Articles tagged as "Eliminate gender inequalities"

Persons left behind: transgender women

Worldwide burden of HIV in transgender women: a systematic review and meta-analysis.

Baral SD, Poteat T, Strömdahl S, Wirtz AL, Guadamuz TE, Beyrer C. Lancet Infect Dis. 2012 Dec 20. pii: S1473-3099(12)70315-8. [Epub ahead of print]

Background: Previous systematic reviews have identified a high prevalence of HIV infection in transgender women in the USA and in those who sell sex (compared with both female and male sex workers). However, little is known about the burden of HIV infection in transgender women worldwide. We aimed to better assess the relative HIV burden in all transgender women worldwide.

Methods: We did a systematic review and meta-analysis of studies that assessed HIV infection burdens in transgender women that were published between Jan 1, 2000, and Nov 30, 2011. Meta-analysis was completed with the Mantel-Haenszel method, and random-effects modelling was used to compare HIV burdens in transgender women with that in adults in the countries for which data were available.

Findings: Data were only available for countries with male-predominant HIV epidemics, which included the USA, six Asia-Pacific countries, five in Latin America, and three in Europe. The pooled HIV prevalence was 19·1% (95% CI 17·4-20·7) in 11 066 transgender women worldwide. In 7197 transgender women sampled in ten low-income and middle-income countries, HIV prevalence was 17·7% (95% CI 15·6-19·8). In 3869 transgender women sampled in five high-income countries, HIV prevalence was 21·6% (95% CI 18·8-24·3). The odds ratio for being infected with HIV in transgender women compared with all adults of reproductive age across the 15 countries was 48·8 (95% CI 21·2-76·3) and did not differ for those in low-income and middle-income countries compared with those in high-income countries.

Interpretation: Our findings suggest that transgender women are a very high burden population for HIV and are in urgent need of prevention, treatment, and care services. The meta-analysis showed remarkable consistency and severity of the HIV disease burden among transgender women.

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Editor’s notes: This paper systematically reviews studies on the prevalence of HIV infection among transgender women in different countries from three continents. Results unfortunately show that there is a dramatic consistency in HIV prevalence data, which reach peaks often above 20%, irrespective of the financial context of the countries where transgenders live. In addition, there is a common theme: risk factors including stigma, discrimination and marginalisation are all factors which dramatically increase the risk of becoming infected by HIV. Not only are transgender women probably the group with the highest risk of acquiring the infection, but they are also in urgent need of prevention, possibly including pre- and post-exposure prophylaxis, and of tailored support and care. But these might not be enough, if marginalisation is supported in some countries with a legal environment contradicting international human rights frameworks.

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Gender based violence

Gender inequality norms are associated with increased male-perpetrated rape and sexual risks for HIV infection in Botswana and Swaziland

Shannon K, Leiter K, Phaladze N, Hlanze Z, Tsai AC, Heisler M, Iacopino V, Weiser SD, PLoS One 2012;7(1):e28739. Epub 2012 Jan 11

There is limited empirical research on the underlying gender inequity norms shaping gender-based violence, power, and HIV risks in sub-Saharan Africa, or how risk pathways may differ for men and women. This study is among the first to directly evaluate the adherence to gender inequity norms and epidemiological relationships with violence and sexual risks for HIV infection. Data were derived from population-based cross-sectional samples recruited through two-stage probability sampling from the 5 highest HIV prevalence districts in Botswana and all districts in Swaziland (2004-5). Based on evidence of established risk factors for HIV infection, Shannon and colleagues aimed 1) to estimate the mean adherence to gender inequity norms for both men and women; and 2) to model the independent effects of higher adherence to gender inequity norms on a) male sexual dominance (male-controlled sexual decision making and rape (forced sex)); b) sexual risk practices (multiple/concurrent sex partners, transactional sex, unprotected sex with non-primary partner, intergenerational sex). A total of 2049 individuals were included, n = 1255 from Botswana and n = 796 from Swaziland. In separate multivariate logistic regression analyses, higher gender inequity norms scores remained independently associated with increased male-controlled sexual decision making power (AORmen = 1.90, 95%CI:1.09-2.35; AORwomen = 2.05, 95%CI:1.32-2.49), perpetration of rape (AORmen = 2.19 95%CI:1.22-3.51), unprotected sex with a non-primary partner (AORmen = 1.90, 95%CI:1.14-2.31), intergenerational sex (AORwomen = 1.36, 95%CI:1.08-1.79), and multiple/concurrent sex partners (AORmen = 1.42, 95%CI:1.10-1.93). These findings support the critical evidence-based need for gender-transformative HIV prevention efforts including legislation of women's rights in two of the most HIV affected countries in the world.

