Posted by Maria Codina on July 30, 2018 at 9:59 am
Throughout the world, women have disproportionately borne the impact of HIV, as caregivers and recipients of care. In sub-Saharan Africa, the region with the greatest number of people living with HIV, 60 per cent of people living with HIV are women. Adolescent girls and young women are particularly impacted. Without effective prevention of HIV, they are likely to pass along the virus to their babies, continuing the cycle of infection to the next generation.
This report examines HIV and AIDS throughout the lifecycle of the child and mother – pregnancy and infancy, childhood, and adolescence – and showcases women’s important role in the HIV response for children. It tells a compelling story about successes achieved over the course of the epidemic, the difficulties encountered and the challenges overcome, and what lies ahead on the continuing road to ending AIDS for children and for all.
The essays and reflections of extraordinary women leaders in the HIV response add a unique perspective to the report.
Graça Machel, who contributes an essay to this publication (see page 90), knows what she is talking about. As an advocate for women’s and children’s rights for decades, she and the women she celebrates are shining examples of how the input and capacity of women have been central to the development of new ideas, standards and strategies that have benefited millions of people worldwide. The essays by women leaders and trailblazers accompanying this report illustrate the extent to which this has been true throughout the history of the global HIV response for children and adolescents.
Yet the impact of the HIV epidemic on women and their contributions to countering it have often been unrecognized and underappreciated. One reason is that HIV was early on identified as an infection that devastated communities of men who have sex with men in high-income countries. For more than two decades now, however, it has been women who have disproportionately borne the impact of HIV, both as caregivers and recipients of care, in most higherburden settings. Women in Africa and most other regions constitute by far the largest share of caregivers, community-level workers and volunteers who provide critical HIV treatment, prevention and support services– both inside and outside their families.
Indeed, women have been the ‘heroines’ Machel lauds – and both they and the HIV response are the stronger for it. They almost certainly will continue to exhibit such strength moving forward, both to build on and sustain successes and to forcefully confront the major gaps and challenges that could inhibit greater progress towards ending AIDS.
The gender dimension
Women make up the majority (60 per cent) of people living with HIV in sub-Saharan Africa – home to 7 out of every 10 people living with HIV in the world – and they account for 34 per cent of people living with HIV in Europe and Central Asia. Without any intervention, these women will be at higher risk of mortality and more likely to pass on the infection to their infants. The burden of HIV in the child population is disproportionately affecting adolescents, particularly adolescent girls. Women in Eastern and Southern Africa are on average infected with HIV five to seven years earlier than men, with the risk especially high between the ages of 15 and 24.
In 2017 alone, 430,000 (confidence interval: 260,000–620,000) new infections occurred worldwide among children and adolescents up to 19 years of age (see Table 1.1). These contribute to the global total of 3.0 million (2.0–4.2 million) living with HIV in this age group, an estimated 87 per cent of whom live in sub-Saharan Africa.
Globally, most (59 per cent) of the 430,000 new HIV infections that occurred in children (0–19 years) in 2017 were in the adolescent age group (10–19), and of the 250,000 (150,000–360,000) infections acquired during adolescence, most (66 per cent) were among girls (see Table 1.1). Similarly, most (60 per cent) of the 3.0 million children living with HIV are adolescents, and of the 1.8 million (1.1–2.5 million) adolescents living with HIV, most (1.0 million) are girls.
If these patterns continue, AIDS will become even more of a ‘woman’s disease’ in reality and perception, which could have regressive social, cultural and economic consequences for women and girls, as well as for efforts to reduce gender inequality. The good news is that women are engaged in both seeking HIV care and support for themselves and providing it to others, including children and adolescents. Among people living with the virus in the most affected regions, women and girls are 24 per cent more likely than men and boys to know their HIV status and 39 per cent more likely to be accessing treatment.