Complex Demographic Impact of HIV/AIDS

Elizabeth Leahy

Despite the major effects of the HIV/AIDS epidemic on mortality and life expectancy, populations are continuing to grow even in the hardest-hit countries. With so much uncertainty about the number of people living with HIV/AIDS, the demographic impact is still incompletely understood.

Despite the major effects of the HIV/AIDS epidemic on mortality and life expectancy, populations are continuing to grow even in the hardest-hit countries. With so much uncertainty about the number of people living with HIV/AIDS, the demographic impact is still incompletely understood. Late last year, UNAIDS estimates of the global scope of HIV/AIDS were significantly revised. As we know from the 2007 AIDS Epidemic Update, the number of people living with HIV/AIDS globally is now estimated at 33 million (down from 40 million) and annual infections are now assumed to number about 2.5 million (half the previous estimate). Recent revisions to United Nations population projections and HIV/AIDS prevalence estimates have rendered much of the previous data outdated (such as the data used in an earlier post on Rewire).

The 2006 revision of the UN Population Division's projections (PDF) includes more recent HIV prevalence survey data, showing lower prevalence rates in some countries than was previously believed, and also assumes greater access to treatment than the 2004 version. This means that the projected demographic impact of HIV/AIDS is slightly less according to the newer 2006 data. As the methodology of estimating HIV prevalence continues to be refined, the 2008 UN population estimates may show an even smaller demographic impact due to the epidemic.

Therefore, from 2005 through the foreseeable future, HIV/AIDS is not projected to lead to either negative population growth rates or shortened life expectancy in any country. As the UN report summary for the 2006 estimates says,

All the countries with the highest prevalence in 2005 are expected to experience positive population growth rates between 2005 and 2050. This trend marks a reversal from previous projections which expected outright reductions of population (that is, negative population growth rates) in countries such as Botswana, Lesotho or Swaziland.

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For those of us working to ensure that sexual and reproductive health are well integrated into HIV/AIDS prevention and treatment programs, it is important to stay on top of these shifting numbers and their meaning in the lives of real people. In particular, as the UN Population Division makes clear in its printed materials, these estimates rely on optimistic policy assumptions. Fertility rates in less developed countries are assumed to decline to below replacement level by 2045-2050, a dramatic change from current levels that will require greater investments and a sustained effort to achieve the Millennium Development Goals target of universal access to reproductive health by 2015. As the data have shown, sexual and reproductive health services still need strong financial and human support. For more information, read PAI's new analysis "U.S. HIV/AIDS and Family Planning/Reproductive Health Assistance: A Growing Disparity Within PEPFAR Focus Countries."

Analysis Politics

Donald Trump and Mike Pence: The Anti-Immigrant Ticket

Tina Vasquez

“My greatest fear is that this ticket doesn’t seem to realize immigrants are actually an incredible resource that fuels our country," Wendy Feliz of the American Immigration Council told Rewire.

On Friday, Republican presidential candidate Donald Trump announced Indiana Gov. Mike Pence as his running mate, giving legitimacy to concerns a Trump presidency would be anti-choice and decimate LGBTQ rights. As Rewire reported last week, Pence has voted against nondiscrimination efforts, signed a so-called religious freedom bill, opposed marriage equality, and attemptednumerous times—to defund Planned Parenthood, something Trump has promised to do if elected president.

But the two Republicans also have something else in common: They are brazenly anti-immigrant.

Despite a misleading article from the Daily Beast asserting that Pence has had a “love affair with immigration reform” and has “spent his political career decrying anti-immigrant rhetoric,” the governor’s record on immigration tells a different story.

Let’s take a look at Trump’s “xenophobic” and “racist” campaign thus far, and how closely Pence’s voting aligns with that position.

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Donald Trump

For months it seemed, Donald Trump’s talking points in the media rarely drifted away from anti-immigrant rhetoric. During his kickoff speech, he referred to Mexican immigrants as “rapists” and “killers” and in the months since, has promised to build a 2,000-mile-long wall along the United States-Mexico border to keep “illegals” out, a wall the billionaire has promised that Mexico will pay for.

