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HIV/AIDS Among Women

Rise Among Women in the U.S.

Stacey Little
Academy for Educational Development Center on AIDS & Community Health
Friday, December 3, 2004; 2:00 PM

The epidemic of HIV/AIDS is growing more rapidly in women than in men in almost every part of the world, according to a new report by the authors of the annual AIDS update prepared by the United Nations, the World Health Organization and the World Bank. The growing proportion of infected women reflects the cumulative effect of many risks. They include teenage girls, the inability of many women to require their partners to use condoms, the infidelity of husbands and the high-risk behavior of sexual partners, the exploitation of young women by older men, rape and other forms of sexual coercion. Women in the U.S. now represent one-third of all new HIV infections and the figures may be steadily rising.

Stacey Little, senior public health specialist at the Academy for Educational Development Center on AIDS & Community Health, will be online Friday, Dec. 3, at 2 p.m. ET to discuss the rise of HIV/AIDS among women in the U.S. Editor's Note: Washingtonpost.com moderators retain editorial control over Live Online discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions.


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Stacey Little: My name is Stacey Little. I'm the Senior Public Health Specialist at the AED Center on AIDS & Community Health. I have been working in women's health for the past decade and have watched the changing face of the HIV/AIDS epidemic in the U.S. move from gay men to heterosexual women.

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.

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Washington, D.C.: How accurate is that new 20 minute HIV test?

Stacey Little: OraQuick is a rapid HIV test you are referring to. The test detects HIV antibodies and scientific studies show it provides results with 99.6 percent accuracy.

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Monterey, Calif.: I would like to make some kind of personal or financial contribution to the work of those fighting/healing AIDS. Would you please recommend a few good options (i.e. organizations etc)?

Thank you.

Stacey Little: There are a number of AIDS Service Organizations that are in need of financial contributions to sustain their important work. Additionally, many organizations are only able to run their programs through a network of volunteers.

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/

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Washington, D.C.: Dear Ms. Little,
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?
Thanks.

Stacey Little: You are absolutely right; women are extremely vulnerable and are disproportionately affected by HIV/AIDS.

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.

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Bowie, Md.: Are there any instances of lesbian women transmitting HIV to other lesbian women since they may pass along the virus but not as easily as a man/woman transmission?

Stacey Little: While cases of female-to-female transmission are not as common as male-to-female and female-to-male cases, it is possible for women to transmit HIV to their female partners. In the past, the rate of HIV transmission in women who have sex with women (WSW) has been difficult to determine because there are often other risk behaviors involved. These risk behaviors may include injection drug use or heterosexual intercourse.

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.

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Bethesda, Md.: Would you say there is a certain "class" of people who tend to get HIV? A friend of mine thinks that if you stick to sleeping with your own "class" of people, i.e., no drugs, educated, then you are less likely to get HIV because those people are less likely to be infected. Thoughts?

Stacey Little: Absolutely not! Being of a certain social class doesn't provide you with a resistance against HIV.

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.

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Virginia: How do the statistics of HIV/AIDS cases among women in the U.S. compare to the rest of the world?

Stacey Little: According to the US Agency for International Development, women and girls make up a growing proportion of those infected by HIV/AIDS. At the end of 2004, UNAIDS reported that women made up almost half of the 37.2 million adults (aged 15 to 49) living with HIV/AIDS worldwide.

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.

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Washington, D.C.: Besides condoms for both men and women....what other preventative methods are available for women to use to protect themselves?

Stacey Little: Other barrier methods that can be used to reduce the risk of transmission include:

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.

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Washington, D.C.: What I would like to know is. What is the US doing to try and stop the spread of HIV/AIDS. Because I dont think they are trying to do anything. It seem to be getting widespread more and more everyday.

Stacey Little: Two measures that the federal government is currently supporting to address HIV transmission rates and prevention efforts in the United States include the Advancing HIV Prevention (AHP) initiative and the SAFE

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.

SAFE:
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.

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Washington, D.C.: Can you recommend a WOMENS organization in the District that provides care for HIV+ women?

Stacey Little: Please contact the DC Comprehensive AIDS Resources and Education Consortium (DC CARE)at 202/332-9091. DC Care provides services to more than 65 HIV/AIDS agencies that are its members. With the support and leadership of the CARE Consortium these agencies are able to give quality services to people living with HIV and AIDS. If they aren't able to serve your needs, they would be able to provide you an appropriate referral.

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New York, N.Y.: I was quite surprised and disappointed in the World Aids Day Washington Post editorial entitled "A Female Pandemic?". The Post editorial suggests the UNAIDS' current emphasis on women's particular vulnerability to AIDS is misguided. Instead more focus on men and sex workers is recommended. Question: would you agree that it is high time we have recognized the importance of "structural factors" such as gender inequality, poverty, conflict, illiteracy, racism, etc. in forming the causal environment for AIDS and that unless we aggressivley address these factors we are simply applying band-aids to a hemorrage?

washingtonpost.com: Editorial: A Female Pandemic? (Post, Dec. 1)

Stacey Little: I strongly agree with the sentiment behind your question. Globally, young women and girls are more susceptible to HIV than men and boys. Recent studies show that they can be 2.5 times more likely to be infected with the virus as their male counterparts. In the U.S., women (especially women of color) comprise a population with the fastest growing rates of infection. In fact, HIV/AIDS-related illness is now the number one killer of African American women between the ages of 24-34.

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.

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Washington, D.C.: What type of strategies are being utilized for minority teenage girls are probably the most vulnerable population because of lack of education, low self-esteem and sometimes oppressive/abusive relationships with the opposite sex?

Stacey Little: There a many HIV Prevention programs out there that are geared to youth. Two intervention that specifically target minority woman are:

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.

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Stacey Little: Thank you for such great questions. It was a pleasure being a quest and being able to discuss such important issues related to women and HIV/AIDS.

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