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As minors, child brides are rarely able to assert their wishes, and are less likely than their peers to be aware of how to protect themselves from HIV and other STIs.64 These factors all increase HIV risk.
The risk of HIV acquisition during vaginal sex has been found to be higher for women than for men in most (but not all) biological-based studies.65 This high susceptibility can be explained by a number of factors including the ability of HIV to pass through the cells of the vaginal lining and the larger surface area of the vagina.66 A study published in 2018 has provided further insight into the specific biological conditions that increase HIV risk in women.
Previously, it was thought that the presence of the lactobacillus bacteria was the biggest factor.
This research provides evidence that microbial diversity is a key factor alongside the concentrations of key bacteria such as lactobacillus.
10 HIV disproportionately affects women and girls because of their unequal cultural, social and economic status in society.11 12 Intimate partner violence, inequitable laws and harmful traditional practices reinforce unequal power dynamics between men and women, with young women particularly disadvantaged.
HIV is not only driven by gender inequality, but it also entrenches gender inequality, leaving women more vulnerable to its impact.13 In some countries, women face significant barriers to accessing healthcare services.
This assumption arises from harmful gendered expectations of intimate relationships; namely, that men are responsible for providing material resources and women are responsible for providing sexual and domestic services.
Researchers found that older men had consistently higher HIV prevalence than younger men, thus exposing young women to an increased risk of HIV infection – particularly given the generally low levels of condom use which were also associated with this age difference.61However, a study into age-disparate relationships between young women and older men in South Africa found HIV risk to be similar across all age gaps once the disparity reached five years and above.62 Every year, around 12 million girls are married before the age of 18.63 Girls who marry as children are more likely to be beaten or threatened by their husbands than girls who marry later, and are more likely to describe their first sexual experience as forced.
A lack of privacy was also cited as a reason for not adhering to treatment, with no safe space at home or work to take medications without others seeing.55 A study in the regions of Brazil with the highest rates of gender-based violence and highest prevalence of HIV (São Paulo in the South-eastern region and Porto Alegre in the Southern region) found women were at increasingly more likely to experience gender-based violence during their lifetime if they were HIV-positive.56 Overall, in Brazil, 98% of women living with HIV reported a lifetime history of violence and 79% reported violence prior to an HIV diagnosis.57 Age-disparate sexual relationships between young women and older men are common in many parts of the world, with particularly high levels in both east and southern Africa and west and central Africa.
In many instances, these relationships are transactional in nature, in that they are non-commercial, non-marital sexual relationships motivated by the implicit assumption that sex will be exchanged for material support or other benefits.
Explore this page to find out more about why women and girls are at risk of HIV, HIV testing and counselling, treatment for women and girls living with HIV, reducing mother to child transmission, HIV prevention programmes and the way forward.
Since the start of the global HIV epidemic, women in many regions have been disproportionately affected by HIV.