Already, women make up half of the world's HIV infections, and adolescent girls are at particular risk in the hardest-hit parts of the world, UNICEF Deputy Executive Director Geeta Rao Gupta told the International AIDS Conference.
Some 4.8 million people ages 15 to 24 are living with HIV, and two-thirds are female. Sexual violence and conditions of poverty that frequently lead to girls leaving school and marrying in their teens — often to much older men — for economic security are chief risks in developing countries, she said.
"These adolescent girls and young women, our sisters and daughters, represent an unfinished agenda in the AIDS response," Rao Gupta said.
She echoed what has become a recurring theme of the meeting since Secretary of State Hillary Rodham Clinton declared Monday that gender equity would be crucial to protecting women.
"Women need and deserve a voice in the decisions that affect their lives," Clinton said.
Their stories suggest too few do.
Hellen Amuge of Uganda showed scars on her arm and chest left when rebels in one of that country's wars attacked and raped her. When eventually she was diagnosed with HIV, Amuge said her husband abandoned her and their seven children.
"I'm taking my drugs, that's why you see me healthy like this," she said. But while pills are free through internationally financed AIDS programs, she described how people in her rural area must travel 50 miles to the nearest clinic for their monthly supply. "Getting money for transport is a problem."
In South Sudan, Evelyn Letio Unzi Boki said, "Men don't accept to go for testing," and their often younger, uneducated wives, dependent on them for economic survival, have no recourse.
"Women don't have voices," she said.
Even in the U.S., infections increasingly are concentrated in poor communities. Here, 1 in 4 people living with HIV is female and most are African-American or Hispanic.
The Affordable Care Act is expected to improve treatment for many uninsured Americans with HIV, but a number of states say they may not expand Medicaid services, one key part of that law. A report from the 30 for 30 Campaign, a women's coalition, found those are states with high numbers of HIV-infected women.
Globally, the women with HIV who get the most attention are pregnant, since one of the United Nations' chief goals is nearly eliminating mother-to-child transmission of HIV. The number of babies born with HIV has been dropping steadily for several years as more HIV-infected women receive AIDS drugs during pregnancy and while they're nursing — 57 per cent of them last year, according to the United Nations.
But UNICEF HIV adviser Dr. Chewe Luo called for a shift from focusing just on protecting the baby to treating the mother for her own good. Few countries automatically continue providing those lifesaving drugs for the mom after her baby is weaned, unless her own condition worsens or she gets pregnant again, Luo said.
"Orphaning will continue to increase if we don't actually provide treatment for women," she said.
New guidelines from the World Health Organization encourage countries to start treatment for life for all pregnant women, regardless of how healthy they may appear between pregnancies. Luo praised Malawi as the first low-income country to adopt that strategy and said Botswana, Rwanda, South Africa and Zambia are considering the same change.
UNICEF's Rao Gupta called for innovative solutions to help women and girls protect themselves. She pointed to an experiment in Kenya that pays poor families a few dollars a month to help support AIDS orphans and other vulnerable children. Researchers found teens in those households stayed in school longer rather than quitting to work and reported fewer risky sexual behaviours such as multiple partners and unprotected intercourse — maybe because they weren't turning to sex for money.
And Serra Sippel of the Center for Health and Gender Equity says too many HIV prevention efforts are missed opportunities for women. Consider: Projects around Africa are pushing male circumcision, which lowers men's risk of heterosexual infection — but they don't educate those men's wives and girlfriends about the importance of continuing condom use since the protection isn't perfect, Sippel said.
"Women are the blind spot in the AIDS conversation," she said.