HIV and AIDS

Women and HIV/AIDS

As of December 2003, nearly 50 percent of people living with HIV/AIDS worldwide were women.⁵ In the United States, about 25 percent of people with HIV/AIDS are women.⁶ Between 1998 and 2002, new AIDS diagnoses increased 7 percent among U.S. women, compared to a 5 percent decline in diagnoses among U.S. men.⁷ In the United States and worldwide, the majority of women are infected through heterosexual  sex, and women of color continue to be disproportionately affected. While representing only 12 percent of the U.S. population, African-Americans account for half of new infections in the country, and that proportion is increasing.⁸ Overall HIV/AIDS death rates for women have decreased since the mid-1990s, but death rates among African-American and Latina women remain much higher than among white women.⁹ (For more information, see "HIV/AIDS Among Asian/Pacific Islanders and Latinas" on the companion website.)
 
Thankfully, physicians, scientists, and activists are paying more attention to women’s experiences of HIV/AIDS. Women are being included in more clinical trials, including a huge national group called the Women’s Interagency HIV Study, which is investigating how HIV progression and treatments affect women. Health care providers are better equipped to diagnose the gynecological symptoms of HIV/AIDS and use routine Pap smears and colposcopy to prevent invasive cervical cancer, a female-specific indicator of AIDS. New treatments have reduced the number of babies born with HIV infection (see "HIV and Pregnancy," p. 304). And in many communities, women with HIV infection and AIDS are supporting one another, doing outreach, teaching prevention, getting into recovery from substance abuse, and finding hope.

Women may be biologically more vulnerable than men to contracting HIV through heterosexual intercourse because infected semen stays in contact with the vaginal lining and cervix longer than infected vaginal secretions remain on the penis. Other factors increase our risk as well. Even if we are in monogamous relationships with male partners, we may still be at risk for getting HIV. Sometimes men pressure or force women into unprotected sex, and sometimes women may be hesitant to talk about safer sex with a partner because we are afraid of being hurt or abandoned. Fear of sexual violence and/or dependence on a male partner may make us less likely to protect ourselves during sex. A study among African-American women in Los Angeles showed that straight couples were less likely to use condoms if the woman was dependent upon her male partner for rent money.¹⁰

Intravenous drug use--both directly, through shared needles, and indirectly, through unprotected sex with male users--plays a significant role in transmitting HIV infection to women in the United States. At the end of 2002, 26 percent of U.S. women living with HIV/AIDS had contracted the disease through personal IV drug use. Of the 72 percent of U.S. women exposed through heterosexual contact, a significant percentage most likely contracted HIV from a male partner who used IV drugs.¹¹ Quality treatment programs can be less accessible to women of color, women who live in poverty, and those of us who are pregnant or have dependent children. Even when we have access to effective combination therapies (see "Treatment Options," p. 302), their required dietary schedules and side effects can make them challenging to use if we have an addiction. However, recent advances in drug therapies, including some once-a-day regimens, have made treatment easier.

Another issue is that we often don’t know whether our male partners have sex with men. A recent study by the Centers for Disease Control found that over one third of HIV-positive African-American men said they had sex with both men and women, but only a small fraction of HIV-positive African-American women reported knowing that their partners had sex with men.¹²

Excerpted from Our Bodies, Ourselves: A New Edition for a New Era, Copyright © 2005, Boston Women's Health Book Collective.