Poverty, gender inequities, and women's risk of human immunodeficiency virus/AIDS
Poverty, gender inequities, and women's risk of human immunodeficiency virus/AIDS
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DOI：
10.1196/annals.1425.013
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发表时间：
2008-01-01
期刊：
影响因子：
--
通讯作者：
Padian, Nancy S.
中科院分区：
文献类型：
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作者：
Krishnan, Suneeta;Dunbar, Megan S.;Padian, Nancy S.
根深蒂固的经济和性别不平等共同推动人类免疫缺陷病毒（HIV）/艾滋病流行在全球范围内蔓延，且女性人数日益增多。迄今为止，尚未观察到艾滋病毒传播在人口层面上显着下降，至少部分原因是大多数预防方法都假定决策中有一定程度的个人控制，而这并不符合世界许多地区妇女和女孩的现实情况。这些努力没有充分关注风险环境的关键特征，尤其是贫困和性别权力不平等。更少的干预措施涉及具体机制，这些不平等通过这些机制产生了危险的性行为，导致妇女感染艾滋病毒的可能性大大增加。本文的重点是确定源于贫困与根深蒂固的性别不平等之间相互作用的机制或结构途径，并提出解决和可能修改这些途径的策略。我们强调了艾滋病毒风险的四种结构性途径，所有这些途径都可以改变：(1) 缺乏获得艾滋病毒/性传播感染 (STI) 预防的关键信息和卫生服务的机会，(2) 获得正规教育和技能发展的机会有限，(3) 亲密伴侣暴力，以及 (4) 经济资源不足导致的移民负面后果。我们主张采取干预措施，增加妇女获得教育、培训、就业以及艾滋病毒/性传播感染预防信息和工具的机会；尽量减少移民；通过与男性和社区合作，同时减少妇女的贫困并促进性别平等规范。总之，我们确定了制定和评估解决这些结构性途径的策略所面临的挑战。
Entrenched economic and gender inequities together are driving a globally expanding, increasingly female, human immunodeficiency virus (HIV)/AIDS epidemic. To date, significant population-level declines in HIV transmission have not been observed, at least in part because most approaches to prevention have presumed a degree of individual control in decision making that does not speak to the reality of women's and girls' circumstances in many parts of the world. Such efforts have paid insufficient attention to critical characteristics of the risk environment, most notably poverty and gender power inequities. Even fewer interventions have addressed specific mechanisms through which these inequities engender risky sexual practices that result in women's disproportionately increased vulnerabilities to HIV infection. This article focuses on identifying those mechanisms, or structural pathways, that stem from the interactions between poverty and entrenched gender inequities and recommending strategies to address and potentially modify those pathways. We highlight four such structural pathways to HIV risk, all of which could be transformed: (1) lack of access to critical information and health services for HIV/sexually transmitted infection (STI) prevention, (2) limited access to formal education and skill development, (3) intimate partner violence, and (4) the negative consequences of migration prompted by insufficient economic resources. We argue for interventions that enhance women's access to education, training, employment, and HIV/STI prevention information and tools; minimize migration; and by working with men and communities, at the same time reduce women's poverty and promote gender-equitable norms. In conclusion, we identify challenges in developing and evaluating strategies to address these structural pathways.