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The number of new HIV infections among women in Uganda has remained high, according to the Joint AIDS Review 2022/23 report.

The same report indicates that although the HIV prevalence among the adult population (15- 49 years) has reduced to 5.1% by 2022, from 5.2% in 2021, the prevalence is higher among women (6.5% compared to 3.6% among men).

Additionally, adolescent girls and young women bear the burden of new HIV infections, contributing 36% of new infections in adults (15-49 years).

Why are women vulnerable?

Experts blame the high burden of HIV among girls and women on structural barriers, such as, the education gap, rape and teenage pregnancies, coupled with girls dropping out of school, consequently getting married off early.

Sarah Nakku, the community mobiliser and networking adviser at United Nations Programme on HIV/AIDS, notes that the biology or physiology of women has a role to play in predisposing them to HIV.

She explains that the largest percentage of HIV infection is through heterosexual (sex between men and women). As such, the female sexual organs have a large surface area, which is potentially exposed to infected sexual fluids and, therefore, the higher the chances of acquiring HIV compared to the men.

The risk of acquiring HIV infection increases considering the nature of prevention tools available, for example, the female condom is perceived as not favourable to facilitate proper use compared to the male condom.

Nakku says through her interactions, women have reported not being comfortable while using the female condom. They say it is not easy to use all the time and despite its availability on the market, the tool does not facilitate them to protect themselves.

A sex worker based in Masaka who prefers to remain anonymous says she abandoned the female condom after two weeks of use.

“It was cumbersome and uncomfortable fixing the female condom on me. In addition, I had to keep holding the outer ring to keep it in place, hence causing a lot of frustration,” she notes.

In addition to the cultural norms, beliefs and customs, many people do not frown upon men who sexually interact with more women, consequently infecting them in case they are HIV-positive, Nakku says.

She is quick to add that such cultural norms hinder women from negotiating for safe or protected sex.

“Culturally in Uganda, women are groomed not to negotiate for sex, even with their husbands. Yet, when a woman is the negotiator, she has a higher chance of using a condom as opposed to when she does not. As such, she is more of a receiver who has little say, hence making women more vulnerable to contracting HIV.”

She cites the other driver as an economic component. Although many women are earning an income, the analysis of the economic scope of the country reveals that men earn more compared to women.

She says economic empowerment plays a critical role in ensuring a woman does not fall victim to interacting sexually with a man who has refused to use a condom for financial gain.

Often, sex workers give justifications for engaging in unprotected sex for a bigger pay.

Nakku says such justifications simply speak to the economic disparities between men and women, consequently putting women at increased risk of contracting HIV.

“If a woman is not economically empowered, she desires more money to satisfy her financial needs, hence increasing her risk of exposure to HIV while they engage in unprotected sex,” she notes.

Sexual and gender-based violence, with rape inclusive, is also associated with young girls and women’s vulnerability to getting infected with HIV.

“Girls and women have three-times increased risk of acquiring HIV due to sexual and gender-based violence compared to where there is no violence,” she notes.

The director of planning and strategic information at the Uganda AIDS Commission, Dr Vincent Bagambe, says there is a need to set up programmes empowering women and also keeping young girls in school while educating them about HIV transmission and its dangers.

Tips for prevention

Practice safe sex. Use condoms consistently and correctly during sexual activity, especially with new or unknown partners.

Know your partner’s status. Communicate openly with partners about HIV-testing and know their HIV status.

Get tested regularly. Undergo regular HIV-testing, especially if engaging in high-risk behaviours or starting a new sexual relationship.

Limit sexual partners. Reducing the number of sexual partners can lower the risk of exposure to HIV

Consider pre-exposure prophylaxis (PrEP). In consultation with a healthcare provider, consider PrEP, a medication that can help prevent HIV when taken consistently.

Avoid sharing needles or syringes: If using injectable drugs, never share needles or syringes.

Plan for pregnancy. If planning a pregnancy and at risk for HIV, seek medical advice to protect both the mother and the child.

Promote awareness. Stay informed about HIV transmission, prevention methods, and access support networks