bearing, decreased child survival, worsening nu-
trition, and increased risk of HIV infection. 
‘‘(F) High rates of gender-based violence, 
rape, and sexual coercion within and outside 
marriage contribute to high rates of HIV infec-
tion. According to the World Health Organiza-
tion, between one-sixth and three-quarters of 
women in various countries and settings have 
experienced some form of physical or sexual vio-
lence since the age of 15 within or outside of 
marriage. Women who are unable to protect 
themselves from such violence are often unable 
to protect themselves from being infected with 
HIV through forced sexual contact. 
‘‘(G) Fear of domestic violence and the 
continuing stigma and discrimination associated 
with HIV/AIDS prevent many women from ac-
cessing information about HIV/AIDS, getting 
tested, disclosing their HIV status, accessing 
services to prevent mother-to-child transmission 
of HIV, or receiving treatment and counseling 
even when they already know they have been in-
fected with HIV. 
‘‘(H) According to UNAIDS, the vulner-
ability of individuals involved in commercial sex
acts to HIV infection is heightened by stig-
matization and marginalization, limited eco-
nomic options, limited access to health, social, 
and legal services, limited access to information 
and prevention means, gender-related dif-
ferences and inequalities, sexual exploitation 
and trafficking, harmful or non-protective laws 
and policies, and exposure to risks associated 
with commercial sex acts, such as violence, sub-
stance abuse, and increased mobility. 
‘‘(I) Lack of access to basic HIV preven-
tion information and education and lack of co-
ordination with existing primary health care to 
reduce stigma and maximize coverage. 
‘‘(J) Lack of access to currently available 
female-controlled HIV prevention methods, such 
as the female condom, and lack of training on 
proper use of either male or female condoms. 
‘‘(K) High rates of other sexually trans-
mitted infections and complications during 
pregnancies and childbirth. 
‘‘(L) An absence of functioning legal 
frameworks to protect women and girls and, 
where such frameworks exist, the lack of ac-
countable and effective enforcement of such 
frameworks. 
‘‘(41) In addition to vulnerabilities to HIV in-
fection, women in sub-Saharan Africa face a 1-in-13 
chance of dying in childbirth compared to a 1-in-16 
chance in least-developed countries worldwide, a 1- 
in-60 chance in developing countries, and a 1-in- 
4,100 chance in developed countries. 
‘‘(42) Due to these high maternal mortality 
rates and high HIV prevalence rates in certain coun-
tries, special attention is needed in these countries 
to help HIV-positive women safely deliver healthy 
babies and save women’s lives. 
‘‘(43) Unprotected sex within or outside of mar-
riage is the single greatest factor in the transmission 
of HIV worldwide and is responsible for 80 percent 
of new HIV infections in sub-Saharan Africa. 
‘‘(44) Multiple randomized controlled trials 
have established that male circumcision reduces a 
man’s risk of contracting HIV by 60 percent or 
more. Twelve acceptability studies have found that 
in regions of sub-Saharan Africa where circumcision 
is not traditionally practiced, a majority of men 
want the procedure. Broader availability of male cir-
cumcision services could prevent millions of HIV in-
fections not only in men but also in their female 
partners. 
‘‘(45)(A) Youth also face particular challenges 
in receiving services for HIV/AIDS. 
‘‘(B) Nearly one-half of all orphans who have 
lost one parent and two-thirds of those who have lost 
both parents are ages 12 to 17. These orphans are 
in particular need of services to protect themselves 
against sexually-transmitted infections, including 
HIV. 
‘‘(C) Research indicates that many youth ben-
efit from full disclosure of medically accurate, age- 
appropriate information about abstinence, partner 
reduction, and condoms. Providing comprehensive 
information about HIV, including delay of sexual 
debut and the ABC model: ‘Abstain, Be faithful, use 
Condoms’, and linking such information to health 
care can help improve awareness of safe sex prac-
tices and address the fact that only 1 in 3 young 
men and 1 in 5 young women ages 15 to 24 can cor-
rectly identify ways to prevent HIV infection. 
‘‘(D) Surveys indicate that no country has suc-
ceeded in fully educating more than one-half of its 
youth about the prevention and transmission of 
HIV.