Aids strategy failing as disease becomes a female epidemic

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The Independent Online

Global efforts to curb the spread of HIV/Aids are failing because the world has not recognised that it is a female epidemic, a report said yesterday.

Global efforts to curb the spread of HIV/Aids are failing because the world has not recognised that it is a female epidemic, a report said yesterday.

Aids claimed 3.1 million lives last year, the highest ever, and the rate at which women and girls are affected is accelerating. The spread of the disease shows no sign of slowing, despite billions of pounds invested in treatment and prevention.

The annual report on the Aids epidemic, published by UNAids and the World Health Organisation yesterday, says a record 39.4 million people are living with HIV, up from 36.6 million two years ago.

Today, the Health Protection Agency will publish figures showing the number of people living in the UK with HIV has also reached a record high, above 50,000 for the first time.

Globally, the fastest increase in infections is among women and girls. They account for 57 per cent of all those infected in sub-Saharan Africa, the worst-hit region, and for 75 per cent of those aged 15 to 24.

In every region of the world, rates of infection in women are rising faster than among men. In Russia, which has the biggest HIV epidemic in Europe, affecting 860,000 people, the proportion of women infected has leapt from 24 per cent to 38 per cent in two years.

The "feminisation" of Aids has dawned slowly on the major international organisations committed to tackling it. Until now they have placed the ABC strategy - Abstain, Be faithful, use a Condom - at the centre of their prevention efforts.

Yesterday's report from UNAids said the ABC approach was "insufficient" and left "serious gaps". The strategy to prevent one of the worst diseases in human history must be rewritten with a new focus on women, it says. Kathleen Cravero, deputy executive director of UNAids, told a press conference in London to launch the report: "The prevention strategies are missing the point. They are not responding to the realities of women's lives. Women do not have the economic power or social choices over their lives to put the information [about HIV prevention] into practice."

Aids began as a mainly male disease, concentrated among homosexuals in the United States, drug users in Russia and the Far East who injected, and men who used prostitutes in Africa. But, as the epidemic has lengthened, the disease has taken hold among women. The number infected globally is about to overtake men.

Women are biologically twice as likely to become infected during sex as they are exposed to a larger dose of virus, and are more prone to be cajoled or forced into sex because of their lack of social power. When sex is violent and non-consensual, abstention is not an option.

Wives of men who die of Aids may be forced out of the family home, which may pass to the husband's relatives, leaving them destitute and forced to resort to sex for economic survival.

Studies in South Africa showed that women under 20 who were married - usually to older men - had higher rates of infection than those who were unmarried but sexually active, because the latter were better able to negotiate condom use.

Ms Cravero said: "We tell women to abstain when they have no right. We tell them to be faithful when they cannot ask their partners to be faithful. We tell them to use a condom when they have no power to do so."

"We need to give women power, to reduce levels of violence against them and to protect their property and inheritance rights. We are still not keeping pace with the epidemic and we need to tackle the problem in women and girls."

The emphasis on women is a major shift for UNAids which up to now has focused on changing the behaviour of men. But the feminisation of the epidemic has forced it to confront the failure of that strategy.

Without an Aids vaccine, the best technical hope for women is a microbicide to prevent transmission and provide them with a method they could control. The report says a first generation microbicide could be ready in five years if investment in research were expanded. A microbicide that was 60 per cent effective and used by one in five women could prevent about 2.5 million infections over three years, it says.

Emma Thompson, the actress and Aids campaigner who attended the UNAids launch, said: "Women's economic independence is vital in this struggle. I know a girl who gave her body to a man for an apple. If we have girls who have absolutely nothing we are not going to protect them."

Alvaro Bermejo, head of the International HIV/Aids Alliance said: "The report makes clear that too many strategies assume a greater level of choice about sex, particularly among women, than exists. Everyone must recognise this in their programmes - and work to change these economic and social realities. If we don't, we cannot have the greatest impact on the epidemic."