Why Focus on Preventing HIV Infection in Pregnant Women?
The rapid spread of HIV infection among women is alarming. Roughly 47% of the 15,000 new infections each day are in women of childbearing age. Women are biologically more vulnerable to HIV infection and other STIs.
This is often exacerbated by sociocultural and economic circumstances that make it difficult for women to have control over their own sexuality and sexual relations. The presence of STIs, which are often asymptomatic in women, increases their risk of and vulnerability to HIV infection.
As a result, HIV infection rates among women – especially young women – are considerably higher than among men, in some communities and age groups, 2 – 4 times higher. In sub-Saharan Africa alone, an estimated 12.2 million women carry the virus, compared to 10.1 million men1.
The pandemic is therefore taking a severe toll on women and children.
While in a few countries alarming infection rates exist, in most countries the great majority of pregnant women are HIV negative. An estimated 200 million women become pregnant each year, of which only about 1.8 million are HIV positive. Thus 99% of pregnant women are HIV negative and must remain so.
By preventing HIV infection in pregnant women, prevention of transmission to children is assured.
Concentrating efforts on the majority – that is uninfected women – in the face of limited resources has been the rationale for UNFPA’s strategic focus on pregnant women. Pregnancy is known to be one of the few occasions where women access the health care system and therefore is an opportunity to provide information on HIV prevention to help ensure that HIV negative women remain free from infection and that HIV positive women are provided with the required support and care to ensure a better chance of a healthy and safe pregnancy and childbirth.
Educating partners on HIV prevention is also an important part of the strategy.
Why Focus on Young People?
The answer lies in the numbers. Of about 1.2 billion young people worldwide, 11.8 million are currently estimated to be living with HIV/AIDS. Every year it is estimated that over 2.6 million young people, contract the virus through the sexual route or through injecting drug use.
In countries with high HIV prevalence rates, young people and especially young women are at particular risk of contracting the virus as soon as they become sexually active. In recent years over half of all new HIV infections – approximately 7,000 every day – are among youth aged 15 to 24 years – the same age group that also has the highest rates (111 million episodes in this group every year) of sexually transmitted infections (STIs).
Young people are not only disproportionately affected by HIV/AIDS; they are also particularly vulnerable to HIV infection because they lack access to sexual and reproductive health information, education, and services.
Gender inequalities and practices like early marriage, sexual violence and the search by older men for younger ‘HIV-free’ partners, create added risks for young women. In certain countries in sub-Saharan Africa, young women are now two to six times more likely than young men to be infected with HIV.
Social and cultural identities and roles (particularly around masculinity) assigned to and expected of boys and young men often place both themselves and their partners at increased risk of HIV. These include the right to initiate sexual activity early, engage in premarital sex and have multiple sexual partners within and outside of marriage in order to prove sexual experience, prowess and dominance, especially amongst peers.
The importance of preventing HIV infections among young people to turn the tide of the pandemic has been a consistent message in all HIV/AIDS related commitments to date, particularly in the 5-year review of the ICPD Programme of Action (ICPD+5) and the recent global commitment made at the United Nations General Assembly Special Session on HIV/AIDS (UNGASS).
The ICPD+5 (1999), endorsed by UNGASS (2001), calls on all Governments to ensure:
“HIV infection rates in persons 15 to 24 years of age should be reduced by 25 percent in the most-affected countries by 2005, and by 25 percent globally by 2010” and “By 2005, at least 90 percent, and by 2010 at least 95 percent of young men and women aged 15 to 24 years have access to information, education and services necessary to develop the life skills required to reduce their vulnerability to HIV infection.”