Women and HIV/AIDS

chillibreeze writer — Tabassum Insaf

There are approximately one million people living with HIV/AIDS in the US (1). Males account for 74% of the population living with HIV. In males, the most common method of transmission is through homosexual contact. In females, the most common method of transmission is heterosexual contact (1). Women account for an increasing number of AIDS cases; from 14% in 1992 to 23 % in 2005(2). Women are less likely than men to receive the most effective treatments for HIV (2).

Women with HIV were also more likely to postpone care (3).

Differences in Biology:

During intercourse, male to female transmission is 2-4 times more likely than female to male (4). This is because a greater surface area is exposed for HIV transmission in females, semen contains a much higher concentration of virus than vaginal fluids and semen is retained longer in the female vaginal tract (4).

Sex hormones in women can interact with HIV. Sex hormones can affect the immune system affecting both the susceptibility to HIV and infectivity (5; 6). Sex Hormones can also cause drug interactions affecting the effectiveness of HIV drugs (6). During acute/early infection, women tend to have lower viral loads than men with the same or similar CD4+ cell counts (7). Therefore, CD4 cell counts are a better indicator of when it’s time to start therapy in women (7).

Social factors:

Sexual division of power: The power dynamics of a relationship determine how condom use is negotiated at the time of intercourse. If women are financially dependent on their partners, it would be more difficult to negotiate condom use or to refuse sex if the partner is positive. The sexual division of power explains why women have lower perceived control in a relationship. A woman may not insist on condom use for fear of physical abuse or being abandoned by their partner. This issue may be more relevant in cases of younger women in relationships with older men.

Women are much more likely to face domestic violence and sexual abuse, which puts them at higher risk of HIV infection during forced intercourse. The woman’s access to testing and treatment may also be dictated by the male partner (6). Women are more likely to be tested for HIV without their knowledge or without explicit consent (8).

Government policies may also contribute to women’s lack of power in this situation. Some states require mandatory testing of newborn infants without any requirement of consent or pre and post-test counseling. A positive test for a newborn implies that the mother is positive. In such cases, women may not receive any psychological counseling while they face the dual stress of childbirth and HIV diagnosis.

Social norms: Women may fail to negotiate condom use because they perceive that this may result in a loss of trust and intimacy in the relationship (9). Some women may be unaware of their male partner’s risk factors for HIV infection (such as unprotected sex with multiple partners, sex with men, or injection drug use). Men who are “down low” i.e. who secretly engage in sex with men while being committed partners in heterosexual relationships can acquire HIV from a male partner and then transmit the virus to unsuspecting female partners`(10). This may be more of a problem in cultures where there is a greater stigma associated with male homosexuality.

A woman’s risk for HIV is also affected by social norms regarding how a woman’s sexuality is related to impurity and immorality (11). Therefore, women face more stigma if they acquire HIV infection. On the other hand, multiple sex-partners may be seen as a status symbol or a sign of masculinity among men. This would put their partners at risk even if the women themselves are not practicing high risk behaviors.

Other cultural norms: Women who have STDs are more likely to acquire HIV. Cultural practices such as douching may increase risk of acquiring HIV by increasing risk of STD (11). Cultural norms regarding contraception and the value of fertility may undermine the use of contraceptives among women (11). Women in committed relationships may perceive themselves at lower risk and therefore not take preventive measures (12). Women with low perceived susceptibility would also be less likely to seek knowledge regarding HIV.

Sexual division of labor: Poverty contributes to the spread of AIDS among women (11). The sexual division of power results in women having lower paying jobs and less access to care (8; 11). Women of color are disproportionately affected because they face both racism and sexism in employment. Poor women, especially IV drug abusers, may find themselves pushed into prostitution, thus putting them at higher risk of HIV (11).

Progression to AIDS results in severe and debilitating diseases. AIDS treatment drugs require strict adherence to long-term regimens. Women are usually the primary caregiver in their family and their “role density” especially in single parent families may limit the amount of time they are able to commit to their own health needs (8). On the flip side, many HIV positive women feel compelled to take better care of themselves in order to be there for their families and take care of them (12).

Women are less likely to have jobs which provide insurance coverage for expensive retroviral drugs. Providers may also perceive women as less likely to adhere because of their competing family responsibilities (13). These factors may explain why women are less likely to be on HAART then men (13).

In summary, the difference in biology explains only some of the difference in HIV susceptibility between males and females. Social factors have a huge impact on the chances of acquiring HIV as well as issues regarding testing, social stigma and access and adherence to treatment. These factors are contributing to the increase in HIV infection among women, especially among those belonging to marginalized groups. In order to curb this rise in HIV/AIDS among women, it is necessary to recognize the underlying factors and design interventions which specifically address these gender differentials.

References

1. Divisions of HIV/AIDS Prevention. HIV and AIDS in the United States: A Picture of Today’s Epidemic. CDC. [Online] 2008. [Cited: April 13, 2008.]

2. CDC HIV/AIDS resources. HIV/AIDS among women. s.l. : CDC, 2007. CDC HIV/AIDS Fact sheet.

3. The Henry J. Kaiser Family Foundation. HIV/AIDS Policy Fact Sheet: Women and HIV/AIDS in the United States. [Online] 2007. [Cited: April 13, 2008.]

4. Planned Parenthood Federation of Canada HIV Women and Youth. [Online] 2003. [Cited: April 13, 2007.]

5 Brabin. Hormonal markers of susceptibility to sexually transmitted infections: are we taking them seriously?. 2001, BMJ , Vol. 323, pp. 394-395.

6. Project Inform. Project Inform Perspective. Project Inform. San Francisco,CA : s.n., 2003. pp. 15-16. 36.

7. Cadman, Jill. Women and Viral Load. The Well Project. [Online] 2003. [Cited: April 13, 2008.]

8. Walsh, Sorenson and Leonard. Gender,Health and Cigarette smoking. In BC Amick, et al. (Eds.)Society and Health. New York: Oxford University Press,1995. pp. 131-171..

9. Umeh, Davidson Chukwuma. Confronting the AIDS Epidemic: Cross-cultural Perspectives on HIV/AIDS Education. s.l. : Africa World Press, 1997. p. 127.

10. L, Phillips. Deconstructing “Down Low” Discourse:The Politics of Sexuality, Gender,Race, AIDS, and Anxiety. 2, 2005, Journal of African American Studies, Vol. 9, pp. 3-15.

11. Wingwood, Declemente. Application of the Theory of Gender and Power to Examine HIV-Related Exposures, Risk Factors, and Effective Interventions for Women5, 2000, health Behavior and Education, Vol. Vol. 27 , pp. 539-565.

12. Henry J.Kaiser Foundation. The Healthcare experience of women with HIV/AIDS: Insights from Focus groups. Menlo Park California : s.n., 2003. 3379.

13. Stone. Women, Access, and Adherence to HAART: A Vital Connection. Bulletin of Experimental Treatments for AIDS. Spring 2000.

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