The unequal AIDS burden

When a member of my staff asked a woman in rural Zimbabwe how many buckets of water it took each day to care for an AIDS patient, she answered simply: "Twenty-four."

But the task is far from simple, underscoring the extent of the HIV/AIDS epidemic's impact on women's lives. Twenty-four buckets means 24 trips to the well. Most of those carrying buckets are women, who have borne the brunt of caring for the growing numbers of people living with AIDS in Africa, where the epidemic has hit hardest.

According to UNAIDS, which released new statistics to coincide with the International AIDS Conference in Barcelona last week, more than 37 million adults are living with HIV/AIDS worldwide. Women now make up 49.8 percent of those infected, and in sub-Saharan Africa, 58 percent of the adults living with HIV/AIDS are women. More than two-thirds of newly infected 15- to 19-year-olds in sub-Saharan Africa are female. Increasingly sought after by older men – often in the belief that sex with a virgin can cure AIDS – young women are least able to say no to unsafe sex.

What UNAIDS' new figures and the "24 buckets" story show is that women are fundamentally more affected by the epidemic than men.

That women are more socially, culturally, and biologically vulnerable than men is a reality that arises directly out of the nature of global inequalities between the sexes. On the one hand, millions of women do not have the power or the wherewithal to say "No!" to unwanted or unprotected sex. At the same time, women – often sick themselves – are continuing to care for the sick, an extension of their daily responsibilities within the home.

Collecting water and caring for patients requires that whole families be mobilized. It means food security is threatened when mothers and daughters tend the sick rather than the garden or a paying job. Too often young girls are withdrawn from school – the one place they might learn how to protect themselves – in order to help their mothers and grandmothers.

Throughout the AIDS-stricken regions of the world, wide age gaps exist in communities that once thrived on intergenerational bonds. Families now often consist of the very old or the very young, with older women caring for orphaned grandchildren. Typically, female caregivers have no access to sanitary gloves, disinfectant, or information to protect themselves. In Zimbabwe women use empty plastic sugar bags to cover their hands. For those seeking medical care, drugs that are taken for granted in the industrialized world are simply not available or affordable for the majority of people living with AIDS.

Meanwhile, healthy girls and women trying to live "normal" lives in the midst of the epidemic have little if any means to protect themselves against infection. Research on HIV-killing microbicides is slow, and the female condom – the only, if not quite satisfactory, barrier method available to women – is too expensive or not available.

Governments that could aggressively respond to the disease with drugs, technical support, and funding are not doing so. At the same time, the coffers of the Global Fund for AIDS, Tuberculosis & Malaria remain at a fraction of the financial goals needed to improve the lives of the infected and those caring for them. This includes improvements in services the industrialized world takes for granted – things as basic as running water that requires only a twist of a knob, which would enable AIDS patients to live with dignity in clean bedclothes and linens.

If we are to tame and reverse the AIDS epidemic, we need to protect women's human rights and put an end to laws that violate them.

• Noeleen Heyzer is executive director of the United Nations Development Fund for Women.