Addressing the Unique Vulnerabilities of Women to HIV/AIDS

When we talk about the HIV/AIDS epidemic in India, the data points to a clear and troubling pattern – women bear a disproportionately heavy burden of infection, stigma, and caregiving. According to the United Nations Development Programme (UNDP), women account for nearly 39% of all HIV infections in India, and a significant proportion of newly infected women are in monogamous relationships, having contracted the virus from husbands or partners with multiple sexual partners. This is not coincidence – it is the outcome of a web of biological, socioeconomic, and cultural factors that stack the odds against women. Understanding these factors is essential, especially from a legal and policy standpoint.

Why women are more biologically vulnerable
Socioeconomic and cultural factors that amplify risk
Low educational attainment and poverty
Gender-based violence and lack of sexual autonomy
Early marriage and trafficking
Stigma and silence around sexuality
The burden of caregiving
India’s legal framework: protections on paper
Empowerment as prevention: what needs to change

Why women are more biologically vulnerable

Biology plays a foundational role in women’s heightened susceptibility to HIV. Research published in PMC confirms that the risk of HIV transmission per heterosexual act is approximately twice as high for the female partner as for the male. Several anatomical and physiological reasons explain this:

The vaginal mucosa has a significantly larger surface area compared to the penis, meaning a greater area is exposed to potentially HIV-infected semen during intercourse. Moreover, semen can remain in the vaginal canal for several days after sex, prolonging exposure to the virus. Young women face even greater risk – those under 17 have an underdeveloped cervix and lower vaginal mucus production, making the mucosal barrier less effective.

Co-infections also compound the problem. Conditions like bacterial vaginosis and untreated sexually transmitted infections (STIs) trigger inflammation in the vaginal mucosa, which increases the concentration of CD4 T cells in that area – the very cells HIV targets. According to experts, bacterial vaginosis alone can increase HIV risk by close to 60%. The presence of genital ulcers from infections like herpes or syphilis further creates entry points for the virus.

These biological vulnerabilities are not failings of the female body – they are physiological realities that demand a tailored public health and legal response.

Socioeconomic and cultural factors that amplify risk

Biology alone does not explain why women in India are so disproportionately affected. Socioeconomic and cultural conditions create an environment where biological vulnerability is actively worsened.

Low educational attainment and poverty

Education is one of the most powerful protective factors against HIV. Yet, an Asian Development Bank study drawing on National Family Health Survey data found that HIV-positive women in India were significantly more likely to have low levels of education compared to their HIV-negative counterparts. Poverty restricts access to healthcare, contraception, and information, and pushes some women into transactional sex – a known high-risk scenario. A 2025 PLOS One study of adolescent girls and young women in Delhi NCR and Mumbai found that only 18.9% of women aged 15-24 possess comprehensive HIV knowledge, and merely 2% of adolescent girls aged 15-19 have ever been tested for HIV.

Gender-based violence and lack of sexual autonomy

One of the starkest findings from research on Indian women and HIV is that their infection risk is often not linked to their own behaviour. The ADB study found that fewer than 10% of HIV-positive women reported having more than one sexual partner in their lifetime – yet they were 45% more likely to have experienced domestic violence and 22% more likely to have experienced sexual violence than the general population. A study in the International Journal of STD & AIDS based on NFHS-3 data confirmed that for married women, having a husband who is HIV-positive or who has other wives significantly elevated infection risk. Women who are subjected to marital rape or coercive sex cannot negotiate safer sex practices – and India’s legal framework on marital rape remains a contested issue.

Early marriage and trafficking

The same PLOS One study identified early marriage, patriarchal norms, and economic coercion as key macro-level drivers of HIV vulnerability among young women. Girls married before they are physically and emotionally mature are less able to negotiate condom use, refuse sex, or access healthcare without spousal consent. Trafficking, another grave vulnerability, exposes women and girls to multiple sexual partners, physical violence, and practically no access to health services – conditions ideal for the rapid transmission of HIV.

Stigma and silence around sexuality

Even when women know they may be at risk, qualitative research from Delhi and Hyderabad found that HIV/AIDS remains so deeply taboo a subject that women avoid discussing it or seeking information. In the study, 8-10 women had to be approached before one was willing to speak about the issue. Fear of stigma, social isolation, and abandonment – especially the threat of being cast out of the marital home – silences women who might otherwise seek testing or treatment.

