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The face of the pandemic in Africa has changed. Now it is women who bear the brunt of the disease. According to UNAIDS, of the 23 million HIV positive adults ages 15 - 49 in Sub-Saharan Africa, fifty-seven percent or 13.1 million are women. So why are women and girls so disproportionately affected? Experts around the continent point to two key areas of concerns: violence against women and girls and the lack of comprehensive HIV prevention approaches that take into account the realities of women's lives.

While national and regional data on violence against women doesn't exist in most countries in Africa, the World Health Organization estimates that from 10 to 69 percent of women will experience violence in their lifetime. This astonishingly high figure is a result of women's low status within their families and society at large. Beliefs and attitudes across cultures in Africa still largely maintain that women are subordinate to men, and thus they lack autonomy, economic independence and decision-making power -- even over their own bodies.

A recent study in South Africa published in The Lancet showed that of 1,366 women attending health services in Soweto, women beaten by their husbands or boyfriends were 48 percent more likely to become infected with HIV than women in non-violent relationships. Physical and sexual violence coupled with the almost ubiquitous acceptance that men 'require' or at the very least have a 'right' to multiple sexual partners, means men are spreading the virus between multiple wives, girlfriends and lovers and bringing it home. The same study reported that women who were emotionally or financially dominated by their partner were 52 percent more likely to be infected than women who were not. Clearly, women's sexual fidelity within marriage or long-term relationships does not keep women safe from HIV infection. The root of intimate partner violence stems from women's lack of power within their relationships. Women in partnerships are often unable to negotiate safe sex and condom use, are physically forced or coerced into sex, and are unable to refuse sex with their partner. Moreover, sexual assault, rape and coercion from unknown men further increases the risk of HIV infection for women and girls.

Young married women are at particular risk. According to UNAIDS, women who are 15 - 24 years old in Sub-Saharan Africa are three times more likely to be infected than their male counterparts. Furthermore, recent studies in Africa indicate that young married women are at higher risk of HIV infection than their unmarried peers. However, unmarried young women's are also highly vulnerable as a result of sexual assault, rape and coercion. Young women, many of them orphans from the AIDS crisis, can become involved in coercive sexual relationships with older men in order to secure food, shelter, clothing or school fees.

Clearly, the violence that women and girls are experiencing increases their already high social and biological vulnerability for contracting the virus. As Stephen Lewis, UN special envoy for HIV/AIDS in Africa stated, "the pandemic of AIDS is a gender-based disease".

The response to the pandemic, therefore also needs to be engendered.

For decades, mainstream approaches to HIV prevention emphasizing the ABC's (Abstinence, Be faithful and use Condoms) have ignored women's context and experience and the deadly consequences for women are apparent in the statistics. The ABC approach analyzed from a gendered perspective recognizes that abstinence is not an option for women and girls who are physically forced or coerced into sex, or who are culturally expected to be sexually available on demand from their partner. Faithfulness requires the commitment of both partners and offers no protection to women whose husbands have multiple partners or who were infected before they were married and condom use requires the cooperation and consent of men.

The ABC approach itself cannot turn the tide of infections for women and girls. A much more comprehensive approach rooted in the reality of women's lives must be designed if women and girls are to be safer. As Kofi Annan stated, "What is needed is positive, concrete change that will give more power and confidence to women and girls, and transform relations between women and men at all levels of society."

Concrete, informed and immediate action is needed at all levels - from individuals to communities to governments - to start reducing HIV infection rates for women and girls. The Global Coalition on Women and AIDS stresses that "prevention methods that promote gender equality and women's human rights can stop the epidemic in its tracks, and steadily reverse the rate of infection."

As individuals, each of us can begin talking - to our partner, children, friends, neighbors and colleagues. Violence thrives on silence. Bringing the problem and its consequences to light can begin to affect change. Everyone can become active in raising awareness and promoting concrete action that will help make change. Communities can support women and girls experiencing violence and hold men who chose violence accountable for their actions. Civil society organizations can recognize that HIV prevention must move beyond traditional ABC approaches to reflect the complexity of women and men's lives. This requires deeper engagement with communities, a willingness to raise issues that challenge the status quo and a solid rights-based approach. Governments, development partners and policy makers can publicly speak about the link between violence and HIV infection. They can create policies, protocols and laws that support gender equality and prioritize comprehensive HIV prevention and ensure adequate funding is earmarked to successfully operationalize the initiatives. The time is now…women are waiting.