Despite being called “racist” by members of his own party, Trump’s immigration plan is largely consistent with what many Republicans have called for: a larger border wall, increasing the number of Immigration and Customs Enforcement (ICE) officers, requiring all U.S. companies to use E-Verify to check the immigration status of employees, increasing the use of detention for those who are undocumented and currently residing in the United States, and ending “birthright citizenship,” which would mean the U.S.-born children of undocumented parents would be denied citizenship.

Again, Trump’s proposed immigration policies align with the Republican Party’s, but it is the way that he routinely spreads false, damaging information about undocumented immigrants that is worrisome. Trump has repeatedly said that economically, undocumented immigrants are “killing us by “taking our jobs, taking our manufacturing jobs, taking our money.” 

Market Watch, a publication focusing on financial news, reported that this falsehood is something that a bulk of Trump supporters believe; two-thirds of Trump supporters surveyed in the primaries said they feel immigration is a burden on our country “because ‘they take our jobs, housing and health care.'” This, despite research that says deporting the 11 million undocumented immigrants who currently call the United States home would result in a “massive economic hit” for Trump’s home state of New York, which receives $793 million in tax revenue from undocumented immigrants. A recent report by the Institute on Taxation and Economic Policy also found that at the state and local level, undocumented immigrants nationwide collectively pay an estimated $11.6 billion each year in taxes.

Trump has also been accused by Muslim Americans and members of the media of engaging in “reckless, dangerous Islamophobia” at every opportunity, using terrorist attacks to call for a ban on all Muslim immigration, while also using terrorism in a self-aggrandizing manner. In a statement released after the Pulse nightclub shooting, Trump said, “I said this was going to happen.”

These dangerous assertions that all U.S.-based Muslims are secretly harboring terrorists or that undocumented immigrants are killing “thousands of peoplea narrative he continued to push at the Republican National Convention by having the families of three Americans killed by undocumented people speak—can be deadly and inspire hatred and violence. This was made all the more clearer when in August 2015 two white brothers cited Trump when they urinated on and beat a homeless Latino man. According to Huffington Post, the men “alegedly [sic] told police they targeted the man because of his ethnicity and added, ‘Donald Trump was right, all these illegals need to be deported.’” Trump’s response? He said that his supporters are simply “passionate” people who want America “to be great again.”

Mike Pence

Wendy Feliz, a spokesperson with the American Immigration Council, succinctly summarized Pence’s immigration approach to Rewire, saying on Monday that he “basically falls into a camp of being more restrictive on immigration, someone who looks for more punitive ways to punish immigrants, rather than looking for the positive ways our country can benefit from immigrants.”

After Trump’s announcement that Pence would be his running mate, Immigration Impact, a project of the American Immigration Council, outlined what voters should know about Pence’s immigration record:

Pence’s record shows he used his time in Congress and as the Governor of Indiana to pursue extreme and punitive immigration policies earning him a 100 percent approval rating by the anti-immigration group, Federation for American Immigration Reform.

In 2004 when Pence was a senator, he voted for the “Undocumented Alien Emergency Medical Assistance Amendments.” The bill failed, but it would have required hospitals to gather and report information on undocumented patients before hospitals could be reimbursed for treating them. Even worse, the bill wouldn’t have required hospitals to provide care to undocumented patients if they could be deported to their country of origin without a “significant chance” of their condition getting worse.

Though it’s true that in 2006 Pence championed comprehensive immigration reform, as the Daily Beast reported, the reform came with two caveats: a tightening of border security and undocumented immigrants would have to “self-deport” and come back as guest workers. While calling for undocumented immigrants to self-deport may seem like the more egregious demand, it’s important to contextualize Pence’s call for an increase in border security.

This tactic of calling for more Border Patrol agents is commonly used by politicians to pacify those opposed to any form of immigration reform. President Obama, who has utilized more border security than any other president, announced deferred action for the undocumented in June 2012, while also promising to increase border security. But in 2006 when Pence was calling for an increase in border security, the border enforcement policy known as “Operation Gatekeeper” was still in full swing. According to the American Civil Liberties Union (ACLU), Operation Gatekeeper “concentrated border agents and resources along populated areas, intentionally forcing undocumented immigrants to extreme environments and natural barriers that the government anticipated would increase the likelihood of injury and death.” Pence called for more of this, although the undocumented population expanded significantly even when border enforcement resources escalated. The long-term results, the ACLU reported, were that migrants’ reliance on smugglers to transport them increased and migrant deaths multiplied.

