left to fend for themselves.

Where women participate in agricultural production, food security at the household and community level is being seriously threatened by the spread of AIDS. Communal agricultural output in Zimbabwe, for example, has been cut in half over the past five years, largely due to AIDS.

Currently, the female condom is the only safe and effective woman-controlled HIV prevention option available. It is now nominally available in over seventy-five countries, but unlike other reproductive health commodities there has been relatively little public sector investment in this method by governments or international donor agencies, making it costly and relatively inaccessible. A microbicide applied in the vagina could prevent infection and still allow couples to have children, but no such product currently exists. The need is compelling and efforts are under way to develop one.

Ultimately, the real key lies in improving the status of women through education, economic empowerment, open communication, and the elimination of violence and sexual coercion. But the impact of AIDS is making it increasingly difficult to implement even the most basic of strategies to halt its spread, such as providing education. Already, affected countries are losing growing numbers of teachers to AIDS. In the Central African Republic, 85 percent of teachers who died between 1996 and 1998 were HIV-positive, dying an average of ten years before they were due to retire. Without a swift and concerted response to the epidemic, the burden of disease is likely to increase.

Twenty years after it was recognized as a new disease, AIDS has claimed the lives of almost twenty-five million people. World AIDS Day on December 1, 2002, highlighted "Live and Let Live." The campaign focused on eliminating stigma and discrimination, the major obstacles to effective HIV/AIDS prevention and care.

Radhika Satin is a staff researcher at the Worldwatch Institute, and this article was written as part of Worldwatch Paper 161: Correcting Gender Myopia (September 2002). Worldwatch is an independent research organization that works toward the evolution of an environmentally sustainable and socially just society. For more information visit www.worldwatch.org