Barriers against prevention and protection
The first step towards reducing the number of babies infected with HIV is to prevent HIV infection in women, and to prevent unwanted pregnancies.
While prevention methods such as the “ABC” approach – Abstinence, Be faithful, and use Condoms – are good, these are not enough to protect women where there are persistent gender inequalities fueled by harmful cultural norms and societal structures. Women's vulnerabilities to HIV increases when they are unable to choose marriage, to decide when and with whom they have sex, and to negotiate condom use.
The three key factors that make women and girls disproportionately at risk to HIV infection are:
1. economic vulnerability,
2. harmful gender norms, and
3. disparities in access to health information and services.
These challenges are further compounded when women and girls do not have access to HIV prevention information and services and by unequal power dynamics which leaves them powerless to negotiate safer sexual practices with their partners.
Some women may not leave risky sexual relationships because of economic dependence or the threat of violence. For these women, the immediate threats of physical harm and poverty poses far greater risks than the possibility of dying of AIDS 10 years down the road.
HIV-positive women may be unable to negotiate sex or condom use, or to access contraceptives, which can lead to unplanned pregnancies. Those who are pregnant may also be unable to access prenatal health services for a variety of reasons, including because their partners control the household financial or transportation resources, because they cannot take time off work, or because they cannot leave their dependents to travel to a clinic or hospital.
Fear of rejection, stigma, violence or abuse are other reasons that may prevent women from utilising HIV voluntary counselling and testing services, disclosing their HIV status, or accessing PMTCT programs.