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Editor’s note: Hanging on to gender inequity norms, such as those that condone beating women or privileging boys for school, is hampering Botswana and Swaziland’s ability to put the HIV epidemic behind them. This representative household survey built local research capacity on how to enumerate households and how to ask questions in an appropriate, non-judgemental manner. In these two countries, where marital rape is not criminalised and laws continue to promote women’s subordination, men who adhere to gender inequity norms are twice as likely to both dominate sexual decision-making and rape their partners. These men are caught up in concepts of masculinity that shape their own HIV risk. Several studies have now shown that perpetrators of partner violence are themselves at increased odds of HIV and other sexually transmitted infections through sex with concurrent sex partners, transactional sex, sexual assault of non-partners, and alcohol and/or drug use. Changes in gender inequity norms are unlikely to occur through public health promotion alone. Legislative changes are urgently needed in marriage, inheritance, and employment laws in both Swaziland and Botswana, to give women equal access to education, credit, land ownership, inherited property, and control over financial resources. Legislative frameworks that subordinate women have downstream macro-level effects on gender inequity norms, violence, and HIV risk. If you have been doubtful about the need for gender-transformative HIV prevention, including law reform, this is an eye-opening read.

Gender
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Gender based violence

Violence towards women, men's sexual risk factors and HIV infection among women: Findings from a national household survey in Rwanda

Kayibanda JF, Bitera R, Alary M, J Acquir Immune Defic Syndr. 2012 Mar 1;59(3):300-7

Kayibanda, Bitera and Alary used the third Rwanda demographic and health survey (DHS) data to examine the relationship between violence towards women, men sexual risk factors, and HIV prevalence among women. The Rwanda DHS was conducted in 10,272 households in 2005. Analyses were restricted to 2,715 women and 2,461 men who were legally married or cohabiting. The authors used logistic regression to analyse associations between HIV and violence towards women. Couple-specific analyses were carried out to assess the relationship between men’s sexual risk factors and intimate partner violence (IPV) reported by their wives. Respectively 29.2%, 22.2% and 12.4% of women reported having experienced physical, psychological and sexual intimate partner violence whereas 52.1% reported control practices by their partners. There was a positive link between intimate partner violence reported by women and attitudes justifying wife beating endorsed by their husband. After controlling for socio-demographic variables and women’s sexual risk factors, the odds of HIV prevalence was 3.23 [Confidence Interval (95% CI): 1.30-8.03] among women with a score from 3 to 4 on the psychological intimate partner violence scale compared to those with a score from 0 to 2. Women who reported having experienced inter-parental violence (father who beat mother) were more likely to test HIV-positive: adjusted odds ratio: 1.95; 95% CI: 1.11-3.43. There was also a statistically significant relationship between men’s risky sexual factors and experience of intimate partner violence as well as HIV prevalence among women. Violence towards women is associated with HIV in Rwanda. Interventions to reduce gender-based violence should be integrated into HIV policy.

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Editor’s note: The figures reported here for intimate partner violence in these cohabiting or married couples in Rwanda are likely underestimates. Between 14% and 18% of women did not answer, or said they did not know, when they were asked questions about physical, psychological, or sexual violence¾and HIV prevalence was higher among these women. Analyses of the same data set have reported divergent results: an association between women’s reports of emotional abuse and higher HIV prevalence or yet no association between violence in general and HIV prevalence. This study takes the data one step further, finding independent associations between HIV infection in women and childhood experiences of inter-parental violence, as well as for emotional violence perpetrated by the cohabiting partner, as previously noted. Couple-specific analyses revealed that women whose cohabiting male partner reported positive attitudes toward wife beating were more likely to report intimate partner violence. As a marker of men’s perpetration of intimate partner violence, pro wife-beating attitudes should be a red flag identifying those men most likely to be trapped in masculinities maladaptive for the 21st century and who most could benefit from social change programmes, including male discussion and action groups focused on understanding and changing gender inequity norms. If reductions in inter-parental violence are the result, the cycles may be broken, with the next generation experiencing less intimate partner violence.

Gender
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