Sub-Saharan Africa is the region most affected by the human immunodeficiency virus, or HIV for short, worldwide. HIV damages the body's own defenses, which is why the body can no longer fight off invading pathogens such as bacteria, fungi or viruses. This can lead to life-threatening illnesses such as severe pneumonia.
In many parts of sub-Saharan Africa, young women and girls between the ages of 15 and 24 in particular are at up to three times the risk of infection than a man of the same age. Due to gender and other inequalities, violence, stigmatization, discrimination and ultra-conservative laws, women and girls are often unable to fully protect themselves against HIV. In particular, the low social status of women and girls is one of the main reasons for the rapid spread of HIV in sub-Saharan Africa.
The Chair of Epidemiology headed by Prof. Dr. Stefanie Klug has conducted a study on the empowerment of women, which is an important factor in HIV prevention. For this reason, the connection between the empowerment of women and HIV-related indicators was investigated. The results were published under the title "The Association of Women's Empowerment with HIV-Related Indicators: A Pooled Analysis of Demographic and Health Surveys in Sub-Saharan African" in the "Journal of Epidemiology and Global Health". The journal has an impact factor of 7.3.
For the analysis, the latest demographic and health surveys were used, which include HIV tests in 31 countries in sub-Saharan Africa in addition to other biomarkers. Women's empowerment was measured using the Survey-based Women's EmPowerment (SWPER) index and compared with HIV-related indicators. These include HIV status, HIV testing (ever and in the last twelve months), condom use during last high-risk sex, ability to ask partner to use a condom, and ability to refuse sex.
"Young women are affected in four out of five new HIV infections in sub-Saharan Africa," explains Theresa Schierl, now a Research Associate at the Chair of Social Determinants of Health and first author of the publication. It is the result of a Master's thesis at the Center for Global Health of the TUM Faculty of Medicine in cooperation with the Chair of Epidemiology. "We wanted to know why young women in particular are infected and what factors can contribute to this. For this reason, we used the SWPER index to analyze factors such as HIV status or condom use. This allowed us to reflect a holistic picture of women."
In total, data from 208,947 women were included in the study, of which 100,924 (48%) were classified as "highly empowered" and 21,933 (10%) as "lowly empowered". In particular, women in South Africa (88%), Angola (82%), Ghana (78%), Namibia (76%) and Zimbabwe (74%) were highly empowered, while Chad (29%), Senegal (23%), Niger (21%), Burkina Faso (19%) and Mali (13%) had the lowest scores. On the one hand, women in urban (58%) compared to rural areas (46%) and women with a better education (79% compared to 36% without education) were more empowered.
However, no correlation was found between women's empowerment and their HIV status. Women with high empowerment were more likely to have ever been tested for HIV, but less likely to have been tested for HIV in the last twelve months. In addition, subjects with a high level of empowerment were more likely to ask their partner to use a condom and refuse sex.
"We were able to determine that the empowerment of women does not appear to be related to HIV status, but is closely linked to a woman's ability to make decisions about her sexual behavior," Prof. Klug summarizes the results and also highlights the importance of the study: "The empowerment of women and young girls can contribute to achieving the United Nations' goal of eliminating HIV/AIDS as a health threat by 2030. However, according to the UN, this requires in particular the consideration of scientific findings. It also requires strong political leadership, the fight against inequalities and sustainable financing."
To the homepage of the Chair of Epidemiology
To the publication „The Association of Women’s Empowerment with HIV-Related Indicators: A Pooled Analysis of Demographic and Health Surveys in Sub-Saharan Africa” in the „Journal of Epidemiology and Global Health”
Contact:
Prof. Dr. Stefanie Klug, MPH
Chair of Epidemiology
Georg-Brauchle-Ring 56
80992 München
phone: 089 289 24950
e-mail: sekretariat.klug.epidemiologie(at)mh.tum.de
Theresa Schierl
Chair of Social Determinants of Health
Georg-Brauchle-Ring 60/62
80992 München
phone: 089 289 24192
e-mail: theresa.schierl(at)tum.de
Text: Romy Schwaiger
Photos: „Journal of Epidemiology and Global Health”/Astrid Eckert/TUM/private