This silence has deadly consequences. Women who discover they are HIV-positive often face not just a medical crisis, but social exclusion from family and community, loss of access to economic resources, and in many cases, sole responsibility for the care of sick family members.

The burden of caregiving

HIV/AIDS has a particularly cruel dynamic when it comes to gender: women are not only disproportionately infected, they are also disproportionately expected to provide care for those who are. The UNDP study on the gender impact of HIV and AIDS in India found that women and girls bear a disproportionate caregiving burden in HIV-affected households – managing nursing duties, domestic work, and economic responsibilities simultaneously. Girls often withdraw from school to assist with caregiving, destroying their own educational and economic prospects in the process.

This caregiving burden is rarely compensated or even acknowledged in policy discussions. It is a form of invisible labour that perpetuates the very gender inequality that fuels female vulnerability to HIV in the first place.

India’s legal framework: protections on paper

India has made important legislative strides in recognising the rights of people living with HIV. The HIV and AIDS (Prevention and Control) Act, 2017, which came into force in September 2018, prohibits discrimination against HIV-positive individuals in employment, healthcare, and educational institutions. It mandates informed consent for HIV testing, protects confidentiality of test results, and provides for a legal mechanism to address grievances.

Under the Indian Constitution, NACO underscores that fundamental rights – including equality before law and the right to life – apply fully to persons living with HIV. The right to keep one’s HIV status confidential is explicitly protected, which is significant for women who fear social consequences from disclosure.

The National AIDS and STD Control Programme (NACP) Phase V continues to pursue NACO’s goal of reaching “Three Zeros” – zero new infections, zero AIDS-related deaths, and zero discrimination. India has seen considerable progress: new infections in 2023 were nearly 44% lower than in 2010, and AIDS-related deaths declined by 79%.

Yet laws and statistics do not tell the full story. Awareness of legal rights among women – especially in rural areas, urban slums, and marginalised communities – remains critically low. The 2024 World AIDS Day theme, ‘Take the Rights Path’, acknowledged precisely this gap: that rights on paper must translate into lived realities for the people most affected.

Empowerment as prevention: what needs to change

Addressing women’s vulnerability to HIV is inseparable from addressing gender inequality more broadly. Research consistently shows that women with greater autonomy in household decision-making are better positioned to protect themselves. A study published in the Journal of AIDS Clinical Research found a negative association between women’s autonomy in decision-making and HIV prevalence – states where women have more control over their lives tend to have lower HIV rates. However, despite improvements in women’s empowerment indicators over the past decade, comprehensive HIV knowledge among women has not improved proportionally.

The path forward requires action on multiple fronts. Legal empowerment means ensuring women know their rights under the HIV and AIDS Act, 2017, can access testing and treatment without spousal consent barriers, and have recourse against gender-based violence. Educational empowerment means keeping girls in school, providing accurate and comprehensive sexual health education free of stigma, and breaking the culture of silence that leaves women uninformed. Economic empowerment means reducing women’s dependence on partners or transactional arrangements for survival – a factor directly linked to HIV risk.

Equally important is engaging men. Changing male sexual behaviour, challenging norms around multiple partnerships, and holding men accountable for domestic and sexual violence are not peripheral issues – they are central to reducing the infection rate among women.

What do you think? Given that most HIV-positive women in India were infected by their husbands – their sole sexual partner – should Indian law require mandatory HIV disclosure within marriage as a condition of informed consent to sexual intercourse? And if comprehensive HIV knowledge among women remains critically low despite decades of awareness campaigns, what structural changes in India’s education and healthcare systems would make the most meaningful difference?

References

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Table of Contents

Why women are more biologically vulnerable 🔗

Socioeconomic and cultural factors that amplify risk 🔗

Low educational attainment and poverty 🔗

Gender-based violence and lack of sexual autonomy 🔗

Early marriage and trafficking 🔗

Stigma and silence around sexuality 🔗

The burden of caregiving 🔗

India’s legal framework: protections on paper 🔗

Empowerment as prevention: what needs to change 🔗