During the past decades women have been at a higher risk of HIV infection than men. In the past, women never wore condoms during sexual intercourse. Today, high-level sensitization from health experts, government and private health institutions has increased awareness on the use of female condoms.

For women to protect themselves from HIV infection, they must not only rely on their own skills, attitudes, and behaviour regarding condom use, but also on their ability to convince their partner to use a condom.

Problems related to gender, culture and power have been barriers to maintaining safer sex practices with a primary partner for most women, especially those living in rural areas.

It is important to understand here that HIV prevention strategies must target both women and men in heterosexual relationships, and address gender norms in sexual decision making.

In most African traditions, women were disproportionately represented among the poor. Because of this, women were less likely to have health insurance and access to healthcare services. Nevertheless, today a small proportion of women living in poverty are also disproportionately affected by HIV. For these women, the struggle for daily survival may take precedence over concerns about HIV infection, whose impact may not be seen for several years.
Like many in committed relationships, women may find intimacy in their relationship to be more important than protection against HIV. Unsafe sex may be linked to emotional and social insecurity among women that are not necessarily financial dependent on men.

It is important to mention, once again, the fact that the ideal of monogamy including assuming that one’s partner is faithful, may increase AIDS risk denial in married couples. 

Required methods for protection

Women are more likely to protect themselves from pregnancy using methods that do not depend on partner cooperation such as oral contraceptives. However oral contraceptives like the pill do not protect against STDs and HIV.

Female-controlled methods to prevent HIV transmission are needed. Traditionally, abstinence, condoms and dental dams have been the main methods of protection.
Nearly 17 years ago, a female condom was introduced on the market but to date results have been mixed as to its efficacy, affordability and rate of popularity.

Most importantly vaginal microbicides that would prevent STD transmission but allow for pregnancy have been developed and piloted in some prevention programs. Further efforts need to include large scale efficacy trials and to increase scientific interest and support from pharmaceutical companies to develop microbicides that prevent HIV infection and sold at affordable prices.

Solutions

The Rwandan government has, in the past 7 years, recruited women as community leaders and this forms the basis for an effective HIV prevention program among low-income urban women. Women opinion leaders are trained to lead risk-reduction workshops, provide HIV educational materials and condoms, and conduct HIV education through community events.

The women effectively mobilized their communities through tailored prevention messages and activities. 
Because women at risk are not always visible as a specific population or community, programs must strive to be where women are.

Previously most drug treatment programs were staffed by men and oriented towards male clients. Allowing pregnant women to enroll in drug treatment programs, and allowing women to bring children with them would be helpful.
Because women are more likely to be infected by men, programs that specifically target men will have a beneficial impact on women.

Encouraging women to seek STD diagnosis and treatment should also be a part of effective HIV prevention strategies.

More research needs to be carried out on modes of HIV transmission and risks for women, including woman to woman transmission. Innovative, women-specific interventions need to be evaluated.

A comprehensive HIV prevention strategy uses many elements to protect as many people at risk for HIV as possible. Interventions that address sexuality, family, culture, empowerment, self-esteem and negotiating skills as well as interventions located in varying community settings are especially important.

Ends