Efforts to address the plight of women infected and affected by HIV/AIDS are lagging behind in Ethiopia's profoundly conservative society, while they continue to bear the brunt of the epidemic.
"Women are more vulnerable to HIV/AIDS in Ethiopia, mainly due to a lack of know-how and control over how, when and where the sex takes place, particularly in the rural areas, where culture and religion dominate the rights of women," Alemu Anno, in the advocacy department of Ethiopia's Federal HIV/AIDS Prevention and Control Office (FHAPCO), told PlusNews.
According to FHAPCO's latest report, of the estimated 1.32 million people living with HIV/AIDS in 2005, 55 percent - or 730,000 - were women. They also accounted for 54.5 percent of AIDS deaths and 53.2 percent of new infections in that year.
Women and girls often have less information and access to services, especially in rural areas. Girls make their sexual debut early - either through early marriage or sexual abuse - and their partners are typically much older men. According to the United Nations Children's Fund (UNICEF), marriage at the age of seven or eight is not uncommon in Ethiopia.
The results are usually premature pregnancies, which cause higher rates of maternal and infant mortality, and increased vulnerability to sexually transmitted infections, including HIV/AIDS.
"Ethiopian culture puts great emphasis on virginity, but young girls do not have the chance of talking about sex, reproductive health and its consequences," Alemu said.
Physical and sexual violence within marriage are also common, and women have little room to negotiate the use of condoms or to refuse sex to an unfaithful partner. A 2005 World Health Organisation (WHO) multi-country study on women's health and domestic violence revealed that in a one-year period nearly a third of Ethiopian women reported being physically forced by a partner to have sex against their will.
"This high rate of forced sex is particularly alarming in the light of the AIDS epidemic and the difficulty that many women have in protecting themselves from HIV infection," WHO said.
Berhane Kelkay, coordinator of the National Association of Positive Ethiopian Women, said female genital mutilation, practiced almost universally in Ethiopia, widow inheritance - in which the woman has to marry a male relative of her deceased spouse - early marriage and rape all contributed to making Ethiopian women more vulnerable to HIV/AIDS.
"Women in Ethiopia have the larger AIDS burden because of factors like economic dependence and difficulty in meeting basic needs, insufficient proper knowledge of prevention, lack of enough access to prevention, and lack of proper information about sex and sexuality," Berhane added.
Although there were organisations to support women and raise awareness of gender-based violence, Berhane said they lacked support for their activities, particularly in rural areas, where women's rights were largely ignored.
"Mobilisation of local resources and indigenous knowledge, as well as the promotion of women's creativity and productivity, can be vital tools in the prevention and control of HIV/AIDS amongst women," said FHAPCO's Alemu.
The WHO report called for programmes to include activities to promote the prevention of sexual violence, and address the issues of sexual consent and coercion.
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