Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Jun 27;17(1):19035.
doi: 10.7448/IAS.17.1.19035. eCollection 2014.

Gender Inequality and HIV Transmission: A Global Analysis

Free PMC article

Gender Inequality and HIV Transmission: A Global Analysis

Eugene T Richardson et al. J Int AIDS Soc. .
Free PMC article


Introduction: The HIV pandemic disproportionately impacts young women. Worldwide, young women aged 15-24 are infected with HIV at rates twice that of young men, and young women alone account for nearly a quarter of all new HIV infections. The incommensurate HIV incidence in young - often poor - women underscores how social and economic inequalities shape the HIV epidemic. Confluent social forces, including political and gender violence, poverty, racism, and sexism impede equal access to therapies and effective care, but most of all constrain the agency of women.

Methods: HIV prevalence data was compiled from the 2010 UNAIDS Global Report. Gender inequality was assessed using the 2011 United Nations Human Development Report Gender Inequality Index (GII). Logistic regression models were created with predominant mode of transmission (heterosexual vs. MSM/IDU) as the dependent variable and GII, Muslim vs. non-Muslim, Democracy Index, male circumcision rate, log gross national income (GNI) per capita at purchasing power parity (PPP), and region as independent variables.

Results and discussion: There is a significant correlation between having a predominantly heterosexual epidemic and high gender inequality across all models. There is not a significant association between whether a country is predominantly Muslim, has a high/low GNI at PPP, has a high/low circumcision rate, and its primary mode of transmission. In addition, there are only three countries that have had a generalized epidemic in the past but no longer have one: Cambodia, Honduras, and Eritrea. GII data are available only for Cambodia and Honduras, and these countries showed a 37 and 34% improvement, respectively, in their Gender Inequality Indices between 1995 and 2011. During the same period, both countries reduced their HIV prevalence below the 1% threshold of a generalized epidemic. This represents limited but compelling evidence that improvements in gender inequality can lead to the abatement of generalized epidemics.

Conclusions: Gender inequality is an important factor in the maintenance - and possibly in the establishment of - generalized HIV epidemics. We should view improvements in gender inequality as part of a broader public health strategy.

Keywords: AIDS; HIV; gender inequality; political ecology; structural interventions.


Figure 1
Figure 1
Components of the Gender Inequality Index. (Adapted from the UNDP.)
Figure 2
Figure 2
Scatterplot of log HIV prevalence by GII with fitted regression line [18,19]. Sample size=133 countries.
Figure 3
Figure 3
Boxplot of predominant mode of transmission (heterosexual vs. men who have sex with men/injection drug users) by GII [19,23]. Vertical line: median GII; shaded box: interquartile range (IQR); whiskers: span all data points within 1.5 IQR of the nearer quartile. Sample size=133 countries.

Similar articles

See all similar articles

Cited by 23 articles

See all "Cited by" articles


    1. UNAIDS. Fact sheet: adolescents, young people and HIV; Geneva: UNAIDS; 2012.
    1. Kenyon C, Buyze J, Colebunders R. HIV prevalence by race co-varies closely with concurrency and number of sex partners in South Africa. PLoS One. 2013;8(5):e64080. - PMC - PubMed
    1. Holmqvist G. HIV and income inequality: if there is a link, what does it tell us?; International Policy Centre for Inclusive Growth (UNDP) working paper; Brasilia: International Policy Centre for Inclusive Growth (IPC - IG); 2009. pp. 1–39. Report No.: 54.
    1. Mehta SD, Moses S, Agot K, Odoyo-June E, Li H, Maclean I, et al. The long term efficacy of medical male circumcision against HIV acquisition. AIDS. 2013;27:2899–907. - PubMed
    1. Barnett T, Whiteside A. AIDS in the twenty-first century: disease and globalization. London: Palgrave Macmillan; 2002.

Publication types