Why Rates of HIV Are Higher Among Female Teens than Males

A teenage girl puts her arm around another teenage girl as they walk together
Experts say young females need better access to HIV treatments. Johner Images/Getty Images
  • A new report states that young women and girls are more than twice as likely to contract HIV than young men and boys.
  • Experts say this indicates that cultural attitudes, gender discrimination, and socioeconomic factors play a role in the spread of HIV among women between the ages of 10 and 19, especially in sub-Saharan Africa.
  • They say more awareness and better access to HIV treatment are needed.

A new UNICEF report indicates that young women and girls are more than twice as likely to contract HIV than young men and boys.

The report notes that nearly 98,000 adolescent females worldwide tested positive for the virus in 2022.

While that number is still nearly half (47%) of HIV infections among that population in 2010, researchers say it still indicates that cultural attitudes, gender discrimination, and socioeconomic factors play a role in the spread of HIV among women between the ages of 10 and 19, especially in sub-Saharan Africa.

Adolescents in general are a growing share of the global population living with HIV.

In 2022, nearly 1.7 million adolescents around the world between 10 and 19 were living with HIV — nearly 4% of all people living with HIV and about 10% of new HIV cases.

However, the statistics around young women and girls are disproportionate to the overall population.

Why are young women are more susceptible to HIV infection

According to the UNICEF report, 384 females between the ages of 10 and 19 test positive for HIV every day across the globe.

Approximately 87% of HIV-positive children between the ages of 0 and 14 and 82% of HIV-positive adolescents aged 10 to 19 live in sub-Saharan Africa. Here, the population of young women is disproportionately at risk.

Dr. Monica Gandhi, a professor of medicine and the associate division chief of the Division of HIV, Infectious Diseases, and Global Medicine at UCSF/San Francisco General Hospital, told Healthline that a combination of cultural and economic factors contribute to the higher numbers of female HIV cases.

“This disparity is likely due to the increased vulnerability of adolescent girls/young women to forced sex (14.7% to 38.9% of sexual debut is forced as evaluated by this CDC report in seven sub-Saharan African countries) and economic circumstances that may lead to young women selling sex for money or food,” Gandhi said. “Moreover, with millions of girls out of school in the last three years due to the COVID-19 pandemic response, economic conditions were even worse for many in sub-Saharan Africa and this economic need for young women to sell sex likely heightened. Most young women’s risk factors for HIV infection are not their own risk factors but those of their partners.”

The CDC report states that forced sexual initiation is “associated with being unmarried, violence victimization, risky sexual behaviors, sexually transmitted infections (STIs), and poor mental health. Early sexual debut was associated with lower education, marriage, ever witnessing parental intimate partner violence during childhood, risky sexual behaviors, poor mental health, and less HIV testing.”

A traditionally skewed patriarchal dynamic is also to blame, according to Dr. William Schaffner, a professor of preventive medicine in the Department of Health Policy and a professor of medicine in the Division of Infectious Diseases at the Vanderbilt University School of Medicine in Tennessee.

“Women across the world are less valued than men, so testing and treatment simply is not as available to them as it is to men,” Schaffner told Healthline. “The second thing is that men often take advantage of women. They’re infected, they pass their infection on to these women, and then we run into the difficulty that they are not tested and treated as comprehensively as men are.”

What are current and future treatments for HIV in these age groups? 

Schaffner says that significant advances in medicine have made implementing combination treatments less onerous for people living with HIV.

“It’s much easier to treat people with HIV infection because you can frequently do it in using very few actual pills. Because we have combination therapies that work very well… you don’t have to take a whole handful of pills several times a day anymore,” he said.

Even with the medical advances, access to combination therapies is still a major obstacle, especially for children. The UNICEF report states that in 2022, “four in 10 infants with HIV missed out on a timely diagnosis.”

The report noted that nearly half of the 1.5 million children living with HIV were still not getting antiretroviral treatment. Coverage was 77% among adults (15 years and older) but only 57% among children (0–14 years).

“We do have good HIV treatments now for children and adults both, mainly with a medication called dolutegravir combined with two other antiretroviral treatments,” Gandhi said. “However, fewer children have access to antiretroviral therapy than adults. As per the UNAIDS July 2023 report, 77% of adults have access to life-saving ART whereas only 57% of children have access to the needed treatment.”

Obstacles to effective HIV treatments

While medicines are more affordable and in many ways easier to take than they have been before, they still require a methodical, consistent application to broader populations, Schaffner said.

“These are not one-shot deals, right?” he noted. “This is not like treating a urinary tract infection where you’re finished in three days. You have to be able to maintain these people in a treatment circumstance, really lifelong.”

“The hurdles involve formulations of antiretrovirals for children that are harder to take (e.g. liquid formulations that are not pleasing in taste or pills which are hard to swallow); difficulty for parents in giving children the pills or liquid every day; lack of pediatric formulations in every area; and the political will to ensure that treatment options are expanded for children,” Gandhi said.

Cultural stigma around HIV is also significant. The UNICEF report states that in 54 surveyed countries, “a median of 59% of people harbored discriminatory attitudes toward people living with HIV.”

The organization’s goal is to have that percentage down to 10% by 2025, which indicates the amount of awareness that must be raised and implemented.

“The first thing is doing exactly what the World Health Organization has done: you have to define the problem before you can affect solutions,” Schaffner said. “So now, it depends upon each country, each society, each medical care institution in all those countries, to be aware of this difference, this disparity and try to effect programs, policies, educational activities, within those countries and within those institutions.”

Takeaway

Despite advances in HIV treatment and an overall reduction in new infections over the past decade, young women and girls are more than twice as likely to contract HIV than young men and boys, with nearly 98,000 new cases among adolescent females reported globally in 2022.

Experts say this indicates that cultural attitudes, gender discrimination, and socioeconomic factors play a role in the spread of HIV among women between the ages of 10 and 19, especially in sub-Saharan Africa.

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