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| At Risk Groups - Women & Youth |
At Risk Groups - Other Groups |
HIV/AIDS disproportionately impacts certain groups. Early in the epidemic, HIV was most closely identified with men who have sex with men. In the early 1980s, heroin addicts, hemophiliacs and Haitians were other groups at high risk of infection.1 The risk of transmission through blood transfusion is very low in most countries, particularly where there is low prevalence of HIV or where HIV testing is conducted on donated blood. Yet, infection through transfusions remains a problem in sub-Saharan Africa.
In recent years, the risk of infection has increased for other groups. Most people in these groups are underrepresented in prevention or treatment interventions. They often suffer social stigma, isolation, poverty and marginalization, which place them at higher risk. Lack of economic opportunity may impede the use of prevention methods and access to treatment and care. The main challenge rests in finding the most effective and appropriate ways to prevent and treat infection in these vulnerable groups without inadvertently increasing their stigmatization.1
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Avert learn about groups affected in the initial wave of AIDS
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Women and Adolescent Girls1
Around the world, women and girls are at high risk of HIV infection. Over the past 10 years, the proportion of women living with HIV has remained stable.2 Women comprise nearly 50 percent, or 15.5 million, of the 33 million people living with HIV/AIDS.2
- In 2007, women in sub-Saharan Africa comprised 61 percent of adults age 16 and older living with HIV.3
- Young women and girls make up a growing proportion of those infected in Asia, Eastern Europe and Latin America and 43 percent of those living with HIV/AIDS in the Caribbean.3
Women and Men Living with HIV/AIDS by Region, 2007
Im concerned that, a good quarter century later, women continue to bear the brunt of HIV. I work with HIV-infected women who live on less than 50 cents per day in resource-scarce settings. For them, opportunities for economic empowerment are few and far between, leaving them to stare in the eyes of the twin social ills of poverty and disease. In these households, when men who happen to be the sole breadwinners pass on, the women are literally left destitute.
Asunta Wagura Executive Director Kenya Network of Women Living with AIDS 4
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There are several reasons women and girls are at increased risk, including:
- They often are powerless in decisions to have sex or use a condom.
- Women who are married and faithful to their husbands are at risk of HIV infection:
- In Uganda, the highest rates of increase of HIV transmission occur among married women.
- Though marriage may appear to offer sexual health benefits for women, research in Kenya and Zambia revealed that this is not always the case. Married women are particularly at risk if their husbands have extramarital affairs or inject drugs and neglect to use condoms.5
- More than 50 million married girls are 17 years of age or younger. Because married girls more frequently have unprotected sex with their husbands, who are older and more sexually experienced, their risk of HIV infection is high.6
- They may experience violence in their relationships with men that result in unwanted or coerced sexual intercourse.
- In Zambia, Kenya and South Africa, 20 to 25 percent of women reported that their first sexual experience involved physical force.7
- Women and girls have greater biological susceptibility to HIV infection.
- Male-to-female transmission of the virus is twice as likely as female-to-male.8
- Tears and lesions, resulting from forced sexual encounters, increase the likelihood of HIV transmission, especially among younger women and girls.9
- They face social and economic inequities that reduce access to education, prevention and treatment services, and increase the likelihood that they will marry at a young age.2, 10
- Poor girls are often unable to access education, which decreases their access to productive employment.
- They are often denied the protection of property and inheritance rights.
- A young womans HIV infection or the death of her husband from AIDS may leave her without a home, unable to support herself and her children.
- Without job skills or the opportunity to acquire skills women and girls may resort to transactional or commercial sex to provide for themselves and their families, greatly heightening the risk of contracting HIV.
- More than 85 percent of pregnant women with HIV live in sub-Saharan Africa.11 Life-saving drugs to prevent mother-to-child transmission of HIV have not been available, resulting in about half a million newborns who have become infected.11
- They may lack knowledge of HIV.
- In Burkina Faso, Haiti, Mozambique and Nigeria, four in five women lack a basic understanding of HIV/AIDS.12
- Only two-thirds of young women in West and East Africa and Central Asia knew that a person infected with HIV can appear to be healthy.12
- In Swaziland, 70 percent of girls in school were not sexually active, while the same proportion of girls out of school were sexually active.13
Programs to stem the rise of new infections among women and girls are especially needed: keeping girls in school, providing for economic independence through vocational training and micro-credit, assuring that youth have accurate information and access to services, and addressing sexual coercion and gender-based violence.7
Fertility. Due to a high level of AIDS deaths among women in their reproductive ages, the disease has led to overall decrease in levels of fertility. Few studies have examined the relationship between HIV spread and the changing levels and patterns of fertility, though findings suggest that fertility may be reduced by as much as 25 40 percent.14 HIV reduces fertility by increasing the likelihood of pelvic inflammatory disease (through co-infection with other STIs), which reduces the likelihood of conception, and by increasing the risk of miscarriage.
