THE view of poor and developing countries is that women and adolescent girls are more vulnerable to HIV infection on each sexual encounter because of the biological nature of the process and the vulnerability of the reproductive tract tissues to the virus, especially in adolescent girls.
For example, young women are generally disadvantaged by gender disparities in terms of food intake and access to health care. Growth patterns of girls are often worse than that of boys. The inequalities become evident soon after the birth, and by adolescence many girls are grossly underweight. Social, cultural and economic forces make women more likely to contract HIV infection than men. Women are often less able to negotiate for safer sex due to reasons such as their lower status, economic dependence and fear of violence.
Adolescent girls in poor families in developing countries often do not have the option to make real choices about their sexual and reproductive lives, such as when and whom to marry, whether and when to have children and how many to have, and whether to use contraceptives. Women tend to marry very young: nearly two thirds of adolescents in most South Asian countries marry before 18 years of age, and many even before 15 years, despite laws prohibiting such early marriage.
In many poor regions women's limited economic opportunity and relative powerlessness may force them into sex work in order to survive through household financial disaster. This exposes them to HIV infection and they in turn transmit HIV to their clients. In those areas girls are particularly vulnerable to HIV infections because of intergenerational sexual relationships, violence, and limited access to information. In addition, discrimination and stigma obstruct adolescent girls' access to health services. Poverty causes increased migration to look for work.
Gender analysis in relation to HIV/AIDS has tended to focus on women of reproductive age, and infrequently on young girls, because young women and girls are increasingly being targeted for sex by older men seeking safe partners and also by those who erroneously believe that a man infected with HIV/AIDS will get rid of the disease by having sex with a virgin. So HIV/AIDS epidemic has been fuelled by gender inequality or discrimination. Unequal power relations, sexual coercion and violence are widely faced by women of all age-groups, and these have an array of negative effects on female sexual, physical and mental health.
In many developing countries poverty and gender discrimination between women and men are both strongly linked to the spread of HIV/AIDS. Gender and age analysis shows the ways in which women and girls of different ages are vulnerable to the infection, and it requires support to help the survivors overcome the financial and social effects of the epidemic. The approach for checking HIV/AIDS and that of poverty alleviation are interconnected. Therefore health and development workers should work on a set of integrated policies and programmes to reduce poverty and address HIV/AIDS. They should emphasise the need for special efforts to protect women and girls exposed to the risk of HIV/AIDS and ensure that the legal, civil and human rights of those affected and infected are duly protected and that women have access to treatment, counselling and support on an equal footing with men.
The writer is HIV/AIDS researcher of the Rainbow Nari O Shishu Kallyan Foundation