Gender inequality and HIV transmission: a global analysis.

Linda‐Gail Bekker,Khai Hoan Tram,Tiffany Kung,Victoria L Boggiano,Andrew R Zolopa,Sean E Collins,Eugene T Richardson,James H Jones

doi:10.7448/ias.17.1.19035

Abstract

IntroductionThe HIV pandemic disproportionately impacts young women. Worldwide, young women aged 15–24 are infected with HIV at rates twice that of young men, and young women alone account for nearly a quarter of all new HIV infections. The incommensurate HIV incidence in young – often poor – women underscores how social and economic inequalities shape the HIV epidemic. Confluent social forces, including political and gender violence, poverty, racism, and sexism impede equal access to therapies and effective care, but most of all constrain the agency of women.MethodsHIV prevalence data was compiled from the 2010 UNAIDS Global Report. Gender inequality was assessed using the 2011 United Nations Human Development Report Gender Inequality Index (GII). Logistic regression models were created with predominant mode of transmission (heterosexual vs. MSM/IDU) as the dependent variable and GII, Muslim vs. non-Muslim, Democracy Index, male circumcision rate, log gross national income (GNI) per capita at purchasing power parity (PPP), and region as independent variables.Results and discussionThere is a significant correlation between having a predominantly heterosexual epidemic and high gender inequality across all models. There is not a significant association between whether a country is predominantly Muslim, has a high/low GNI at PPP, has a high/low circumcision rate, and its primary mode of transmission. In addition, there are only three countries that have had a generalized epidemic in the past but no longer have one: Cambodia, Honduras, and Eritrea. GII data are available only for Cambodia and Honduras, and these countries showed a 37 and 34% improvement, respectively, in their Gender Inequality Indices between 1995 and 2011. During the same period, both countries reduced their HIV prevalence below the 1% threshold of a generalized epidemic. This represents limited but compelling evidence that improvements in gender inequality can lead to the abatement of generalized epidemics.ConclusionsGender inequality is an important factor in the maintenance – and possibly in the establishment of – generalized HIV epidemics. We should view improvements in gender inequality as part of a broader public health strategy.

Highlights

The HIV pandemic disproportionately impacts young women
Our final model did not show a significant association between a country’s predominate mode of transmission whether it is predominantly Muslim, has a high/low gross national income (GNI) at purchasing power parity (PPP), or has a high/low circumcision rate. This analysis demonstrates that predominantly heterosexually driven epidemics are associated with higher Gender Inequality Indices in comparison to countries where MSM or IDU are the primary mode of transmission
The countries of the Middle East and North Africa are a notable exception: they uniformly show high Gender Inequality Indices coupled with a low HIV prevalence

Summary

Introduction

The HIV pandemic disproportionately impacts young women. Worldwide, young women aged 15Á24 are infected with HIV at rates twice that of young men, and young women alone account for nearly a quarter of all new HIV infections. A UNAIDS/South African Development Community (SADC) think tank Á convened to assess prevention in the high prevalence countries of southern Africa Á reported that ‘‘high levels of multiple and concurrent sexual partnerships by men and women with insufficient consistent, correct condom use, combined with low levels of male circumcision are the key drivers of the epidemic in the sub-region’’ [6, p. Halperin and Epstein examine these recommendations in regards to the high prevalence in southern and parts of eastern Africa [7] They highlight that Uganda, Kenya, and Ethiopia were able to achieve significant reductions in HIV incidence through socalled ‘‘zero grazing’’ campaigns (i.e. promotion of monogamy and partner reduction) and suggest the feasibility of implementing these elsewhere. That these countries fare poorly on the Democracy Index [8], and such gains may be more realizable in autocratic nations

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Conclusion