Associated Press - November 23, 2004
Emma Ross, AP Medical Writer

Women and girls in the developing world are increasingly becoming its main victims, but current safe-sex prevention strategies are of little use to the millions who don't have the power to say no to sex or to insist on condom use.

The inequality women face -- from poverty and stunted education, to rape and denial of women's inheritance and property rights -- is a major obstacle to victory over the virus, according to the latest global HIV status report published by UNAIDS.

The core of HIV prevention is advice to abstain from sex until marriage, be faithful and to use condoms.

"The prevention strategies now in place are missing the point when it comes to women and girls," Dr. Kathleen Cravero, deputy chief of UNAIDS told a news conference. "We are finding in most regions of the world, they simply do not have the economic and social power or choices, or control over their lives to put that information into practice."

AIDS prevention strategies need to address the factors that will give women control over their lives, the report said.

"Moving to a situation where every woman gets to keep her house, her land and her furniture when her partner dies is not beyond the realm of possibility," Cravero said. "It doesn't even require turning society on its head. It requires getting the right laws there and making them enforceable for women."

AIDS has to be the catalyst for women's rights in the developing world, UNAIDS chief Dr. Peter Piot told The Associated Press.

"There was reason enough before AIDS, but now the link between the whole gender inequality and death has never been so direct as with AIDS," Piot said. "If AIDS is not enough to shift the agenda for women, then what is enough?"

"It's time now for the women's movement and the AIDS movement to find each other, and that hasn't happened yet," Piot said. "Ultimately, without putting women at the heart of the response to AIDS, I don't think we will be able to control this epidemic."

Violence against women is a worldwide scourge, but it is feeding the HIV epidemics in the developing world, where women and girls often don't have the power to say no to sex or to insist on condom use.

For millions of women, sex is their only currency.

"The fact that the balance of power in many relationships is tilted in favor of men can have life-or-death implications," concluded the report by UNAIDS. "These factors are not easily dislodged or altered, but until they are, efforts to contain and reverse the AIDS epidemic are unlikely to achieve sustained success."

Nearly 50 percent of the 39.4 million people infected with HIV worldwide are women. In regions where the epidemic has been raging for years, more women are infected than men, and in countries where epidemics are just beginning, new infections among women outnumber those among men and the gap continues to widen.

East Asia experienced the sharpest increase in the number of women infected with HIV in the past two years -- 56 percent. Eastern Europe and Central Asia come next, with infections among women rising 48 percent in the past two years. In the Caribbean, which is the second-worst hit area of the world after sub-Saharan Africa, young women are twice as likely as men their age to become infected.

Part of the reason for the rapid increase is that it is physically easier for women to get HIV through intercourse than it is for men to get it from women. However, more women than men are now getting the disease also because the virus has escaped the confines of brothels.

Twelve years ago, about 90 percent of HIV transmission in Thailand occurred between prostitutes and their clients. But now, about half of all infections are occurring in the wives of men who visit prostitutes.

In many parts of the world, stressing marriage and long-term monogamous relationships doesn't protect women from AIDS because they are unable to control whether they have sex. The approach -- favored by the American anti-AIDS package -- also could backfire in areas where being married actually increases the risk of contracting HIV, research has found.

One study conducted in several areas of Kenya and Zambia found that among teenage girls, HIV infection levels were 10 percent higher for married girls than for those who were sexually active but not married. Similar findings have been reported in Uganda.

Married women in some African countries are in more danger of HIV than unmarried ones because young women often marry men much older than themselves -- for financial security -- and these men are more sexually experienced and thus more exposed to HIV, the report found. On the Net:

UNAIDS report, www.unaids.org

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