In 2020, UNAIDS reported that 53% of all people living with human immunodeficiency virus (HIV) were women and girls [1]. About 79% of female adults had access to treatment while only 68% of male adults had access to treatment [1]. These statistics are a result of prevailing patriarchal norms and their impact on both men and women. Systemic gender inequality that limits women’s access to health services is a main factor in disproportionate HIV prevalence in women [2], whereas men are targeted by masculine norms and stigma that deter them from utilizing HIV testing services [3], thus preventing them from accessing adequate treatment. Advocacy for gender equality and efforts to reduce stigma are essential in ending HIV/AIDS as a public health problem.
Gender inequalities including intimate partner violence and inequitable laws are major factors in the disproportionate effects of HIV on young women and adolescent girls. Intimate partner violence against women is a major barrier that prevents women from seeking HIV testing and counselling, disclosing an HIV-positive status, and accessing and adhering to HIV treatment [4]. With limited access to these services, women are unable to receive adequate support and treatment, resulting in the disproportionate impact of HIV in this population. In addition, laws and policies that affect women are a component in HIV disparities. Parental, spousal, and other third-party consent requirements for access to HIV and sexual and reproductive services deter many women from utilizing these services [4]. Similarly, age restriction laws that prevent underage women from accessing important HIV prevention resources such as contraceptives and needle exchange programs put women at a high risk of acquiring HIV [5]. Intimate partner violence and laws both limit women’s access to health and social services resulting in an increased vulnerability to HIV [5]. These factors perpetuate gender inequalities and contribute to the disproportionate prevalence of HIV in women, but they also result in stigma and false ideas of masculinity that are harmful to men’s health-seeking behaviors.
The scale-up of antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) use in men is crucial to eliminating HIV as a public health problem. In sub-Saharan Africa, men are less likely than women to know their HIV status, access HIV treatment in a timely manner, and adhere to treatment [6]. These disparities are a result of some challenges faced by men including a lack of access to regular health services like family planning and prenatal care provided to women, a construct of masculinity that causes men to downgrade their health concerns, and HIV stigma and homophobia that prevent men from seeking HIV services [6]. Some approaches that have been implemented to encourage male uptake in HIV services include HIV-testing in male centered clinics, HIV self-test kits, and at home ART programs [6]. While these strategies are important in improving current male engagement in HIV prevention and treatment resources, reducing stigma and addressing harmful patriarchal norms are imperative in creating meaningful changes in health disparities.
Various organizations such as the United Nations Entity for Gender Equality and the Empowerment of Women (UN Women) and the Global Coalition for Women and AIDS (GCWA) have emerged to address the effects of gender inequality on the HIV/AIDS epidemic. UN Women was created in 2010 and promotes gender inequality as a central tenet of social, economic, and cultural development [7]. The five main goals of UN Women are to increase women’s leadership and participation, ending violence against women, including women in peace and security processes, promoting women’s economic empowerment, and making gender equality central to national planning and budgeting [7]. UN women became a cosponsor of UNAIDS in 2012 and have since worked to ensure that gender equality is central to global action regarding HIV/AIDS [7]. Another important organization is the Global Coalition for Women and AIDS, founded in 2004, that unites civil society groups, AIDS service organizations, networks of women from populations at high risk, and men’s organizations that focus on gender equality [8]. GCWA works on efforts to position women as central in the HIV epidemic and addresses issues regarding women’s sexual and reproductive health rights [8]. These two organizations, along with many more, have played a crucial role in centering the HIV/AIDS epidemic as a social issue and advocating for gender equality as a strategy to end the epidemic as a public health concern. The effect of gender inequality on public health disparities is evidently a pressing issue for both women and men. National and global support for accessibility, equitable policies, and mitigating stigma is essential in reducing the disproportionate prevalence of HIV between women and men. Advocacy for gender equality and the dismantlement of patriarchal norms are central to ending the HIV/AIDS epidemic and preventing future public health disparities.
Source
1. https://www.unaids.org/en/resources/fact-sheet
2. https://www.avert.org/professionals/hiv-social-issues/key-affected-populations/women
4. https://www.unaids.org/en/resources/documents/2017/when-women-lead-change-happens
5. https://www.avert.org/professionals/social-issues/gender-inequality
6. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32994-5/fulltext
7. https://www.unaids.org/en/aboutunaids/unaidscosponsors/unwomen
