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Executive summary

In South Africa (SA), most women are in the reproductive age group (Brittain et al., 2019). In comparison to any other country, South Africa has a heavy burden of HIV, high chances of accidental pregnancy in women infected with HIV is still a main point of worry. In 2012, it was reported that about 65% to 85% of accidental pregnancy was among women infected with HIV (Adeniyi et al., 2018). Here in the report, we are discussing about the prevalence of HIV amongst women in SA. Later the report will outline the relevant demography and key health issues related to HIV and the contribution of social determinants of health to it.

Background (or Introduction 1)

In South Africa, around 7.9 million persons are existing with HIV in which around 60% of women account for new infections. In the year 2017, a survey has been conducted by South African National household-based HIV Prevalence, Incidence, Behavior and Communication; the report of the survey states that in the age group of 15 to 49 years, around 26.3% of females and 14.8% of males are living with HIV. The advanced prevalence is in the age group of 15-24 years, around 1.51%. (Palanee-Phillips et al., 2022). Several factors are responsible for the higher occurrence of HIV in SA, including age-desperate relations, unpredictable condom use and primary sexual debut in increased risk and socioeconomic status.

Women living in informal areas, women who are engaged in transactional sex or other high-risk coping behaviour and those who have a history of Sexually Transmitted Infections (STI) are at higher risk of getting HIV in comparison to other women (Dellar et al., 2015). However, Wand et al (2020) state that the rate of HIV among women in SA was higher among women younger than 20 years. The rate of HIV is increasing from 6.2 to 9.3 per 100 person-year over the years (Wand et al., 2021). Using injectable contraceptives, being single/ not cohabiting and having less than two children are also reported as the reason for this increased rate of HIV in women in South Africa (Wand et al., 2021). In SA, late presentation or detection of HIV-infected individuals is responsible for the late reduced eradication rate and HIV-related mortality. Women in South Africa lack knowledge about HIV and face cultural and social stigmas and socioeconomic barriers that limit healthcare access. Other demographic factors that lead to the higher prevalence of HIV in women are age, gender & occupation status and low socioeconomic contribution. Women living in rural areas have poor access to healthcare services, resulting in late presentation for HIV care (Sogbanmu et al., 2019). Due to the lack of government involvement in HIV prevention program and unequal distribution of healthcare resources among women in South Africa, the HIV status remains vulnerable.

Results (or findings)

South Africa contributes to around one-fifth of people living with HIV worldwide. Among adults (15-19 years), the prevalence rate of HIV is 20.4%, out of which the majority are women (UNAIDS, 2020). In 2005, the HIV infection prevalence among women was 16.9% in the age group 15-24 years; however, in the year. Transmission of HIV is mostly through heterosexual sex, with women excessively infected compared to their male counterparts. The study by Ramjee et al (2013) stated that each minute one young woman is getting infection of HIV. The higher prevalence of HIV among pregnant women also affect the health of the child, which is reported as one of the severe cases in SA nowadays.

Women in South Africa face many challenges, resulting in an increased risk of getting HIV infection. Some major contributing features to the higher prevalence of HIV in South Africa are poverty, violence among women, gender inequality and disparity, unprotected sex, biological risk factors and pregnancy, dry sex, food insecurity. There is a strong relationship between poverty and the higher prevalence of HIV among women. Poverty rises the risk of HIV among women as poverty forces girls and women to exchange sex for food and to work as sex workers for their living and existence needs, as other work choices are little paying to cover their expenses (Dellar et al., 2015).

Violence among women: It has been reported that there is an association between intimate partner violence and the rate of HIV infection. The study stated that HIV-positive women report a higher prevalence of women in comparison to HIV-negative women. As per the statistical data, around 0.46 % of the women are reported as HIV positive after experiencing intimate partner violence, whereas only 0.2% of women who did not experience intimate partner violence were HIV positive (Shri & Muhammad, 2021). Gender inequality and disparity: Women are disproportionally suffered by HIV in Sub-Saharan Africa (SSA). Gender inequality is the leading factors for it. Compared to men, women account for 59% of all HIV infections in SSA. Due to gender inequality, women are uneducated and unemployed, predisposing them to transactional sexual exchanges (Ramjee et al, 2013). Women lack the power and decision-making ability to deny sexual intercourse or negotiate for safe sex, like using condoms. Some social customs allowed violence against women involving rapes, and spousal abuse (Sia et al., 2020). Unprotected sex: Women are at advanced risk of getting HIV when involved in unprotected sex; the chances are even higher in the anal intercourse. Biological risk factors and Pregnancy: In women, hormones such as progesterone are reported as the biological factor which may increase the susceptibility to HIV infection. Higher levels of oestrogen and progesterone lead the change in genital mucosa, which is related with cervical ectopy in young women resulting in an increased chances of HIV infections. It has been reported that pregnancy is a significant risk feature for HIV in young women. Pregnancy is the immunocompromised state in which women are more prone to acquiring infections, including HIV (Sia et al., 2020). Dry sex is reported as one of the increased practices in some southern African countries. Young women used to insert drying agents into the vagina to increase sexual pleasure. These agents cause tearing of vaginal mucosa and enhance the chance of inflammation and HIV infection (Ramjee et al, 2013). Food insecurity: Women are discriminated in many parts of SA, men are known as the dominant character of the family. Women are not allowed to have meal before men and in worst cases they are not allowed to have multiple meals. In the rural areas of SA some of the cultural tribes women are treated bad, which makes them malnourished and more prone to get infections like HIV (Sia et al., 2020).

