National Women & Girls HIV/AIDS Awareness Day 2013
March 10 is National Women and Girls HIV/AIDS Awareness Day, a nationwide observance designed to inform women of all ages about protecting themselves against HIV, to increase HIV testing among women and girls, to promote services for those already living with HIV, and to ultimately reduce the impact of HIV/AIDS on women and girls.
According to data from the Centers for Disease Control and Prevention (CDC), women received 21% of the estimated 49,273 new HIV diagnoses in 2011. Out of 10,270 newly diagnosed HIV cases among women and adolescent girls, an overwhelming 86% were attributed to heterosexual sex, with the remaining 14% due to injection drug use. CDC estimates that at the end of 2009, a total of 279,100 women and girls had HIV—and 15% of them didn’t know it. Not knowing their status means these women are not receiving HIV care and may be unknowingly transmitting the virus to their partners.
What Puts Women at Risk?
In addition to biological aspects (for example, vaginal tissue, like rectal tissue, is more vulnerable to entry by the virus than are the skin and mucous membranes of the penis), a number of social and cultural factors set women up to be susceptible to HIV infection.
“For women, gender dynamics have to do chiefly with inequitable power arrangements,” says social scientist Judith D. Auerbach, PhD, a consultant to the NIH Office of AIDS Research and San Francisco AIDS Foundation. “In most countries and most cultures, still to this day, women just do not have the same economic, social, or political authority, power, or standing as do men.” These dynamics, she explains, affect a woman’s “ability to exercise agency—your ability to act on your own behalf—around things like protected sex, and how much sex, with whom, and under what conditions.”
They also conspire to put women in positions of economic dependence on men: “You wouldn’t be in a position to negotiate your safety if you need the guy to give you money and goods and he doesn’t want to wear a condom,” Auerbach notes. For too many women, this kind of “exchange sex” offers a way to get by but simultaneously puts them at higher risk for HIV infection.
Women of color are disproportionately affected by HIV; for example, although CDC reports that although new HIV infections dropped by 21% among African-American women in 2010, black women still became infected at 20 times the rate of their white counterparts.
Among African-American women, says Auerbach, those at increased risk for HIV infection are women with less education and lower income—again, social and economic factors that contribute to the HIV epidemic among women. “Some of that results from being in communities and situations in which the school system isn’t particularly good, or you don’t have health insurance, or access to prevention and care services or reproductive health services,” she adds.
The Agenda for HIV-Positive Women
Access to health care, and the quality of that care, are also of critical importance to women already living with the virus. According to leaders of the Positive Women’s Network of the USA, it’s time for a “women-centered” model of health care to better serve women with HIV. “Women-centered care means medical and supportive services that address the unique needs of women, including transgender women,” says Sonia Rastogi, communications director for the PWN-USA.
“Currently, services for women are disjointed,” Rastogi adds. “For example, HIV care is not systematically integrated with sexual and reproductive health care.” This lack of integration has real-life consequences; for instance, recent research suggests women with HIV are not getting regular Pap tests and other gynecological screenings that can help prevent invasive cervical cancer—a malignancy seen more frequently among HIV-positive women.
Not only do women with HIV need better medical care, they also need services to help them stay in care while they manage all the other aspects of their lives, such as maintaining their housing, working or finding employment, and caring for their families, Rastogi emphasizes. These services range from child care and transportation (which can make the difference between missing or keeping a medical appointment) to more extensive support services like housing assistance, case management, peer advocacy, mental health services, legal assistance, and employment services.
Furthermore, recent breakthroughs in biomedical HIV prevention can be better leveraged to support HIV-positive women’s choices around sex and childbearing. “We know from personal experience that an HIV diagnosis is deeply traumatic and that for women, it may color our perceptions of ourselves as sexual and reproductive beings,” says Naina Khanna, director of the PWN-USA.
Pre-exposure prophylaxis (PrEP) for HIV-negative partners and “treatment as prevention,” in which an added benefit of antiretroviral drug therapy is the reduced risk of transmitting HIV, can go a long way toward changing those perceptions. Not only can these new tools allow women to conceive with lower risk to their HIV-negative male partners, they are also meaningful for women who want safer ways to have sex for pleasure and intimacy, not just to start a family: “We need to take it out of the sole realm of reproduction,” Khanna states. Using antiretroviral drugs for prevention “is an exciting development because it also has implications for HIV-positive people’s rights and dignity as whole, sexual beings.”
Political leaders and medical and service providers have a part to play in employing these new tools to help reduce HIV stigma and discrimination, adds Khanna. “The conversations that providers and policymakers should now be having are: ‘Given the new science, what is my role in normalizing a discussion of sex, sexuality, and reproduction that is evidence-based and affirming of people living with HIV?’”
Resources for Women’s HIV Prevention and HIV Health
How will you mark National Women and Girls HIV/AIDS Day? Whether you’re joining an event, thinking about getting tested, or looking to learn more about preventing or living with HIV as a woman, these resources can get you started.
- National Women and Girls HIV/AIDS Day website: Find events happening in your area and access HIV prevention and health information for women.
- HIV Test Site Finder: Enter your zip code to find locations that offer HIV testing and counseling.
- Positive Women’s Network of the USA: The PWN-USA trains new leaders and mobilizes women living with HIV to advocate at local, state, and federal levels for policies that are grounded in the reality of women’s lived experiences. “The work of PWN-USA’s members and allies is vital to PWN’s work,” says the organization’s Naina Khanna. Want to get involved? Send an email to positivewomensnetworkUSA (at) gmail.com.
- Organizations Supporting Women with HIV in the U.S.: Use this listing from TheBody.com to learn about other groups and agencies working to improve quality of life for HIV-positive women.
- HIV/AIDS Resource Center for Women: Find news, personal stories, expert interviews, and information on living well with HIV on this site, also from TheBody.com.
- Making the Most of Your Medical Visits: Although not strictly for women, this article from Kathleen Clanon, MD, and Nancy Halloran, MPH, can help you communicate better with your doctor (or find a new one) and get your agenda met during your medical appointments.
Reilly O’Neal is the editor of BETA.