Gender parity is the key in the fight against HIV/AIDS, according to a new report focussing on Swaziland and Botswana, the two countries with the world's highest prevalence rates.

The report, ‘Epidemic of Inequality: Women's Rights and HIV/AIDS in Botswana and Swaziland’, released by Physicians for Human Rights (PHR), a US-based right group, found that “deeply entrenched gender inequalities perpetuate the HIV/AIDS pandemic”.

"If we are to reduce the continuing, extraordinary HIV prevalence in Botswana and Swaziland, particularly among women, the countries' leaders need to enforce women's legal rights, and offer them sufficient food and economic opportunities to gain agency in their own lives - the impact of women's lack of power cannot be underestimated,” said Karen Leiter, co-author of the study.

“Women bear a disproportionate burden of the AIDS epidemic, particularly here [Southern Africa] - their legal status, lack of social power, certain cultural or socially constructed practices, lack of access to resources and lack of income all are factors in women’s daily lives that translate into elevated vulnerability and sexual risk taking,” Leiter told IRIN. In sub-Saharan Africa 75 percent of HIV-positive 15-25 year olds are female, the report noted.

The study, based on over 2,000 respondents in Botswana and Swaziland, found that four key factors contributed to women's vulnerability to HIV/AIDS: their lack of control over sexual decision-making, including the decision to use a condom; the prevalence of HIV-related stigma and discrimination; gender-discriminatory beliefs (associated with sexual risk-taking) and a failure of traditional and government leadership to promote the equality, autonomy, and economic independence of women.

Leiter said that despite their very distinct demographic and policy profiles, the key issues that characterised the epidemic in Botswana and Swaziland - women’s disempowerment, lack of human rights, poverty and food insufficiency – were typical in most southern Africa countries. “The findings are relevant throughout the region,” she added.

“Food insufficiency is one of the highlights from the survey that should be explored further. Food insecurity is known as a consequence of the HIV/AIDS epidemic but is also becoming more understood as a driver, particularly for women,” Leiter commented.

The report said that many HIV-positive women were forced to engage in risky sex with men in exchange for food for themselves and their children. "Woman are having sex because they are hungry. If you give them food, they would not need to have sex to eat," one interviewee quoted in the report said.

Nthabiseng Phaladze, senior lecturer in the Department of Nursing Education of the University of Botswana pointed to a direct link between attitudes, people's environment and risky behaviour: “the issues of poverty in this region [southern Africa] definitely influence peoples attitudes - are you concerned about falling sick from HIV two years from now - or do you want to put food on the table for your children?”

“If you are socialised to believe that as a woman you have to respect your husband and [even] if you don’t want sex - you consider yourself powerless – you have no choice,” she said.

In both countries there was a sense of a lack of leadership “at all levels” - from government officials to traditional leaders - in protecting and empowering women, Leiter said. She added that “the governments of the two countries need to go beyond the rhetoric and policies that they have” and implement a comprehensive plan around prioritising gender inequity.

The international community had a role to play in strengthening local capacity through “resources, technical assistance and particularly with coordination of programmes that already exist,” Leiter said.