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. 38.6 Million adults infected(2002)
. 19.2 Million women (nearly 50 %)
. Percentage not equity but gender inequality.
. Increasing infection rate among women.

 .Gender refers to societal beliefs about

the roles and responsibilities that are
appropriate for women and men.
 Gender dynamics – different roles,
expectations, identities, needs,
opportunities and obstacles that society
assigns to women based on sex.
 Sex is biological, gender is socially
 Social inequalities and power relations
have impact on HIV transmission.
 Poverty, migration, urbanisation,
 Social background, age, race, gender
and sexuality.
 Prevailing relationship within and
between sexes or gender relations also
affect the epidemic.
 Interplay of variables.
Sex differences in HIV/AIDS.
 Efficiency of male – female infection is
more than two times that of female –
 Biological reasons –
 large mucosal surface of vagina,
 High concentration of the virus in semen.
 Langerhans’ cells of the cervix may provide a
portal of entry for HIV.
 Vulva and vaginal inflammation/ulceration
 STI.
 Initial infection in women by multiple variant of
HIV virus while men are not.
 Women develops AIDS at lower CD4 count
than men and also show a faster rapid decline.
 Women are likely to
experience significant weight drop than men.
.More prone to HPV infection – cervical cancer.
.Women metabolizes zidovudine faster than men.
Gender roles

 Increases risk of HIV.

 Three areas of influence of gender role
in epidemiology of HIV infection.
 Knowledge (sexual knowledge), Sexual
passivity/aggression and promiscuity.
 Some gender roles are incompatible with
safe sex eg child bearing.
 Insufficient or incorrect information is a risk
 Many young people lack adequate knowledge
about transmission, prevention and risks
associated with HIV/AIDS eg the virgin myth.
 Improper in most societies for a woman to
demonstrate sexual knowledge.
 Young women are hesitant to seek information
on sexual health.
Sexual passivity/aggression
 In most societies women should display sexual
 Women tacitly discouraged from taking active
steps to defend themselves from infection.
 Women unable to negotiate sex in cultures that
permits male superiority.
 For men sexual stereotype is aggression.
 Many partners.
 Dominance, physical strength, virility and risk taking.
 Drug/alcohol.
 Sexual violence – increased HIV EPIDEMIOLOGY.
 Cultural permissiveness for men while chastity
for women is valued.
 Male experimentation.
 Double standards puts both male and female at
 Anal sex where virginity is valued.
 Older men may seek young girls.
 Male – male sex.
 Popular notion that HIV is for promiscuous
people leads to stigmatization.
Women social/ economic
 Women economic, political and social
positioning forms the backdrop.
 Healthy choices limited.
 Low economic and social indicators –
literacy level, income, education.
 Difficulty controlling when, where, and
how sex takes place.
 Most HIV + women got infected through
heterosexual sex – husbands.
Enabling environment for HIV
 Economic factors – affects mostly the
most impoverished.
 HIV/AIDS can lead to poverty.
 Poverty
 Too expensive drugs
 Economic status of women influence when
to have sex.
 Migrant labourers especially men
Cultural/societal factors.

 Traditional practices – bed sharing, dry

sex, FGM, marrying of virgins to older
Changing social structures of
 Children as bread winners of the family
 Grand parents taking care of children.
Political factors

 War. Armed conflict

 Women access to political power.
 Political will to establish HIV/ AIDS
Men and HIV epidemic

 Too much critisms for men.

 Many gender equality programmes
geared only towards women.
 Difficult for women alone to persuade
men to use condomes.
 Change of terminology from ‘women in
development to gender development.
Gender and masculinity
 Gender roles are not ‘natural’ but are
culturally produced – no consensus on
what causes them.
 Links between gender roles and broader
sexual inequalities had not been fully
 Effort to explain position of men difficult
as ‘sets of ideologies governing
thoughts, actions and behaviors’ are
constituted and reproduced over time.