HIV and AIDS

• + Gender issues
  • In sub-Saharan Africa, women are more likely than men to be infected with HIV, while in other regions of the world, men are more likely than women to be infected. At the global level, half of adults living with HIV are women. However, in sub-Saharan African countries with the highest HIV prevalence, women represent the majority of people living with HIV/AIDS (UNAIDS, 2010, 2011b). Levels of new infections in sub-Saharan Africa continue to remain higher among women than among men, especially in the younger groups (UNAIDS, 2010). In this region, the adult mortality rate due to AIDS is also higher for women than for men. In other regions, men are more likely than women to be infected with HIV, often in concentrated epidemics involving men who have sex with men or people who inject drugs, and adult men have a higher risk of mortality due to AIDS than adult women (UNAIDS, 2010).
    
    Women face a higher risk of becoming infected with HIV during unprotected sexual intercourse than men. In addition to being more biologically vulnerable than men to infection, women and girls may have difficulties in negotiating condom use with their partners. In particular, sexual violence and abuse hampers women’s ability to protect themselves from HIV infection and/or to assert healthy sexual decision-making. Furthermore, sex outside a marital union and multiple sexual partnerships are often tolerated for men (although not for women) and, hence, a woman can be vulnerable to HIV infection because of her husband’s concurrent sexual relations. These risks are higher in contexts where women have partners much older than themselves, have a lower status than men and are economically dependent on men owing to social or legal discrimination (United Nations, 2000; UN, Economic and Social Council, 2011; WHO, 2009; UNAIDS, 2010).
    
    Young women and young men may have different HIV-related knowledge and behaviour. In many countries, HIV-related knowledge is still lower among young women than among young men (UNICEF, Division of Policy and Practice, 2011; United Nations, 2011c). In general, knowledge of HIV prevention among young people has increased; however, it remains low in many developing countries (United Nations, 2011c).
    
    More girls than boys start their sexual life early, although the prevalence of early sex is declining for girls as well as boys (United Nations, Economic and Social Council, 2011; UNICEF, Division of Policy and Practice, 2011). In countries with a high HIV prevalence, young women are at particularly high risk of HIV infection when they have older male sexual partners who are more likely than younger men to be infected with HIV (WHO, 2009).
    
    Young men are more likely than young women to report having multiple sexual partners, but also more likely to report using a condom during sex with a non-marital, non-cohabiting partner (defined as higher-risk sex) (UNICEF, Division of Policy and Practice, 2011). In some countries, the proportion of women who report having multiple sexual partners and not using a condom has increased (UNAIDS, 2010).
    
    HIV/AIDS has placed significant burdens on family members, especially women (United Nations, 2008). The primary caregivers for sick patients are usually the women and girls within a family. HIV/AIDS has also led to a large number of orphans, who are cared for by other family members or institutions. In Africa, for example, it is often grandmothers who take responsibility for this care, in skipped-generation households.

• + Data needed
  • Data needed to analyse HIV/AIDS from a gender perspective are:
    
    (a) People living with HIV by sex and age;
    
    (b) HIV/AIDS deaths by sex and age;
    
    (c) HIV testing in the past 12 months by sex and age;
    
    (d) Access to antiretroviral drugs by sex and age;
    
    (e) Multiple sexual partnerships and condom use during last high-risk sexual encounter (i.e., sex with a non-marital, non-cohabiting partner) by sex and age;
    
    (f) Comprehensive correct knowledge of HIV/AIDS by sex and age;
    
    (g) Other data can contribute to an understanding of the causes and consequences of HIV/AIDS. Such data may refer to violence against women, early sex or time spent caring for household members who are living with HIV;
    
    (h) Additional data on sexual behaviour and HIV prevention, prevalence and treatment related to special risk groups, such as sex workers, men who have sex with men and people who inject drugs, should also be considered.

• + Sources of data
  • Sentinel surveillance may be used to collect data on HIV status and sexual behaviour for populations with high-risk behaviours, such as sex workers, injecting drug users and men who have sex with men.
    
    Population-based surveys with HIV testing, such as DHS and the AIDS Indicator Survey, provide data on HIV prevalence. These surveys, as well as MICS and reproductive health surveys, also provide other HIV-related data, such as on knowledge of HIV transmission and prevention, multiple sexual partnerships, use of a condom during sexual intercourse with a non-marital, non-cohabiting sexual partner in the past 12 months and access to antiretroviral therapy.
    
    Integrated Biological and Behavioural Surveillance surveys can provide data on key populations at higher risk of HIV infection, such as men who have sex with men, sex workers and people who inject drugs.
    
    Reports from health facilities, including antenatal clinics attended by pregnant women, may provide information on results from HIV-tested blood from a sample of patients and on access to antiretroviral therapy.
    
    Time-use surveys can provide data on time spent caring for household members who are sick or disabled, including household members who are infected with HIV. However, data specific to care given to HIV-infected persons are difficult to obtain.

• + Conceptual and measurement issues
  • Non-participation in HIV-testing in population-based surveys is often higher for men than for women (Mishra and others, 2008). This may induce a sex bias in estimates of HIV prevalence.
    
    Normative reporting (interviewed persons giving answers perceived to be socially desirable) may artificially increase or decrease the estimated gender gap in sex-related behaviour, such as condom use during last high-risk sexual encounter and multiple sexual partnerships.