Why HIV is twice higher among young girls, women

Statistics from Uganda AIDS Commission (UAC) indicate that the prevalence of HIV in women  at 6.8 percent, is nearly double the 3.9 percent prevalence in men. 

This implies that nearly seven in every 100 women are living with HIV, while about four in every 100 men are also living with the virus.

UAC data indicates that a total of 820,000 women who are 15 years and above are living with HIV, which is higher than the 490,000 men in the same age bracket living with the virus. 
Government data shows that women make up 51 percent of the overall national population, which is only one percent more than men. 

Prof Pontiano Kaleebu, one of Uganda’s renowned HIV/Aids research scientists and the director at Uganda Virus Research Institute (UVRI), says the prevalence is higher in women because of greater risk of exposure to infected partners and genetic predisposition.
“The issue of women having more HIV than men has to do with culture, economy and biological factors which predispose them to the infection. Biologically, it is easier for a man to transmit the virus to a woman during intercourse than for a woman to transmit to a man,” he said.
“A lot of what we have found is that older men tend to go to the young girls and infect them,” he adds.

Cases of defilement and domestic violence in the population have spiraled during the Covid-19 pandemic, which activists and some legislators say have been caused by prolonged closure of school and other containment measures for the pandemic.
The Police crime report for 2020 shows that a total of 14,134 cases of defilement were reported to police in 2020 compared to 13,613 cases reported in 2019, giving a 3.9 percent rise. 

United Nations Population Fund says a total of 354,736 teenage pregnancies were registered in the country in 2020, and the majority, 196,499 occurred in the first six month when national Covid-19 lockdown was being enforced. 

A 2021 research report by Abrahams Naeemah from South African Medical Research Council says people who suffer sexual violence such as rape are 60 percent more likely to contract HIV.
Media reports also say close relatives, including fathers, were allegedly impregnating the teenagers/daughters in Uganda.

Prof Kaleebu says the other important factor underpinning higher prevalence of HIV among women is majority of women live in rural areas, are less educated and may not have access to the interventions that are required to prevent the infection. 
The researcher also blamed the high prevalence on the country’s past interventions on HIV/Aids that focused on men. 

 “Most of them [women] are poor and they are not as empowered in terms of income and driving their destiny as men. This should be addressed to prevent HIV infections among women,” he said.
“For instance, we have been saying “men have the condom” and yet they can’t even protect themselves. Whether or not to use condom is always determined by the man [and yet not using affects the woman]; the woman has little say,” Prof Kaleebu said.

“That is why we are now talking about microbicides [a drug smeared inside the lady parts to kill viruses and other infectious agents], pre-exposure prophylaxis [medication for prevention] and so on, so that we empower a woman to have something that will prevent itself so that it is not a male dominated intervention,” he added.

Dr Nelson Musoba, the director general of UAC, said out of the 38,000 new infections registered in the country annually, “you will find that young people contribute 14,000 and girls between 15 and 24 years are three times more affected compared to their male counterparts.”

“So they [adolescent girls and young women] are bearing a higher brunt. This is because of the inequalities, the low income, poverty issues, and the inability to negotiate for safe sex predisposing them to more infections,” he said.

The King of Tooro, Oyo Nyimba Kabamba Iguru Rukiidi IV, said on Thursday in Kampala there is need to address high levels of unemployment among young people to bring down HIV infection rates.“Poverty is one of the root causes of HIV infection in young people, especially among girls who engage in transactional sex,” he said.

He said the Kingdom of Tooro is already working with partners to ensure youth who are unemployed are skilled. 
“We are working together with our partners to ensure that we mobilise the youth to achieve economic empowerment through skilling in the areas of innovation, entrepreneurship, creative industry, youth cooperatives and micro industries. This will help them to become productive but also avoid HIV infection,” King Oyo said.

UAC statistics indicate that although the national prevalence of the virus is at 5.4 percent, in sex workers the prevalence is very high at 31 percent. 
Ms Dora Kiconco Musinguzi, the executive director of Uganda Network on Law Ethics and HIV/Aids (UGANET), said sex workers told them in a study last year that “men who are HIV-positive often refuse to use condoms and when the woman [sex worker] resists, the man often rapes them.”

She said  beyond the issue of sex workers, sexual and gender-based violence is very high in the country, a situation worsened by Covid-19 pandemic. The activist said many people who suffer sexual violence and gender- based violence in country are not reporting the issues for redress.

Dr Musoba of UAC said they are rolling out the national policy guidelines on stigma reduction to inform the public about the dangers of stigma and empower people living with HIV about their rights. 

Dr Stephen Watiti, the chairperson of National Forum of People Living with HIV/AIDS Networks in Uganda (NAFOPHANU), said lack of food was worst felt by their members during Covid-19 lockdown. People who adhere to medication become virally suppressed thus living longer to contribute to national development and may not transmit the virus during intercourse, according to UAC. 

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