Summary

Ending HIV as a public health threat by 2030 presents challenges significantly different to those of the past 40 years. Initially perceived as a disease affecting gay men, today, HIV disproportionately affects adolescents and young women in Africa. Current strategies to prevent HIV mostly rely on using biomedical interventions to reduce the risk of infection during risky sex and to address that biologically; women are more vulnerable to HIV infection than men. Ongoing policies and strategies to end the AIDS epidemic in Africa are likely to fail if implemented alone, given they fail to address why vulnerable young women engage in risky sexual behaviors. Evidence strongly suggests economic vulnerability, rather than income level, is a primary driver of women's decision to engage in commercial and transactional sex. By viewing HIV through the lens of structural gender inequality, poverty, and use of risky sexual behaviors to cope with economic shocks, a new explanation for the HIV gender gap emerges. New and promising approaches to reduce HIV acquisition and transmission by protecting women from economic shocks and increasing their ability to participate in the economy have proven effective. Such interventions are vital to break the pattern of unequal HIV transmission against women and if HIV is to be beaten.