After decades of working in HIV and Aids programmes in Tanzania, Dr Yeronimo Mlawa knows it too well why women are more prone to HIV infection than men.
Recently, the National Bureau of Statistics (NBS) released data showing that the adult HIV prevalence in the county was now higher among women, at 6.5 per cent compared to 3.5 per cent among men.
Dr Mlawa believes that apart from biological factors, women have been subjected to many risk factors for HIV transmission over the years. "Society ought to deal with these factors if the aim of having an HIV-free generation is to be attained," he says.
But, he raises one caution about the data. "Socially, men are not always good at seeking healthcare. We might be seeing high numbers of HIV-infected women because more of them reported to various centres for testing compared to men," says Dr Mlawa.
How to track down the men
Through focused testing, Dr Mlawa says, men are now being tracked down, tested and if found HIV-positive, they are enrolled on Anti-retroviral Treatment (ARTs).
"We are doing this through partner notification; whereby one HIV-positive individual informs us about a network of partners he/she might have been sexually in contact with," he explains.
"In the process, we reach out to these people and extend HIV testing services or ART to them," says the Senior Technical Advisor of Social and Behavioral Change at Jhpiego, an international health organization affiliated with John Hopkins University.
However, he emphasizes that gender factors in Tanzania still need to be streamlined in such a way that they do not subject a woman to more risk of HIV infection.
"We conducted a study and found that girls aged between 15 to 24 years were more affected by HIV compared to their counterparts, the boys. This means there is a gap that must be bridged here," he says.
The persistently high gender imbalance of HIV among young people has led to an increase in research to understand the disparate burden and associated risks facing adolescent girls and young women, experts say.
Partly, the disconnect among women about their HIV status and their vulnerability relates to their perceptions that they have a low risk to HIV, says a Senior Scientist at the University of KwaZulu-Natal Ayesha BM Kharsany.
On his article, titled, "What can be done to turn the tide of HIV among young girls in sub-Saharan Africa," Mr Kharsany, says such perceptions among women perpetuate the vulnerability to HIV, particularly in situations of high household poverty levels and unemployment.
Are hormones to blame?
A researcher in virology from the Muhimbili University of Health and Allied Sciences (Muhas), Professor Fred Mhalu, explains that pregnancy could also increase the chances of women being infected with HIV.
"Women who are also highly likely to be infected with HIV are those of reproductive age because of low body immunity that could be attributed to hormonal changes caused by pregnancy," says Professor Mhalu who has been among experts researching on an HIV vaccine in Tanzania.
Most women unaware they are infected
A new study published this month shows that only less than half of young women with HIV in Tanzania and six other southern and east African countries are aware they are infected.
The rest of the women, according to the study published in the US Center for Disease Control's Morbidity and Mortality Weekly, are unaware of their HIV status.
The findings come at a time when HIV and Aids stakeholders, political leaders and experts in Tanzania are increasingly raising their eyebrows on the trend of new infections in women.
During the National Assembly in Dodoma three weeks ago, the Deputy Minister of Health, Community Development, Gender, Elderly and Children Dr Faustine Ndugulile was at pains to explain to the MPs who demanded answers regarding the trend.
Dr Ndugulile partly it on blamed Gender-based Violence (GBV),not downplaying the anatomical factors for women. He also said that in patriarch societies, there has been increasing evidence of men abusing women, forcing them into unprotected sex and early marriages.
Yet, the study in CDC's Morbidity and Mortality Weekly said only 46.3 per cent of women found to be infected were aware that they had the disease, and only 45 per cent of those with the infection were receiving treatment and virally suppressed.
The incidence of HIV infection among 15- to 24-year-old women in Lesotho, Malawi, Swaziland, Uganda, Tanzania, Zambia and Zimbabwe is currently around 3.6 per cent - some 1.5 million young and adolescent women - with an infection rate almost double that of their male counterparts, it said.
The 90-90-90 goal
The two-year survey, has revealed gaps in reaching the UNAids targets for young women and adolescents in sub-Saharan Africa, set for realization by the year 2020.
It is envisioned that by the year 2020, a 90 per cent of HIV-infected people would be aware of their status; with another 90 percent of that total receiving anti-retroviral treatment and 90 per cent of those virally suppressed.
The researchers, who did the study, interviewed more than 28,000 young women under the auspices of surveys funded by the US president's emergency plan for Aids relief (PEPFAR), the reports show. They conducted interviews and took plasma specimens to evaluate infection.
Although the research suggested that young women who were aware they were HIV positive and undergoing treatment meant they were close to the UNAids targets, it also flagged up a large group who claimed to be unaware of their infection.
The result is that just 45 percent of young women in the seven countries are virally suppressed, falling behind the UNAids targets.
The authors are positive about the success in reaching young women who are aware they are infected with HIV, but the figures are particularly worrying as this group currently accounts for a disproportionate number of new HIV infections.
Other studies have suggested that young women in east and southern Africa risk being infected with HIV some five to seven years earlier than their male peers.
Previous work in the area has outlined lack of access to continuing education, an imbalance in gender relations and lack of specific education on HIV as being significant contributors to the spread of the disease, even amid moves to control it.
A study in Tanzania between 2003 and 2012 found HIV testing was also more likely among young women who were married than young women who were not.
Commenting on their results, the authors of the new research said: "There is a need to design, implement, and evaluate strategies aimed at ensuring HIV-positive adolescent girls and young women know their HIV status and are on [antiretroviral] treatment to improve their immunity status and reduce transmission to others."
Breaking gender complexities
Most HIV prevention literature portrays women as especially vulnerable to HIV infection because of biological susceptibility and men's sexual power and privilege, according to a study titled: Rethinking Gender, Heterosexual Men, and Women's Vulnerability to HIV/AIDS. It says that conversely, heterosexual men are perceived as active transmitters of HIV but not active agents in prevention.
There is a growing momentum for HIV and Aids interventions that acknowledges biology, gender inequality, and gendered power relations but also directly examines social structure, gender, and HIV risk for heterosexual women and men.