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The risk of HIV acquisition during vaginal sex has been found to be higher for women than for men in most (but not all) biological-based studies.48 This high susceptibility can be explained by a number of factors including the ability of HIV to pass through the cells of the vaginal lining, the larger surface area of the vagina.49 Adolescent girls may be at further increased risk due to the existence of greater proportions of genital mucosa, which are present in an immature cervix.
Adolescent girls are also susceptible to relatively high levels of genital inflammation which may also increase the risk of HIV acquisition.50 Due to the lower uptake of ART among men, in most countries it is likely that fewer men than women are virally suppressed, which means men are more likely to pass the virus on to others.
This increases both the risk of HIV advancing and onward transmission.36 Intimate partner violence and gender based violence prevents many women, particularly young women, from protecting themselves against HIV.37 This is evidenced by the fact that, in places with high HIV prevalence, women who experience intimate partner violence are 50% more likely to acquire HIV than women who do not.38 Intimate partner violence has been identified as a key driver of HIV transmission in east and southern Africa.
More than 30% of ever married or partnered young women (aged 15–24 years) in Uganda, Tanzania, Zambia and Zimbabwe experienced intimate partner violence in the previous 12 months in 2015.
Similarly, in Uganda ART coverage is 65% in women over the age of 15, yet PMTCT service coverage is over 95%.54 Clearly PMTCT services are proving effective.
However, despite considerable progress, 27% of pregnant women living with HIV in 2014 did not access antiretroviral drugs (ARVs) for PMTCT and efforts are failing to reach young women who are not pregnant.55 For more information on PMTCT see our children and HIV page.
The poorest women may have little choice but to adopt behaviours that put them at risk of infection, including transactional and intergenerational sex, earlier marriage, and relationships that expose them to violence and abuse.
51 A major gap in HIV service provision for women can be found in HIV testing and counselling (HTC), which is a vital gateway to treatment services.
The study found a cycle of transmission, whereby high HIV prevalence in young women was driven by sex with older men (on average 8.7 years older) who themselves had female partners with HIV, many of whom had acquired HIV as young women.45 As of 2017, around one in seven adolescent girls (aged 15 to 19) in the world were married or in union.46Girls who marry as children are more likely to be beaten or threatened by their husbands than girls who marry later, and are more likely to describe their first sexual experience as forced.
As minors, child brides are rarely able to assert their wishes, such as whether to practice safer sex.47 These factors all increase HIV risk.
Explore this page to find out more about why women and girls are at risk of HIV, HIV testing and counselling, treatment for women and girls living with HIV, reducing mother to child transmission, HIV prevention programmes and the way forward.
Since the start of the global HIV epidemic, women have been disproportionately affected by HIV in many regions.