Discussion

Women living with HIV in South Africa face socially determined barriers, making them more vulnerable. Women face restrictions to getting benefits from the factors men used to take, like education, access to healthcare, shared decision-making, and ability to respond. Due to inequality that women face it results in poor health standard and makes women more prone to acquiring infections in comparison to men.

Two Major Social Determinants Of Health That Are Contributing To The Advanced Prevalence Of HIV Among Women In SA Are Discussed Below:

Education:

Women are at advanced risk of having HIV infection than men because of having a greater mucosal surface area exposed to pathogens and infectious fluid for a longer duration during sexual intercourse. Most women are unaware of this risk because of poor education status (Ramjee & Daniels, 2013). In SA, around 270 000 new HIV infections were reported in the year 2016, increasing the number of infected to 7.1 million people (Durevall et al., 2019). In the study done by Duravell et al (2019), it has been stated that education has a protective effect on HIV infection. In the initial stage of the epidemic, HIV spread faster among the well-educated and wealthy. However, over time, the epidemic pattern changed and shifted towards the population with low educational status and a poor lifestyle. In South Africa, women have poor education about the transmission of HIV and its preventive measure compared to men, resulting in increased prevalence among women (Durevall et al., 2019). There are varied factors by which education could be defensive against the acquisition of HIV among women. Mee et al (2018) state that if women spend more time in school, it can help them to get higher exposure to sexual and reproductive health education. Higher education can make women more independent and could recover young women's socioeconomic status and ability to make decisions and convey safer sexual practices, such as by increasing the use of condoms (Mee et al., 2018). Sexual education has now become a part of schooling. The aim is to educate the young generation about the sec related disease and their prevention. Education decrease the risk of HIV infections, boosts self-esteem, and helps women to choose an alternative of living rather than depending on their partner (Ramjee & Daniels, 2013). It can be stated that the poor level of education amongst women in SA is the major social determinants that contribute to higher prevalence in HIV infection. To educate older women about HIV there is need to intimate the programmes that can make women aware of the early sign and symptoms of the disease (Durevall et al., 2019).

2. Access To Affordable Health Services Of Decent Quality:

WHO has defined access to healthcare services, as the ability of a person to receive appropriate healthcare. It is the significant social determinant of health that those unable to access the healthcare services often experience deprived health (Nnko et al., 2019). Bogart et al (2013) state that in South Africa around 5.6 million of individual are existing with HIV but only 1.4 million of people can get antiretroviral treatment. Socio-demographic factors like lack of knowledge related to the disease and its treatment, low socioeconomic status, and residence in rural areas are some of the factors which reduce the access to treatment of HIV. Many of the HIV-infected women reported that they are unable to reach the healthcare centre because of a lack of transportation and some of them are unable to pay for transportation. The stigma about HIV and the fear of discrimination affect the early diagnosis and treatment of women having HIV in South Africa (Mburu et al., 2019). Stigma may result in the lack of social support, and may prevent the HIV-infected patient from confiding to others and also in the reluctance to take medications in front of other people. Women who are not financially independent have to rely on their partner and family for treatment, women whose partner is not supportive have to face challenges in seeking treatment. Also, the treatment for HIV is cost-effective and not available in rural areas. Hence, women in these areas have to face financial crises and the inability to reach the healthcare centre (Friedman et al., 2020).

Conclusions

It can be concluded that South Africa needs to take strong actions to decrease the prevalence of HIV amongst women. Some of the factors like gender inequality, poverty, and domestic violence against women need to be addressed, and the government should develop policies for the welfare of women. Social determinants of health, like education and access to healthcare services, should be promoted so that women can make a stand for themselves by getting educated by educated. To reduce the higher transmission rate and HIV-induced mortality, government and private healthcare sectors should incorporate the healthcare care sector to provide equal access to services.

References

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