Joyce Kosolo is a grandmother raising four children while her daughter is looking for work in the city. Her daughter is HIV+, but her grandson Kwanele is negative. Women are more likely to live with HIV than die from it. (Photo/ PWRDF)

More Women Infected, More Men Die: HIV’s Unlikely Gender Story In Africa

THE 21st International AIDS Conference just ended in Durban, coming sixteen years after the last one held in the South African city.

There has been remarkable progress since then in rolling back the disease, particularly in the past few years. AIDS-related deaths have dropped 43% since the first global treatment target was set in 2003.

In eastern and southern Africa, the world’s most affected region, the number of people on treatment has more than doubled since 2010, reaching nearly 10.3 million people. AIDS-related deaths in the region have decreased by 36% since 2010, according to data from UNAIDS.

But there’s a gender gap both in new infections and treatment, which reflects hidden social dynamics that make women and girls more vulnerable to infection, but also more likely to get treatment live longer with HIV compared to men.

In sub-Saharan Africa, adolescent girls and young women accounted for 25% of new HIV infections among adults, despite being 17% of the total population. Women in general make up 56% of new HIV infections among adults.

SOCIAL FORCES

There are social forces that make women (young ones, especially), vulnerable to HIV infection. Foremost of which are patriarchal gender norms that see a woman’s sexuality as something to be traded in return for resources – whether literally for cash and material support, or implicitly for social status and respectability in marriage.

The unequal power dynamic makes women unable to negotiate for safe sex, and restricts access to sexual and reproductive health services.

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But there’s a flip side. The reduction in deaths since 2010 has been greater among adult women (33% decrease) compared with adult men (15% decrease). This reflects higher treatment coverage rates among HIV+ women (52%) compared to HIV+ men (41%).

Part of the gap is because women are routinely tested for HIV when pregnant. That gives them a “default” opportunity to know their status and start treatment.

But the same gender norms that make women vulnerable to HIV infection make men less likely to know their status, start treatment, or stick to treatment schedules.

Men are “supposed” to be strong and in charge, and being HIV positive would mean that you are weak or a victim – the ultimate humiliation.

REVENGE

No wonder then, that there are many stories about a man who finds out he is HIV positive and decides to “go out” in a blaze of grisly glory, infecting as many others as possible as “revenge” for getting the virus (the subtext being that this is not ‘supposed’ to happen to a man). This has the risk of re-infection, blunting the preventative effects of treatment.

It means that despite having lower infection rates than women, men account for 58% of adult AIDS-related deaths. It’s an unlikely irony – the lower status of women makes them better able to cope with the uncertainty of a HIV diagnosis, possibly because adversity is an every day reality anyway.

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