General Articles

Specific Actions Urgently Needed to Address Women’s Disproportionate Burden under the Global HIV/AIDS Epidemic

In the international fight against HIV/AIDS, advocates have struggled to bring the needs of women and girls to center stage. In areas where the general population is-or is beginning to be-at high risk of HIV-infection, women and girls suffer disproportionate risk of infection. Advocates say that addressing the vulnerability of women and girls and providing them with appropriate services will not only alleviate the suffering of individual women but also curtail the pandemic at large.

Recognizing that gender inequalities are a linchpin in the HIV/AIDS pandemic, the United Nations Secretary-General’s Task Force on Women, Girls and HIV/AIDS in Southern Africa, studied the role of gender in the AIDS crisis in nine countries severely affected: Botswana, Malawi, Mozambique, Swaziland, South Africa, Namibia, Zambia, Lesotho, and Zimbabwe. In its recently released report, Facing the Future Together, the Task Force writes, "Gender inequality fuels HIV infection because many women and girls cannot negotiate safer sex or turn down unwanted sex. The findings also demonstrate that HIV/AIDS deepens and exacerbates women’s poverty and inequality because it requires them to do more domestic labour as they care for the sick, the dying, and the orphaned."1

The report and its recommendations are "rooted in the experiences and insights of people grappling with these challenges on the ground, supplemented by information from existing literature and discussions with individuals working on human rights, gender and development, and HIV/AIDS within and beyond the sub-region."2

The Task Force’s findings confirm advocates’ concerns for women in countries facing the worst of the AIDS pandemic. Women in sub-Saharan Africa have surpassed the number of men who are HIV-positive, and the data shows that many young women are being infected almost as soon as the become sexually active. With more and more people falling sick, these same women and girls are facing intensified responsibilities as care-givers, a role traditionally and persistently assigned to women.3 Often, young women are expected to leave school to care for family members. Progressively more elderly women are caring for orphans or ill community members. "This burden is particularly heavy in a context where women-particularly older women-are often more affected than men by poverty," writes the Task Force.4

The report offers precise recommendations for responsive policy and programming. According to the Task Force, "We cannot wait for the social and economic context to change before taking action."5

The Task Force sets out six areas requiring immediate action: HIV-prevention among girls and young women; girls’ education; violence against women and girls; property and inheritance rights; women and girls as care-givers; and access to care and treatment for women and girls. For each area, the report describes the situation in the studied countries and proposes specific ways to address the problems. The Task Force also provides examples of programs and initiatives that have already shown positive results. For example, the report profiles the Girl Child Network in Zimbabwe, a network of 150 girls’ clubs that has supported at least two thousand girls to go to school since 1995. This network includes the Chitsotso Girls’ empowerment village, a ‘one stop shop’ for girls living in rural areas, proving professional and peer-to-peer counseling, medical services, shelter from abuse, education, and a ‘women as role models’ museum of achievements.

The President’s Emergency Plan for AIDS Relief: U.S. Five-Year Strategy to Fight Global HIV/AIDS (PEPFAR, also known as the U.S. Strategy) directs the expenditure of $15 billion to 15 countries for HIV/AIDS-related prevention, treatment, and care over 5 years. In this policy document, the Administration acknowledges that culture and traditional roles contribute to increased vulnerability to HIV-infection for women and girls and states that interventions particularly tailored to women are needed.6 PEPFAR, however, fails to set out a substantive strategy for addressing the dangerous situation facing women in these countries.

In order to bridge this gap in the U.S. Strategy, Representative Barbara Lee (D- CA) has sponsored the United States Global HIV Prevention Strategy to Address the Needs of Women and Girls Act of 2004 (H.R. 4792). If enacted, the Act would require country plans to be "comprehensive, integrated, and culturally appropriate" and to establish comprehensive health and gender education. Each country strategy would include measures to promote gender equality generally; increase access to women-controlled prevention methods; de-stigmatize HIV/AIDS; reduce child-marriage; reduce violence against women; support educational opportunities for women and girls; and coordinate HIV-prevention services with existing health care services, including family planning and reproductive health services. Although PEPFAR already requires that each country receiving funds develop an in-country plan, the Act would expand the scope and depth of those plans.

The Act would also remove the earmark of one-third prevention funds for abstinence-only-until-marriage programs. According to the Act, such programs ‘are not always effective at addressing the central fact that women and girls are often powerless to abstain from sex or to insist on condom use even within marriage." Removing the earmarks allows for flexibility in designing HIV-prevention strategies, especially those intended to reach women and girls. The bill currently has 61 cosponsors. It has been referred to the House Committee on International Relations.

The complete Report of the United Nations Secretary-General’s Task Force on Women, Girls and HIV/AIDS in Southern Africa: Facing the Future Together.


  1. Report of the United Nations Secretary-General’s Task Force on Women, Girls and HIV/AIDS in Southern Africa: Facing the Future Together (New York: NY: United Nations Secretary-General’s Task Force on Women, Girls and HIV/AIDS in Southern Africa, July 2004), p. 4. Available online.
  2. Ibid.
  3. Ibid.
  4. Ibid.
  5. Ibid.
  6. President’s Emergency Plan for AIDS Relief: U.S. Five-Year Strategy to Fight Global HIV/AIDS, (Washington: State Department, February 23, 2004). Available online.