Children | read information
Young People12
In 2007, it was estimated that 5.5 million young people were living with HIV 3.4 million in sub-Saharan Africa alone. Of newly infected adults in 2007, roughly 45 percent were estimated to be aged 15-24.2, 15
Estimated Regional Comparison of HIV/AIDS in Young People (aged 15-24), 200715
- In 2007, sub-Saharan Africa was home to over 60 percent of young people living with HIV, an overwhelming majority of whom were female.2, 15
- In 2005, the Working Group on HIV/AIDS of the UN Millennium Project Task Force on HIV/AIDS, Malaria, TB and Access to Essential Medicines proposed a target of reducing prevalence among young people to 5 percent in the most affected countries and by 50 percent elsewhere by 2015.16
- Where injection drug use and men having sex with men are primary modes of HIV transmission, young males are at a greater risk for infection.17
- Where heterosexual sex is a primary mode of HIV transmission, young females are at a greater risk for infection than young males.17
- In Eastern Europe and Central Asia, most people infected with HIV are younger than 30; the primary mode of transmission is injecting drug use.2
- In sub-Saharan Africa, it was estimated that approximately three of four new infections in 2004 occurred among young women aged 15 24, as young women are popular targets of forced sex most often with much older men and often with their husbands.7, 18
Disparities in HIV Prevalence Among Young People (aged 15-24) in Select
Sub-Saharan African Countries, 200715
HIV does not affect all adolescents in the same way.19 Those infected as young children typically have developed advanced AIDS by the time they reach adolescence. Those infected as teens tend to develop disease symptoms more gradually than the average HIV-infected adult. Regardless of age at time of infection, all adolescents and young people with HIV have similar needs:19, 20
- Access to medical treatment, protection from opportunistic infections, and counseling to aid with faithful adherence to treatment regimens and a proper diet.
- During a time when they are developing sexually, physically and mentally, it is important for HIV-infected adolescents to receive counseling and information about living with their disease, and disclosing and preventing the spread of HIV to others.
I have faced so many challenges because of my HIV status. The community that I live in still has a lot to learn about HIV and AIDS. Being HIV positive at 17 when every girl in the village is still expected to be a virgin has left most people wondering what my story is exactly.
Rudo Moyo an orphaned Zimbabwean girl who contracted HIV when she was raped by her male cousins a student and peer counselor Girl Child Network 21
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Orphans of the AIDS Epidemic | read information
More than half of all of the orphans in sub-Saharan Africa are between the ages 12 and 17.19, 22, 23 To develop into healthy and successful adults, adolescents living with HIV and adolescent orphans require attention, care and support that differs from what is needed by their younger counterparts. They need access to health care, particularly if they are infected with HIV. They need educational and employment opportunities to sustain themselves and build a productive future.
- About 90 percent of orphans are cared for by a single parent or other family members; most double orphans are cared for by grandparents.22
- Though orphans may be living with family members, they may not receive sufficient or adequate food, vigilance or support, putting them at increased risk of engaging in unsafe sexual and drug-related behaviors.23
- Some are forced to move several times, from home to home or from guardian to guardian.23
- Orphans, particularly double orphans, in many sub-Saharan African countries are less likely to attend school, although the rates vary widely by country.7
- Older siblings, especially girls, may be tasked with providing care for their parents and for younger siblings, preventing them from completing school or learning vocational skills.
- In Kenya, nearly one in five children who lost one or both parents were living in a home where they or their siblings were the head of household.23
- Psychosocial consequences play out in the lives of orphans as a result of caring for ailing parents, which can have long-lasting negative effects on development and socialization.16 Poor mental health of adolescents and young people is associated with lower educational attainments, drug use and poor sexual and reproductive health.24
- Orphans living on the streets or those who have become heads of households are especially at risk for homelessness and exploitation.25 These adolescents are more vulnerable to HIV infection through injection drug use or sexual transmission, particularly if they are girls.22
Potential Problems for Adolescents Affected by HIV/AIDS26
Preventing Infections in Youth Through Education
Many young people are misinformed about HIV.12 Although HIV education is being scaled up in schools, at least half of youth who attend school do not have HIV education in their curricula.
