Gender inequality fuelling HIV infections

Andile Tshuma
THE unequal cultural, social and economic status of women in society positions them such that they are at the mercy of those in power.

Discriminatory social and cultural norms are translated into laws that repress the autonomy of women and girls.

The education and empowerment of women and girls is fundamental in reducing inequalities that may put them in harm’s way and at risk of getting infected with HIV.

The World celebrated Sexual Health Day recently and it is therefore, a good time to be reminded that many women are still not sexually liberated and have their sexual lives dictated by the male figures in their lives to a point where they are at risk of getting infected with HIV.

The National Aids Council has said gender inequalities in society fuel HIV infections as many women are not able to negotiate safe sex in their relationships though they are aware many men are into risky sexual behaviour.

Statistics from Avert.org reveal that about 20 percent of married women have experienced sexual violence from their partners in the past 12 months.

The HIV research organisation revealed that 14 percent of adult women reported experiencing sexual violence at least once in their lifetime while eight percent reported experiencing it in the last 12 months.

This prevents many women from negotiating for safer sex such as the use of condoms, thereby exposing them to high risk of contracting HIV.

Such challenges also translate to unwanted pregnancies, risky illegal abortions and even increased poverty with more unplanned mouths to feed.

Zimbabwe however, fares better than its counterparts in the region when it comes to reproductive health as it has the lowest reported unmet need for family planning among married women in sub-Saharan Africa, at 15,2 percent.

The challenge however, is that a small percentage of the women are sometimes unable to seek such sexual health services if the men in their lives do not approve.

These factors contribute to situations where women are disproportionately affected by HIV compared to men.

To bring matters of these gender inequalities into perspective, the 2015/16 Population Based HIV Impact Survey found that HIV prevalence among adults who had intercourse before the age of 15 was nearly three times as high for women at 25 percent compared to nine percent for men.

Among people reporting two or more sexual partners in the 12 months before the survey, prevalence was more than twice as high among women (31 percent) compared to men at 12 percent.

Such statistics show that the country still has a long way to go in championing the rights of women, particularly their sexual reproductive health rights.

Gender inequalities and power relations are largely to blame for the high HIV prevalence among women who are infected mainly through unprotected heterosexual sex.

Commercial sex workers and men who have sex with other men find it difficult to freely access HIV services.

In 2019 alone, the country recorded 40 000 new HIV infections, which is quite steep, but still a significant drop from 62 000 infections recorded in 2010. Behaviour change communication, high treatment coverage and prevention of mother to child transmission have all contributed to this significant decline.

It is encouraging that deaths from Aids-related illness continue to fall, from 54 000 recorded in 2010 to 20 000 in 2019.

However, even with such significant drops recorded, women remain at higher risk of infection.

The country has also made strong progress towards the Unaids 90-90-90 target. The overall picture in the country is that a total of 85 percent of HIV-positive people are on treatment and 73 percent of them are virally suppressed.

Young people, particularly young women and girls, remain at higher risk of HIV infection.

In 2010, around a third of all new HIV infections in people above the age of 15 in the country were among young people under the age of 24.

There were 9 000 new infections among young women, more than double the number of new infections among young men which was 4 200.

Young people are more likely to engage in risky sexual behaviour than older adults, making them vulnerable to HIV, yet they have less frequent contact with the healthcare system in general, including HIV prevention and treatment services. Young men also coerce young girls into risky sexual behaviour and girls are vulnerable especially with the advent of vuzu parties which are believed to be mostly sex orgies.

Gender inequalities in sexual relationships also manifest in intergenerational relationships with close to 20 percent of teenage girls reporting to have engaged in sexual intercourse with men 10 years older than them.

Intergenerational relationships are believed to be the main drivers of HIV infections in the country, especially among the heterosexual demographic. In such relationships with older partners, power games are at play and teenage girls and young women may not have much room to negotiate safer sex, thereby exposing them to HIV.

Gender inequality also rears its head in sex work, where sex workers are also at risk of abuse and rape by clients while they are often harassed by police. Their vulnerability to HIV is exacerbated by police harassment as possession of condoms has often been used as proof of sex work. Sex workers and their representative organisations often do not have much say in the country’s HIV response yet they are at high risk.

Financial disparities and intimate partner violence further hinder women from negotiating safe sex, especially if they are financially dependant on an abusive partner.

Gender inequality in education and restricted social autonomy among women is directly linked to reduced access to sexual health services, including HIV testing and treatment.

In eastern and southern Africa, young women will acquire HIV seven years earlier than their male peers according to Avert.org.

The power imbalance between genders also means that women are not always able to make decisions about their lives, with child marriages and forced marriages still rife in some parts of the country and globally, further putting women and girls at even higher risk of getting infected with HIV.

As Zimbabwe joins the world in marking World Sexual Health, it should be a time to self-introspect and ensure plans are implemented to empower women to be in charge of their sexual health to help the country achieve its goals in the fight against HIV.