HIV/AIDS knowledge, lack of supportive/understanding work environments, lack of employment opportunities, and personal financial resources were also key barriers stopping participants from accessing care.64 Nonetheless, AIDS-related illness are the leading cause of death among women of a reproductive age.65 A lack of youth-friendly HIV treatment, support and care services prevents many young women from accessing ART.Studies from Southern Africa have shown how loss to follow up a year after enrolling on ART is higher among young people compared to both adults and children.66 67 Various factors can act as barriers to women adhering to ART including a lack of accurate information about the use of ARVs.HIV is not only driven by gender inequality, but it also entrenches gender inequality, leaving women more vulnerable to its impact.13 In some countries, women face significant barriers to accessing healthcare services.
In 2016, 60% of women had access to treatment compared to just 47% of men.57 This has meant that despite women being more affected by HIV globally, the AIDS-related death rate is 27% lower among women than among men, decreasing by 33% since 2010.58 59 In 2015, 9.2 million women aged 15 years and older living with HIV were accessing life-saving ART.
Coverage is higher among pregnant women attending clinics that provide PMTCT services.
This increases both the risk of HIV advancing and onward transmission.37 There is evidence that shows that cash transfers to young girls can improve their SRH outcomes, empowering them and helping them to stay in school.38 Intimate partner violence and gender based violence prevents many women, particularly young women, from protecting themselves against HIV.39 In some regions it has been estimated that women who experience intimate partner violence are as much as 1.5 times more likely to acquire HIV.40 In places with high HIV prevalence, women who experience intimate partner violence are 50% more likely to acquire HIV than women who do not.41 Intimate partner violence has been identified as a key driver of HIV transmission in east and southern Africa.
More than 30% of ever married or partnered young women (aged 15–24 years) in Uganda, Tanzania, Zambia and Zimbabwe experienced intimate partner violence in the previous 12 months in 2015.
Procedures relating to a women’s sexual and reproductive health (SRH), performed without consent, including forced sterilisation, forced virginity examinations and forced abortion, also deter women from accessing services.15 In some cases, healthcare providers do not fully understand laws around childbirth and HIV.
This can lead to women choosing to have an abortion because they are misinformed about their options and how to protect their health as well as their child's.16 Additionally, in 29 countries women require the consent of a spouse or partner to access SRH services.17 A lack of access to comprehensive HIV and SRH services means that women are less able to look after their sexual and reproductive health and rights (SRHR) and reduce their risk of HIV infection.It is estimated that in South Africa a third of sexually active adolescent girls will experience a relationship with a man at least five years older than them.The study found a cycle of transmission, whereby high HIV prevalence in young women was driven by sex with older men (on average 8.7 years older) who themselves had female partners with HIV, many of whom had acquired HIV as young women.48 As of 2017, around one in seven adolescent girls (aged 15 to 19) in the world were married or in union.49 Girls who marry as children are more likely to be beaten or threatened by their husbands than girls who marry later, and are more likely to describe their first sexual experience as forced.In many settings, where SRHR and HIV services exist, they are primarily for married women with children and do not meet the specific needs of unmarried young women and adolescent girls.Healthcare providers often lack the training and skills to deliver youth-friendly services and do not fully understand laws around the age of consent.18 In many countries, organisations cannot legally provide SRHR and HIV services to people under 18-years-old because it is seen as encouraging ‘prostitution’ or the trafficking of minors and may bring the organisation into conflict with the law.19 A study of young women aged 18-24,in Soweto, South Africa, found they knew where to obtain SRH information and services but that common experiences of providers’ unsupportive attitudes, power dynamics in relationships and communication issues with parents and community members prevented respondents from accessing and utilising the information and services they needed.20 A study on SRH services in Indonesia found that, in large part, sexual activity outside of marriage, often referred to as ‘free sex’, was viewed as unacceptable by both service providers and young people themselves, due to dominant cultural and religious norms.Adolescent girls are also susceptible to relatively high levels of genital inflammation which may also increase the risk of HIV acquisition.53 Due to the lower uptake of ART among men, in most countries it is likely that fewer men than women are virally suppressed, which means men are more likely to pass the virus on to others.In settings where the main mode of transmission is heterosexual sex, this further increases women’s risk of acquiring HIV.5455 A major gap in HIV service provision for women can be found in HIV testing and counselling (HTC), which is a vital gateway to treatment services.Today, women constitute more than half of all people living with HIV.1AIDS-related illnesses remain the leading cause of death for women of reproductive age (15-44).2 Young women (15-24 years), and adolescent girls (10-19 years) in particular, account for a disproportionate number of new HIV infections.In 2016, new infections among young women aged (15-24) were 44% higher than men their age.3 In eastern and southern Africa, young women made up 26% of new HIV infections despite only accounting for 10% of the population.A study of around 2,000 women living with HIV from Western Europe, Canada, Central and Eastern Europe, Latin America and China found 88.2% were currently taking ART.Barriers to accessing care that disproportionately affected women included transportation, lack of gender autonomy, stigma, economic constraints, lack of knowledge, and gender roles.63 The study found the most prevalent barrier to care experienced by women in the study was HIV-related stigma from within their own community.