Why the Difference? : The Increasing Gap between Men & Women living with HIV

31 October 2017
Residents of Mbale district gather to receive family planning counseling and treatments. Photograph: Juozas Cernius for the Guardian

Uganda’s HIV epidemic emerged in the 1980s amongst issues surrounding the Lord’s Resistance Army and violence. ‘31000 people with HIV died in 2014, down from 63,000 in 2013, a reduction of 32,000 deaths. AIDS-related deaths were 67,000 in 2010 and over 75,000 in the late 1980s and early 1990s’, according to Dr. Aceng. The huge progression and reduction over the recent years have revealed that the prevalence of HIV is more than 3% higher among women than men, according to research revealed by the government’.  So what are the causes? Why are women more prone to HIV than men despite the large reductions of the number infected?

How much of it Is Discrimination & Stigma?
Discrimination and Stigma tend to be the most common factors affecting the growing epidemic. However, it is important to acknowledge that discrimination exists within various categories. This may range from gender, gender-based violence, and sexual orientation discrimination. But it may also be legal discrimination, such as Uganda’s Anti-Homosexuality Bill passed in 2013, which is thought to have increased anti-gay sentiment. There is also an issue of age along with taboo occupations such as sex work. But overall discrimination and stigma continue to exist and act as a barrier to the prevention and cure of HIV.

Stigmatisation Prevents Access
On one hand, there is the criminalization and notion of dishonor shown towards sex work. This has led to female sex workers avoiding access to health services and as a result conceal their occupation from healthcare providers. On the other hand, stigma towards male sex workers who have sex with men is exacerbated by homophobia. Indeed, many sex workers in Uganda consider social discrimination as a major barrier in their willingness or desire to test for HIV.

Also, there is age discrimination where teenage girls and young women are more likely to face judgment when seeking preventative measures, such as asking for condoms. The stigma and taboo surrounding teenage sex prevents the use of contraception and increases the likelihood of the risk of infection. This accounts for the rising percentages of HIV for women in comparison to men, disproportionately affecting young women, as the statistics show: ‘In 2014, HIV prevalence among young people aged 15-24 in Uganda was estimated at 3.8% for women and 1.9% for men’.


Unintended Consequences
It is always necessary to consider the unintended consequences and challenges that continue to arise within this issue. Firstly, poverty is an explanation for the rise of sex work and the subsequent increased risk of contracting the virus. Female sex workers and their clients were estimated to account for 16% of new HIV infections in Uganda in 2014. The partners of the clients of sex workers then account for an additional 3%. A 2013 study with female sex workers in Uganda found that the refusal to use condoms by clients remained a key barrier to consistent condom use. Poverty has been one of the main reasons female sex workers engage in unprotected sex for money, especially as various accounts show that a higher price is rewarded to sex workers willing to dismiss contraception.

A box of free condoms outside the Bwindi community hospital, western Uganda. Photograph: Andrew Aitchison/Corbis via Getty Images


Discrimination and stigma act as significant barriers to prevention and treatment towards both women and men. However, statistics support evidence that women and young girls are much more likely to be infected than men, due to teenage sex, female sex work and the lack of access to contraception. Despite the gender gap, it is necessary to acknowledge in particular that gay Ugandan men and are just as vulnerable as adolescent girls, young women, and female sex workers. It is important that discrimination is tackled and specifically focused considering that discrimination is extremely multidimensional, and only then will a decline in women with HIV occur. Equally, social discrimination and taboos within the community must be eliminated.

Disclaimer: This blog is a space for discussion and personal reflection. Any opinions expressed within the blog are those of the author and are not necessarily held by HART. Individual authors are responsible for the accuracy of statements made within the blog.


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