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Connecting the dots between HIV incidence, social norms, and gender-based violence

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Did you know that every minute somewhere around the world a woman is infected with HIV/AIDS?  (Data from UNAIDS)

To commemorate both World AIDS Day and the 16 Days of Activism against Gender-Based Violence, we take a deeper look at some of the gender disparities of HIV. In particular, we explore the relationship between violence, social norms, and HIV using data from the World Bank Gender Data Portal.

Data from 2019 show that the global HIV incidence among the 15-49 age group is higher for men than for women (0.38 and 0.36, respectively). However, for youth this trend is flipped – the HIV incidence among women ages 15-24 is 1.7 times higher than among men of the same age group.

In a little over a quarter of countries with data, among youth ages 15-24, women are two to five times more likely to be newly infected with HIV than men.  This is most visible in Sub-Saharan Africa, where 86% of countries have HIV incidence rates above the global country average. Compared to women in other regions, young women from Sub-Saharan African countries with the highest HIV incidence are 10-30 times more likely to be newly infected with HIV.

To understand why young women are infected with HIV at disproportionately high rates, we look at sexual violence and the sexual behavioral norms that underlie the relation between violence and HIV transmission.


Sexual, partner violence associated with higher rates of HIV for women and girls

In the last decade, several global and regional studies have investigated the relationship between violence and HIV infection.

­­­­The majority have found that sexual violence – most often committed by a partner or spouse - is associated with women’s vulnerability to HIV. Women who have experienced sexual violence by a partner are 1.5 times more likely to be HIV-positive. In certain countries and key populations, women are up to 4 times more likely to be infected with HIV compared to those who have never experienced any violence.


Social norms impact women’s control over sexual decision making

Harmful norms that promote men’s authority over female behavior make women vulnerable to violence and restrict their ability to negotiate sex.

It has often been noted that these are not norms only held by and perpetuated by men. Women also hold these norms, especially those in poor households.

In almost all regions, a third of women feel unable to refuse sex if their husband has sex with other women.  When looking at the poorest households surveyed, this share increases to about 40% in all regions except for Latin America & Caribbean and East Asia & Pacific. And in some countries, the social acceptability of extramarital sex makes it difficult for women to speak up as they are afraid that discussing fidelity or refusing sex will lead to violent consequences.

One-quarter of women in the Middle East and in North and Sub-Sharan Africa feel unable to refuse sex with their husband even if he has a sexually transmitted disease (STD). Similarly, in South, East Asia & the Pacific, one-fifth of women report this. In this scenario, if women don’t have the power to negotiate condom use, ensuring safe sex, they are very likely to contract their partner’s STD, jeopardizing their health.

The increase in partner violence and the potential decrease in HIV prevention services brought on by COVID-19 threatens to undermine years of progress towards gender equality. Stepping up multisectoral interventions will be critical to reinvigorating progress towards women’s empowerment in sexual relationships and HIV reduction.­ The world cannot afford a rebound in the HIV epidemic.


Sarah Bunker

Data Fellow, Gender Group, World Bank

Haruna Kashiwase

Consultant, Development Data Group, World Bank

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