HIV disproportionately affects women and girls because of their unequal cultural, social and economic status in society.
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.
Lack of access to healthcare services
In some countries, women face significant barriers to accessing healthcare services. These barriers occur at the individual, interpersonal, community and societal levels.
Barriers take many forms including denial of access to services that only women require, discrimination from service providers that stems from views around female sexuality and poor quality services.
Procedures relating to a women’s sexual and reproductive health (SRH), performed without consent, including forced sterilisation, forced virginity examinations and forced abortion also deter women from accessing services. In some cases, healthcare providers do not fully understand laws around childbirth and HIV. This can lead to HIV-positive women choosing to have an abortion because they are misinformed about their options and how to protect their health, as well as their child’s.
Additionally, in 29 countries women require the consent of a spouse or partner to access SRH services.
A lack of access to comprehensive HIV and SRH services means that women are less able to look after their sexual and reproductive health and rights (SRHR) and reduce their risk of HIV infection.
A review of evidence from Latin America and Caribbean relating to HIV-positive women’s use of, and access to, SRH services found women living with HIV experienced more unplanned pregnancies, more induced abortions, a higher risk of immediate sterilisation after birth and higher exposure to sexual and institutional violence, compared to HIV-negative women.
Young women’s lack of access to healthcare
In many settings, where SRH and HIV services exist, they are primarily for married women with children and do not meet the specific needs of unmarried young women and adolescent girls. Healthcare providers often lack the training and skills to deliver youth-friendly services and do not fully understand laws around the age of consent.
In 45 countries, organisations cannot legally provide SRH and HIV services to people under 18 without parental consent. In some countries, doing this is an offence linked to encouraging ‘prostitution’ or the trafficking of minors. Some national laws also require healthcare providers to report underage sex or activities such as drug use among adolescents.
Closely related to this is the finding, taken from evidence gathered in 28 sub-Saharan Africa countries, that 52% of adolescent girls and young women in rural areas and 47% in urban areas are unable to make decisions about their own health.
As a result of age restrictions, in Kenya, Rwanda and Senegal, over 70% of unmarried sexually active girls aged 15 to 19 have not had their contraception needs met. This is despite the fact that in sub-Saharan Africa around half of young women living in rural areas and around 40% of young women living in urban areas will have been pregnant by the time they reach 18.
A study of young women in Soweto, South Africa, found they knew where to obtain SRH information and services but that common experiences of providers’ unsupportive attitudes, power dynamics in relationships, and communication issues with parents and community members prevented respondents from accessing and using the information and services they needed.
A study of SRH services in Indonesia found that, in large part, sexual activity outside of marriage, often referred to as ‘free sex’, was viewed as unacceptable by both service providers and young people themselves, due to dominant cultural and religious norms. As a result, service providers were often reluctant to provide SRH services to unmarried but sexually active young people, and unmarried young people were too ashamed or afraid to ask for help.
Research into attitudes towards sexual and reproductive health among adolescent girls in Ghana found varying degrees of negative social and community norms, attitudes and beliefs about adolescent girls’ sexuality. The study found that adolescent girls tended to endorse these stigmatising attitudes, and also observed or experienced SRH-related stigma regularly.
Adolescent girls and young women belonging to groups most affected by HIV (sometimes known as ‘key populations’) are also negatively affected by laws that criminalise injecting drug use, sex work and homosexuality.
Adolescent girls’ and young women’s vulnerability to human rights violations and HIV is further amplified by age. Despite this, even where programmes for key populations exist, the presence of ‘youth-friendly’ services to address the specific needs of young people from these groups are normally lacking.