Marriage is no protection against infection -- and in some places appears to increase the risk.
In India, where about 5.1 million are infected, women account for one-quarter of new HIV cases. Among those who test positive at prenatal clinics, 90 percent say they are in long-term, monogamous relationships. In a study of young women in Kisumu, Kenya, and Ndola, Zambia, married teenage girls were more likely to be infected than unmarried, sexually active ones.
Princess Mbatha and her son Johannes, who are both HIV-positive, wait for free antiretroviral treatment in Soweto, South Africa. In that nation, women ages 15 to 24 are three to six times more likely to be infected than young men.
(Themba Hadebe -- AP)
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African Americans now account for 72 percent of infections among women in the United States. A recent study of a low-income section of New York found that women were twice as likely to be infected by a husband or long-term lover as by a casual sex partner.
In some places, however, the plight of women is improving, according to the report, which draws on national reports and dozens of epidemiological surveys.
For example, the percentage of infected women at prenatal clinics in Uganda and Kenya fell from 13 percent in 1998 to about 9 percent in 2002. At clinics in Ethiopia, it dropped from 14 percent to 12 percent. While the reason for that trend is not certain -- and probably reflects the cumulative effect of many prevention messages -- it appears to be real.
"It cannot be a burning out of populations at high risk because it is really happening," Piot said in a teleconference yesterday.
UNAIDS and WHO are gathering data on who is receiving access to AIDS drugs as life-extending antiretroviral therapy is finally reaching people in poor countries. Preliminary evidence suggests that women are getting drugs less often than men are.
Piot said he was recently at an AIDS clinic in the Ethiopian capital of Addis Ababa. One-third of the patients were women, even though they account for half of HIV-infected Ethiopians. There is a small charge for treatment, and many women either do not have the money or cannot get it from their husbands, he said.
Karen Stanecki, a biostatistician who helped prepare the report, said the French medical organization Doctors Without Borders has a higher percentage of women in its treatment programs because they are free.
"But if you look at centers that have fee-for-service, even when it is minimal, you immediately see more men," she said. "It's a real issue in terms of getting women into treatment."
Piot said that to fully address the AIDS epidemic, societies must address such issues as the laws governing property ownership and inheritance by women, as well as sexual norms under which older men believe it is acceptable to have sex with teenage girls in exchange for buying them school uniforms.
Microbicides -- substances that can kill HIV during intercourse and that a woman could use without a partner's knowledge -- will also be essential, he said. Three types are now undergoing final testing in humans.
The report noted that "there has been a sea change" in the amount of money spent on AIDS treatment and prevention in the developing world. In 2001, it was $2.1 billion. This year, it will be $6.1 billion -- half of it raised by developing nations and the rest provided by donors.