The AIDS pandemic rampaging around the globe will not be stopped without radical social change to improve the lot of women and girls, who now look likely to die in greater numbers than men, United Nations agencies said Tuesday. Infections among women are soaring, from sub-Saharan Africa to Asia to Russia. What began as a series of epidemics among men -- in some regions gay and bisexual men, in others men who frequented sex workers or male drug users -- has spread to their female partners, who are biologically more easily infected.
In many countries, women's subordinate status, and their lack of education and economic power, have made it impossible for them to negotiate sex with men or to ask for the use of condoms. Tuesday the UN agency set up to combat the pandemic, UNAIDS, called for all that to change in the interests of checking the spread of a disease that killed 3.1 million adults and children last year.
"We will not be able to stop this epidemic unless we put women at the heart of the response to AIDS," said UNAIDS' executive director, Peter Piot.
At the launch of the UNAIDS annual report on the pandemic Tuesday, actor Emma Thompson, who is a founding member of the Global Coalition on Women and AIDS launched this year, put it in starker fashion. "There are some countries where women are an endangered species -- they will disappear from the face of the Earth," she said. "I think this is the greatest catastrophe that the human race has ever faced." Across the globe, 39.4 million people, including 2.2 million children, are carrying HIV and will die without treatment to contain it -- up from about 36.2 million two years ago. Only one in 10 in developing countries can get the drugs they need.
Last year, 4.9 million people were newly infected and 3.1 million died. In some regions, such as sub-Saharan Africa, the numbers living with HIV appear to have stabilized, but only because as many are now dying as are getting infected. In the U.K., HIV continues to spread. UNAIDS says it "has become the fastest-growing serious health condition." A report Wednesday from the Health Protection Agency will confirm the trend. Last year there were 7,000 new diagnoses, taking the total numbers living with infection well above 50,000.
The numbers of women affected globally are rising faster than those of men, and women now make up nearly half of the total. In sub-Saharan Africa, where the pandemic is furthest advanced, the transition is complete -- 57 percent of those with HIV are women. In Zambia, Zimbabwe and South Africa, 77 percent of all young people infected with the virus are women. Across nine countries in that region, the infection rate in the whole population is one in four.
In other parts of the world, there have been large hikes in the proportion of women affected. In east Asia, there has been a 56 percent increase in the number of HIV-positive women in the past couple of years. In Russia, where the epidemic began in young, mostly male injecting drug users, the proportion of women infected has gone up from 24 percent to 38 percent in just 12 months. In every region of the world -- including the U.S., where AIDS is one of the biggest killers of African-American women, and Europe -- it is the same story, said Kathleen Cravero, deputy executive director of UNAIDS, Tuesday, and it means that a new strategy must be adopted.
"The prevention strategies now in place are missing the point when it comes to women and girls," she said. The ABC mantra favored by the U.S. -- abstinence, be faithful and use a condom -- is useless to women who do not have the power to refuse sex, sometimes from an older, sexually experienced husband who already has HIV.
Social and cultural change is the only way to check the pandemic in countries where women have no status or power, UNAIDS says -- although it accepts that revolution is not on the cards. "What we're talking about is very specific actions that are doable, moving to a situation where every woman gets to keep her house and her land and her furniture when her partner dies," said Cravero. "It doesn't mean turning society on its head. It means getting the right laws in place and making them enforceable. We have to work against the fatalistic idea that you can never change these things."
UNAIDS is urging governments to reform their inheritance laws, pass legislation protecting women from domestic violence and help girls attend secondary schools. A woman who has some education and some economic power through possession of her own house and garden will be better able to negotiate sex, said Cravero. "We have to turn abstinence on its head and fight for the right of every woman to abstain when and if she wants to, because right now she doesn't have that right." Thompson related stories from three trips to Africa of sugar daddies who offered schoolgirls meals or trainers for sex. "I knew of a girl who gave her body to a man because he gave her an apple, because nobody had ever given her anything before," she said.
Mothers who were desperate for money would gamble that if they were infected with HIV, they could stay alive long enough to bring up their children. "I would sell my body if I had to do it to feed my child," said Thompson. She suggested that British Prime Minister Tony Blair could contribute by going to Ethiopia, where she had recently been, and publicly taking an AIDS test. "I think it is going to take big gestures like that. Examples have to be set by men of power."