There are more direct ways Pence has illustrated a xenophobic agenda, including co-sponsoring a congressional bill that would have made English the official language of the United States and as governor, blocking Syrian refugees en route to Indiana, saying he would not accept any more Syrian refugees out of fear they were “terrorists.” The governor also added Indiana to the Texas lawsuit challenging expanded Deferred Action for Childhood Arrivals (DACA) and Deferred Action for Parents of Americans and Lawful Permanent Residents (DAPA). And he praised the inaction by the Supreme Court last month to expand DACA and DAPA, which leaves millions of undocumented immigrants living in fear of deportation.

According to the Office of Refugee Resettlement, “when a child who is not accompanied by a parent or legal guardian is apprehended by immigration authorities, the child is transferred to the care and custody of the Office of Refugee Resettlement (ORR). Federal law requires that ORR feed, shelter, and provide medical care for unaccompanied children until it is able to release them to safe settings with sponsors (usually family members), while they await immigration proceedings.”

The ORR added that these sponsors “live in many states,” including Indiana, which received 245 unaccompanied minors between January and July 2014. Pence was reportedly unaware that unaccompanied minors were being placed in his state by the federal government, something he said he was made aware of by media reports. These are asylum seeking children, often girls under the age of 10, escaping violence in their countries of origin who arrive at the United States-Mexico border without an adult. Many, including advocacy organizations and the Obama administration, have contended that the circumstances surrounding unaccompanied minors is not simply an immigration issue, but a humanitarian crisis. Not Pence. In a letter to President Obama, the Indiana governor wrote:

While we feel deep compassion for these children, our country must secure its borders and provide for a legal and orderly immigration process …. Failure to expedite the return of unaccompanied children thwarts the rule of law and will only continue to send a distorted message that illegally crossing into America is without consequence.

In the four days since Pence was named Trump’s running mate, he’s also taken a much harsher stance on Muslim immigration. Back in December when Trump called for a “total and complete shutdown of Muslims entering the United States,” Pence tweeted that banning Muslims from entering the United States was “offensive and unconstitutional.” However, on Friday when Pence was officially named Trump’s VP pick, he told Fox News’ Sean Hannity, “I am very supportive of Donald Trump’s call to temporarily suspend immigration from countries where terrorist influence and impact represents a threat to the United States.”

Wendy Feliz of the American Immigration Council told Rewire that while Pence’s rhetoric may not be as inflammatory as Trump’s, it’s important to look at his record in relation to Trump’s to get a better understanding of what the Republican ticket intends to focus on moving into a possible presidency. Immigration, she said, is one of the most pressing issues of our time and has become a primary focus of the election.

“In a few days, we’ll have a better sense of the particular policies the Republican ticket will be pursuing on immigration. It all appears to point to more of the same, which is punitive, the punishing of immigrants,” Feliz said. “My greatest fear is that this ticket doesn’t seem to realize immigrants are actually an incredible resource that fuels our country. I don’t think Trump and Pence is a ticket that values that. An administration that doesn’t value immigrants, that doesn’t value what’s fueled our country for the past several hundred years, hurts all of us. Not just immigrants themselves, but every single American.”

Commentary Sexual Health

‘Not the Enemy, But the Answer’: Elevating the Voices of Black Women Living With HIV

Dazon Dixon Diallo

National HIV Testing Day is June 27. But for longtime advocates, ensuring that the women most affected by the epidemic can get and influence care and policy is the work of many years.

I met Juanita Williams in the mid-1980s. She was the first client at SisterLove, the then-new Atlanta nonprofit I founded for women living with AIDS.

June 27 is National HIV Testing Day, and many women will be tested during the observance. But when I met Williams, HIV was a growing reality in our communities, and women were not even recognized as a population at risk for HIV at that time.

