<i>Poverty, Gender Inequities, and Women's Risk of Human Immunodeficiency Virus/AIDS</i>

TLDR

Economic and gender inequities fuel a growing, predominantly female HIV/AIDS epidemic worldwide, yet prevention efforts have fallen short because they overlook how poverty and gender power imbalances create risky sexual environments for women. The article aims to identify structural pathways linking poverty and gender inequities to women's HIV risk and to propose strategies to modify these pathways. Four key pathways—lack of access to prevention information and services, limited education and skills, intimate partner violence, and migration driven by economic hardship—are identified, and interventions are suggested to improve education, employment, prevention tools, reduce migration, and promote gender equity. The authors conclude that significant challenges remain in developing and evaluating interventions targeting these structural pathways.

Abstract

Entrenched economic and gender inequities together are driving a globally expanding, increasingly female, human immunodeficiency virus (HIV)/AIDS epidemic. To date, significant population‐level declines in HIV transmission have not been observed, at least in part because most approaches to prevention have presumed a degree of individual control in decision making that does not speak to the reality of women's and girls' circumstances in many parts of the world. Such efforts have paid insufficient attention to critical characteristics of the risk environment, most notably poverty and gender power inequities. Even fewer interventions have addressed specific mechanisms through which these inequities engender risky sexual practices that result in women's disproportionately increased vulnerabilities to HIV infection. This article focuses on identifying those mechanisms, or structural pathways, that stem from the interactions between poverty and entrenched gender inequities and recommending strategies to address and potentially modify those pathways. We highlight four such structural pathways to HIV risk, all of which could be transformed: (1) lack of access to critical information and health services for HIV/sexually transmitted infection (STI) prevention, (2) limited access to formal education and skill development, (3) intimate partner violence, and (4) the negative consequences of migration prompted by insufficient economic resources. We argue for interventions that enhance women's access to education, training, employment, and HIV/STI prevention information and tools; minimize migration; and by working with men and communities, at the same time reduce women's poverty and promote gender‐equitable norms. In conclusion, we identify challenges in developing and evaluating strategies to address these structural pathways.