Vulnerable Groups

While HIV/AIDS does not discriminate among individuals, certain groups of people have greater risks of exposure and are thus more vulnerable to infection. For social and biological reasons, women are more vulnerable than men. Poor people are more vulnerable than the better-off; adolescents are more vulnerable than adults; and young girls are more vulnerable than young boys.

Special risk groups include migrants and refugees, especially those uprooted by conflict or natural disaster; sex workers and their clients; street children; girls and women who are sexually exploited and trafficked; uniformed servicemen; men who travel for work and their partners; men who have sex with men; and intravenous drug users.

Infection takes different routes in different countries.

• In Eastern Europe and Central Asia, drug injection among men is the major source of infection.
• In Cambodia, the common practice of premarital and extra-marital sex for men, usually with sex workers, drives the epidemic.
• Older men seeking sex with young girls have pushed infection rates higher in some African countries, where AIDS spreads primarily through heterosexual relations.
• Men who have sex with men are the primary HIV transmitters in Australia and New Zealand1 and wherever condom use is not an accepted practice.

The world's poor:

Poor people tend to lack education in reproductive health care or ways to prevent HIV infection, as well as resources to avoid high-risk relationships or buy care or medicines.

• At least 35 percent of women in developing countries receive no prenatal care where they might learn their HIV status and ways to avoid transmitting the infection to their infants. Almost 50 percent give birth without a skilled attendant (doctor, nurse or midwife), and 70 percent receive no care in the six weeks after delivery.3

• With less access to jobs, assets, health care and other services, poor people are more likely to resort to commercial sex work and other survival strategies that raise HIV risk.

• The rural poor, who are the majority of the impoverished, are the least likely to have access to HIV/AIDS information, preventive measures or health care. Many infected urban dwellers return to their families in rural areas when they fall ill, imposing additional burdens of care and risk of infection.

• When AIDS strikes, the poor are least able to absorb the loss of livelihood and the additional costs of medications and care for the sick and, later, for their orphans.

The uniformed services:

Soldiers, militia, police, national guards and UN or multinational peace-keepers are overwhelmingly male and 18 to 25 years old, a group at high risk for HIV/AIDS.

• They may be on duty in high-risk areas, working far from home and outside their cultural norms, and so are more likely to engage in risky sexual behavior.

• Sexually transmitted infection rates among soldiers even in peacetime are estimated at two to five times that among the civilian population.

• Officers may encourage rape or other aggressive behavior toward adversaries or refugees as part of political policy.

Displaced people and refugees:

Refugees from conflict or natural disasters have little or no access to reproductive health care or services amid widespread social disruption, which also loosens cultural norms against risky sexual behavior.

• In emergency situations, couples may have no access to condoms; women giving birth may have no access to sanitary conditions or care for complications. People unable to escape conflict zones face high risks of sexual abuse, forced military recruitment and prostitution.

• Rape and sexual assault are common. They may also be used as weapons of terror against civilian populations.

• Sex may be traded for food or security among displaced people with few other resources to offer.

In the past three years, the UN Population Fund has worked in over 50 emergency situations that arose from acute conflicts, as in the former Yugoslavia; natural disasters, as in Turkey; and long-term refugee problems, as in Africa's Great Lakes area.

Men on the move:

Men who migrate for work, travel professionally (such as truck and bus drivers), or live apart from their families may pay for sex, have multiple partners or use alcohol or toher substances that contribute ro risky behavior. Their mobility contributes to spreading HIV/AIDS from region to region and group to group.

• In Carletonville, Namibia, a town near a gold mine, two of every three women under 25 have HIV and will die before they are 30. Migrant gold miners going home often take the virus with them.4

• A 1993 study of truck drivers visiting four drop-in health centers in India found that 94 percent had visited sex workers on the highway or local brothels; 85 percent were married and had one or more children; and 41 percent said their wives had no knowledge of their other sexual partners.4 Sex between men accounts for about 10 percent of HIV infections worldwide.4

• Fear of violence, abuse and stigmatization because of homophobia make this group hard to reach and often keep its members from seeking sources of information or medical care, especially in many developing countries.

• The ease of transmission between men who have sex with men increases the risk to their female partners.

• Men in prisons or other all-male environments may be coerced into sex, usually without condoms.

Intravenous drug users:

• About five percent of HIV infections occur among people who inject drugs, which may involve sharing contaminated substances, blood or equipment.

• This is the fastest mode of transmission and often correlates with risky sexual practices.