This lack of understanding was reflected in women’s experiences when seeking care. Williams’ attempt to get a tubal ligation had been met with fear, ignorance, and hostility from a medical team who informed her she had AIDS. Not only did they refuse to provide her the medical procedure, the hospital staff promptly ushered her down the back staircase and out the door. Williams was left without information or counseling for what was devastating news.

A Black woman who grew up in Syracuse, New York, she had moved to her family’s home state of South Carolina. Her first major decision after her diagnosis was to leave South Carolina and move to Atlanta, where she believed she would get better treatment and support. She was right, and still, it wasn’t easy—not then and not now. Even today, Williams says, “Positive people are not taken seriously, and positive women are taken even less seriously. People think positive people are way down on the totem pole.”

As communities across the United States observe National HIV Testing Day and emphasize taking control of our health and lives, women’s voices are an essential but still neglected part of the conversation. The experiences of Black women living with HIV, within the broader context of their sexual and reproductive health, highlight the need to address systemic health disparities and the promise of a powerful movement at the intersection of sexual and reproductive justice.

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The urgency of adopting an intersectional approach to sexual and reproductive health comes to light when considering the disproportionate impact of HIV on women of color. Black women account for 69 percent of all HIV diagnoses among women in the South. Advocates also acknowledge the history of biomedical and reproductive oppression that Black women have suffered throughout American history, including forced pregnancy and childrearing during slavery to forced sterilization afterward. Keeping these matters in mind helps us understand how the HIV epidemic is a matter of sexual and reproductive justice.

Taking seriously the perspectives of women such as Williams would amplify our collective efforts to eradicate HIV’s impacts while elevating women’s health, dignity, and agency. This is especially pressing for women living with HIV who experience the greatest disparities and access barriers to the broad spectrum of reproductive health, including contraception and abortion.

The policy context has created additional barriers to advancing the reproductive health of women living with HIV. For example, the 2015 National HIV AIDS Strategy Update neglected to mention family planning or reproductive health services as arenas for providing HIV prevention care. Yet, in many instances, a reproductive health clinic is a woman’s primary or only point of access to health care in a given year. Providing HIV prevention and care in family planning clinics is a way to provide a space where women can expect to receive guidance about their risk of exposure to HIV.

As advocates for women living with HIV, we at SisterLove are committed to ensuring that human rights values are at the center of social change efforts to protect and advance the sexual and reproductive health and rights of women and their families. We work to transform the policy frame to one that asserts women’s agency to make decisions that are best for themselves and their loved ones. We draw strength from the resilience and determination of the women we serve.

Several years after becoming deeply involved with SisterLove, Williams became an advocate for her own reproductive health and began speaking out on behalf of other Black women living with HIV. She eventually became a trainer, counselor, and health outreach worker.

Later, in 2004, Williams was the only woman living with HIV invited to be a main speaker at the historic March for Women’s Lives in Washington, D.C. She is a mother, grandmother, and great-grandmother who has returned to South Carolina, where she teaches other women living with HIV about sexual and reproductive justice and human rights. Williams uses her own story and strength to help other women find theirs.

“Give [women living with HIV] a voice and a platform for that voice,” she has said. “Give a safe place to let their voices be heard and validate them …. We need positive women’s voices to continue to fight the stigma. How do we do that? We tell our stories and reflect each other. I am not the enemy, I am the answer.”

Advocates need strength as we work at many critical intersections where the lives of women and girls are shaped. We cannot address HIV and AIDS without access to contraception and abortion care; health and pay equity; recognition of domestic and gender-based violence; and the end of HIV criminalization. And as advocates for sexual and reproductive health in our communities, SisterLove is working alongside our sisters to support National HIV Testing Day and ensure all people have the information, tools, and agency to take control of their health.

Elevating the health and dignity of people living with HIV calls for special attention to the epidemic’s implications for women of color and Black women, particularly those within marginalized communities and in the Deep South. The voices and leadership of the most affected women and people living with HIV are essential to making our efforts more relevant and powerful. Together, we can advance the long-term vision for sexual and reproductive justice while working to eradicate HIV for all people.