Almost 3 million people are newly diagnosed with HIV annually, with only 1 in 8 receiving antiretroviral therapy.1 A new focus on this ongoing epidemic is needed. Healthcare personnel should examine what drives the spread of HIV in various populations to develop multifaceted prevention strategies. Differences in the social value of women, power differences, varying opportunities, and behavioral expectations of men and women contribute to gender-related violence.

The evidence supporting the role of gender-based violence and gender inequity in HIV spread in women has increased.1 Women in South Africa experiencing physical or sexual intimate partner violence or those in relationships with low equality are at a greater risk for HIV infections when compared with women who have not experienced these inequalities.2 One in 7 new HIV infections could have been prevented if the women in this study have avoided physical or sexual abuse; women who have experienced childhood sexual abuse are at a two-thirds greater risk for HIV infection.2 Women and girls constrained by poverty and limited opportunities are more likely to tolerate partners who are violent and controlling and to view engagement in transactional sex or prostitution as a viable choice. Women who are depressed, abusing substances, or experiencing posttraumatic stress disorder related to rape are more likely to engage in risky sex, thus increasing their risk of HIV infection.

Cultural complexities related to gender roles are difficult to address. Introducing women to the possibility of empowerment within their relationships or justifying the idea that relationships should be based on mutual respect is not an easy task. Empowerment of women requires an educational and financial base for the women to assert independence. Few long-term, randomized controlled trials have addressed these issues. The IMAGE (Intervention with Microfinance for AIDS and Gender Equity Study) trial, a 3-year study in South Africa that provided a program to economically empower women and assist with gender equality, resulted in a 55% decrease in violence experienced by women. This study and the strategies used are worth noting.

Decreasing gender inequities to address the spread of HIV requires political resources as well as political will. As difficult as this topic is to discuss, we need to address these issues with our students and encourage involvement, research, and intervention in areas that are shown to make a difference in this devastating epidemic. Addressing gender equity as it relates to HIV can also help nursing students understand how cultural complexities and epidemiology relate.

References

1. UNAIDS. Agenda for Accelerated Country Action for Women, Girls, Gender Equality and HIV. Geneva: UNAIDS; 2010. Available at http://data.unaids.org/pub/Agenda/2010/20100226_jc1794_agenda_for_accelerated_co. Accessed July 19, 2010. [Context Link]

2. Jewkes RK, Dunkle M, Nduna P, Shai N. Intimate partner violence, relationship power inequity, and incidence of HIV infection in young women in South Africa: a cohort study. Lancet. 2010. Available at http://press.thelancet.com/equityhiv.pdf. Accessed July 19, 2010. [Context Link]

Source: Jewkes R. Gender Inequities must be addressed in HIV preventions. Science. July 9, 2010;329(5988):145-147. Available at http://www.sciencemag.org/cgi/content/full/329/5988/145. Accessed on July 16, 2010.

Submitted by: Robin E. Pattillo, PhD, RN, CNL, News Editor at [email protected].