- The World Health Organization recommends that social interventions educate teens about HIV/AIDS, encourage them to delay their first sexual experience, and ensure that those who do engage in sexual activity have adequate means to prevent HIV infection.17
- More research on youth in developing countries is needed, particularly as the risks of becoming infected with HIV vary by contextual factors, such as cultural and religious beliefs, environmental risks, and behaviors that vary by region.12
| 1 |
Chin J. 2007. The AIDS Pandemic: the collision of epidemiology with political correctness. Oxford: Radcliffe Publishing. |
| 2 |
UNAIDS, World Health Organization. 2008. Report on the Global AIDS Epidemic. Available from: www.unaids.org/en/KnowledgeCentre/HIVData/GlobalReport/2008/2008_Global_report.asp |
| 3 |
UNAIDS, World Health Organization. 2007. AIDS epidemic update. Available from: data.unaids.org/pub/EPISlides/2007/2007_epiupdate_en.pdf |
| 4 |
Wagura A. Positive Voice. The long road from Nyeri, to Nairobi, to New York. Global AIDSLink. Global Health Council. July/August 2006 (98) 27. |
| 5 |
Wellings K, Collumbien M, Slaymaker E, Singh S, Hodges Z, Patel D, et al. 2006. Sexual behaviour in context: a global perspective. Lancet 368:1706-28. |
| 6 |
Mathur S, Greene M, Malhotra A. 2003. Too young to wed: the lives, rights and health of young married girls. ICWR. Available from: www.icrw.org/docs/tooyoungtowed_1003.pdf |
| 7 |
UNAIDS. 2006. Report on the global AIDS epidemic. Available from: www.unaids.org/en/HIV_data/2006GlobalReport/default.asp |
| 8 |
Global Coalition on Women and AIDS. 2004. HIV prevention and protection efforts are failing women and girls. Press Release. Available from: http://data.unaids.org/Media/Press-Releases02/pr_gcwa_02feb04_en.pdf |
| 9 |
National Institute of Allergy and Infectious Disease. 2004. HIV infection in women fact sheet. Available from: www.niaid.nih.gov/factsheets/womenhiv.htm |
| 10 |
Bernstein S, Hansen CJ. 2006. Public choices, private decisions: sexual and reproductive health and the Millennium Development Goals. New York: U.N. Millennium Project. |
| 11 |
World Health Organization. 2007. Towards universal access: scaling up priority HIV/AIDS interventions in the health sector. Available from: www.who.int/hiv/mediacentre/universal_access_progress_report_en.pdf |
| 12 |
UNAIDS Inter-agency Task Team on Young People. 2006. Preventing HIV/AIDS in young people. WHO Technical Report Series; no 938. Geneva: World Health Organization. Available from: www.who.int/child-adolescent-health/New_Publications/ADH/TRS/ISBN_92_4_120938_0.pdf |
| 13 |
UNAIDS. 2005. Educate girls, fight AIDS. Geneva: UNAIDS. Available from: http://data.unaids.org/GCWA/GCWA_FS_GirlsEducation_Sep05_en.pdf |
| 14 |
United Nations Population Division. 2005. Population, development and HIV/AIDS with particular emphasis on poverty: the concise report. New York: UN Dept. of International Economic and Social Affairs. Available from: www.un.org/esa/population/publications/concise2005/PopdevHIVAIDS.pdf |
| 15 |
UNAIDS. 2008. Children and AIDS: third stock-taking report. Available from: http://data.unaids.org/pub/Report/2008/20081201_3rd_stocktaking_en.pdf |
| 16 |
U.N. Millennium Project. 2005. Combating AIDS in the developing world. Task force on HIV/AIDS, Malaria, TB and Access to Essential Medicines, Working Group on HIV/AIDS. Available from: www.unmillenniumproject.org/documents/HIVAIDS-complete.pdf |
| 17 |
World Health Organization. HIV/AIDS and adolescents. (accessed July 3, 2007), Available from: www.who.int/child-adolescent-health/HIV/HIV_adolescents.htm |
| 18 |
Global Coalition on Women and AIDS, World Health Organization. Intimate partner violence and HIV/AIDS. Information bulletin series: violence against women and HIV/AIDS: critical intersections. Available from: www.who.int/gender/violence/en/vawinformationbrief.pdf |
| 19 |
Shears KH. 2005. HIV-infected youth. YouthLens on reproductive health and HIV/AIDS no 13. FHI. Available from: www.fhi.org/en/Youth/YouthNet/Publications/YouthLens+English.htm |
| 20 |
US Dept of Health and Human Services. 2006. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Available from: http://aidsinfo.nih.gov/contentfiles/AdultandAdolescentGL.pdf |
| 21 |
Moyo R. Francisca S. Positive Voice. The sky's the limit. Global AIDSLink. Global Health Council. January/February 2007 (101) 23. |
| 22 |
UNICEF. Children on the brink 2004. Available from: www.unicef.org/publications/index_22212.html |
| 23 |
Daileader Ruland C, Finger W, Williamson N, Tahir S, Savariaud S, Schweitzer A-M, et al. 2005. Adolescents: orphaned and vulnerable in the time of HIV/AIDS. Youth Issues Paper 6. YouthNet. FHI. Available from: www.fhi.org/en/Youth/YouthNet/Publications/YouthIssuesPapers.htm |
| 24 |
Patel V, Flisher AJ, Hetrick S, McGorry P. 2007. Mental health of young people: a global public-health challenge. Lancet 369:1302-13. |
| 25 |
Burns A, Daileader Ruland C, Finger W, Murphy-Graham E, McCarney R, Schueller J. 2004. Reaching out of school youth with reproductive health and HIV/AIDS information and services. Youth issues paper. FHI. Available from: www.fhi.org/en/Youth/YouthNet/Publications/YouthIssuesPapers.htm |
| 26 |
UNAIDS. 2004. Report on the global AIDS epidemic. Available from: www.unaids.org/bangkok2004/GAR2004_html/GAR2004_00_en.htm |
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