HIV/AIDS Among Women
Rise Among Women in the U.S.
Friday, December 3, 2004; 2:00 PM
The Academy for Educational Development (AED) is one of the world's foremost human and social development organizations. In addition to working in the areas of education, leadership and democracy, youth development, and the environment, AED works internationally and domestically on HIV/AIDS prevention and care programs. One of our main goals is to reduce stigma and discrimination, which is a major barrier to stemming the spread of HIV.
Just a few days after the commemoration of World AIDS Day when so much attention has focused on the global impact of the pandemic, it's great to be part of a forum that examines the epidemic here in the U.S. and I'd like to thank The Washington Post for hosting this chat.
In your area, the Monterey County AIDS Project would be a good place to start. This organization is a community-based, non-profit, volunteer supported organization whose goals are: to improve the quality of life of people living with HIV/AIDS in Monterey County and their families and friends; to prevent HIV disease and AIDS related discrimination through advocacy and community education. You can contact them by phone: 831-394-4747 or via the web at http://www.mcap.org/
The spread of HIV/AIDS, while heavy concentrated among men in Russia and East Europe, is also growing among women in the region. Could you comment on how/why men and women have different risk factors for contracting the infection? What makes women in this region vulnerable?
Factors that make women more vulnerable include:
1) Women's physiology makes them more vulnerable to the virus. It is easier for women to contract HIV through sexual intercourse than for men who contract it from women. 2) Women in this country as in other countries around the world often face an imbalance of power in their relationships. For these women condom negotiation and insisting on the use of condoms can be very difficult. Domestic violence is another factor that can render women powerless in relationships and make it difficult for them to feel empowered to insist on condoms.
The Centers for Disease Control is not only seeing a rise in the number of women who are HIV positive, but there is also an increase among MSM (men who have sex with men) particularly among men of color. Some recent studies indicate that there may be an increase in the number of MSM who aren't using condoms as a protective measure.
Last year, however, a 20-year-old African American female who had tested negative for HIV for the previous 6 months tested positive for HIV infection. After reviewing her potential risk behaviors, it was determined that her only risk behavior was having unprotected sex with an HIV-positive woman. The 20-year-old woman had been engaging in lesbian sex with her HIV-positive partner (this included oral-anal and oral-genital contact) and reported that sometimes the use of sex toys resulted in significant bleeding. It is important to note that sex never occurred during menstruation.
When the woman discovered that she was HIV-positive, she had her HIV genotyped and compared to her partner's viral strain. The match of the two genotypes was significant enough to conclude that female-to-female transmission had occurred.
The case of this young woman establishes there are risks for WSW and that all WSW should be counseled on the need to practice safer sex even when no other risk behaviors are involved.
Yes, often when people are under the influence of drugs or alcohol they may be less inhibited and more likely to engage in risky sexual behavior.
In the US, Rates of AIDS diagnoses in
2002 were 26.4 per 100,000 among men and 8.8
per 100,000 among women. However, African American women are 23 times as likely as white women to be diagnosed with AIDS.
1. The female condom, (made of polyurethane plastic), which can be used for vaginal or anal sex.
2. Dental dams (latex sheets) provide a barrier when performing oral/anal and oral/vaginal sex.
Advancing HIV Prevention:
The Centers for Disease Control and Prevention (CDC) announced a new initiative in April 2003 to strengthen HIV prevention in the United States. The initiative, "Advancing HIV Prevention: New Strategies for a Changing Epidemic," involves incorporating four key strategies into prevention efforts. These strategies include:
1. Making Voluntary HIV Testing a Routine Part of Medical Care
2. Implementing New Models for Diagnosing HIV Infections Outside Medical Settings
3. Preventing New Infections by Working with Persons Diagnosed with HIV and their Partners
4. Further Decreasing Perinatal HIV Transmission
Another approach that U.S. federal support exists is the SAFE: Serostatus Approach to Fighting the Epidemic.
In 2001 at the 8th Conference on Retroviruses and Opportunistic Infections, the Centers for Disease Control (CDC) introduced a newly expanded initiative to cut the estimated 40,000 new HIV infections a year in the US by half. The initative centers on enlisting and supporting HIV positive individuals in caring for their partners, their communities and themselves.
The SAFE initiative was developed after experience consistently showed that effective prevention interventions targeted the needs of the individuals for whom they are intended. SAFE directly targets the prevention needs of individuals living with HIV and their partners so that preventing HIV transmission is possible.
The vulnerability of women to HIV throughout the world can be attributed to many factors, these factors may include the following: gender inequality, limited opportunities for employment, poverty, conflict, illiteracy, racism, fewer rights to property and education than men, sexual violence, inadequate knowledge about AIDS, insufficient access to HIV prevention services, inability to negotiate safer sex, and a lack of female-controlled HIV prevention methods, such as microbicides. Many other factors relating to socioeconomic and cultural issues contribute to the increased vulnerability of women and their risk of contracting HIV.
The new intervention, SiHLE (a Swahili word for beauty that stands for sistering, informing, healing, living, and empowering) seeks to lower the n umber of STDs and pregnancies among Alabama teens aged 14 to 18. Delivered by peer educators on Saturday mornings in a Birmingham clinic, it begins the educational program by enhancing ethnic and gender pride. Like the earlier intervention, SiHLE presents information on HIV especially tailored to this age group, and it ends with a fourth session that discusses coping strategies for problems such as abusive partners or alcohol and drug use. SiHLE recruits the peer facilitators from local schools to serve a s role models and teachers. Unlike its predecessor, this program includes a long-term follow-up of 18 months as well as multiple assessments of STDs using newly developed and noninvasive nucleic acid amplification technology.
Becoming a Responsible Tean (BART) is based on social learning theory and stresses attention to participants' informational needs, motivational influences, and behavior. The intervention consisted of 8 weekly educational and behavior skills sessions of 90 to 120 minutes each. The intervention was proven to be effective for African-American youths.