Report on the Global HIV/AIDS epidemic

What makes people vulnerable?

Figure 17. Proportion of sex workers and sex work clients always using
condoms with commercial partners, Cambodia, 1997-1999
90
80
70
E
0
S 60 ---- military/police
0
-A* motorbike taxi drivers
-4-+ brothel-based sex workers
50 4- beer promotion women
0
30
20
0
0
1997 1998 1999
Source: National AIDS Programme, Cambodia, and Family Health International, 2000
Compounding their biological vulnerability, women often have a lower status in society at large and in sexual relationships in particular. This gender vulnerability, again,
is particularly acute for young girls.
It is the interplay of biological, cultural and economic factors that makes young girls particularly vulnerable to the sexual transmission of HIV. While both girls and boys engage
in consensual sex, girls are more likely than boys to be uninformed about HIV (see pages
40-42), including their own biological vulnerability to infection if they start having sex very
young. Girls are also far more likely than boys to be coerced or raped (see pages 49-54)
or to be enticed into sex by someone older, stronger or richer. Sometimes the power held
over them is mainly that of greater physical strength. Sometimes it is social pressure to
acquiesce to elders. Sometimes it is a combination of factors, as may be the case with
older "sugar daddies" who offer schoolgirls gifts or money for school fees in return for
sex. In the era of AIDS, the consequences for young girls can be disastrous.
In a recent comparison of HIV infection and behaviour in two cities in East Africa with
a high prevalence of infection and two in West Africa with a lower prevalence, few
striking differences were found in the frequency of extramarital sex or condom use.
However, there was a major difference in the proportion of girls aged 15-19 who said
they had started having sex before turning 15 - an age at which virtually none are
married. In areas where HIV is common, greater sexual activity during the early teens
translates inexorably into a high prevalence of HIV among girls. Figure 18 shows the
prevalence by age among teenage girls in Kisumu, western Kenya. Over a quarter of
this group said they had had sex before they were 15, and indeed 1 girl in 12 was

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