As we mark this year’s International Women’s Day, we look at the devastating toll the global HIV/AIDS epidemic is taking on women, and the critical role of women in fighting AIDS.

At the beginning, many people thought of AIDS as a disease striking mainly at men. Even a decade ago, statistics indicated that women were less affected. But a terrifying pattern has since emerged. All over the world, women are increasingly bearing the brunt of the epidemic. Today, in sub-Saharan Africa, more than half of all adults living with HIV/AIDS are women. Infection rates in young African women are far higher than in young men. In the world as a whole, at least half of those newly infected are women, and among people younger than 24, girls and young women now make up nearly two thirds of those living with HIV. If these rates of infection continue, women will soon become the majority of the global total of people infected.

As AIDS strikes at the lifeline of society that women represent, a vicious cycle develops. Poor women are becoming even less economically secure as a result of AIDS, often deprived of rights to housing, property or inheritance or even adequate health services. In rural areas, AIDS has caused the collapse of coping systems that for centuries have helped women to feed their families during during times of drought and famine — leading in turn to family break-ups, migration, and yet greater risk of HIV infection. As AIDS forces girls to drop out of school — whether they are forced to take care of a sick relative, run the household, or help support the family — they fall deeper into poverty. Their own children in turn are less likely to attend school — and more likely to become infected. Thus, society pays many times over the deadly price of the impact on women of AIDS. 
Why, then, are women — usually not the ones with the most sexual partners outside marriage, or more likely than men to be injecting drug users — more vulnerable to infection? Usually, because society’s inequalities puts them at risk. There are many factors, including poverty, abuse and violence, lack of information, coercion by older men, and men having several partners. That is why many mainstream prevention strategies are untenable, for example those based exclusively on the ‘ABC’ approach — “abstain, be faithful, use a condom”. Where sexual violence is widespread, abstinence or insisting on condom use is not a realistic option for women and girls. Nor does marriage always provide the answer. In many parts of the developing world, the majority of women will be married by age 20, and have higher rates of HIV than their unmarried, sexually active peers — often because their husbands have several partners.

What is needed is positive, concrete change that will give more power and confidence to women and girls, and transform relations between women and men at all levels of society.

Change that will strengthen legal protection of women’s property and inheritance rights, and ensure they have full access to prevention options — including microbicides and female condoms.

Change that makes men assume their responsibility — whether ensuring their daughters get an education; abstaining from sexual behaviour that puts others at risk; forgoing relations with girls and very young women; or understanding that when it comes to violence against women, there are no grounds for tolerance and no tolerable excuses.

That is why, last month, UNAIDS launched a Global Coalition on Women and AIDS as an effort to ensure that the empowerment of women is at the centre of the response, and to build on the critical role that women already play in the fight against HIV/AIDS worldwide. In most countries and communities I have visited around the world, it is women who have been the most active and effective advocates and activists in the fight against AIDS. Everywhere that the epidemic is taking a severe toll, there are heroic women’s groups and cooperatives doing remarkable work on prevention and care. Supporting these women, and encouraging others to follow their example, must be our strategy for the future. It is among them that the real heroes of this war are to be found. It is our job to furnish them with strength, resources and hope.