HIV Crosses the Gender Divide

Molly M. Ginty

HIV, once only the scourge of gay men in major cities, is killing women in small towns and suburbia. Since 1988, why has HIV infection quadrupled among females, the fastest-growing group of new patients?

A 73-year-old grandmother in Kansas City, Kansas.

A 16-year-old Bronx girl living in a foster home.

A mother in Virginia, infected at 19 by a rapist and fighting years later to protect her daughter from her devastating disease.

Now that the human immunodeficiency virus (HIV) that leads to
acquired immunodeficiency syndrome disease (AIDS) has crossed the
gender divide, these are the faces of AIDS in America.

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is spreading rapid-fire among women—especially senior women and those
of color. Striking a new female every 20 seconds, it’s the leading
cause of death among black women ages 25 to 34 and plagues a total
260,000 women in the United States.

Why is this
incurable disease, once the scourge of gay men in major cities, killing
women in small towns and suburbia? Since 1988, why has HIV quadrupled
among females, who are the fastest-growing group of new patients and
account for a quarter of new infections?

“This pandemic is about biological differences—and about political inequities,” says Dázon Dixon Diallo, president of SisterLove,
an Atlanta-based health advocacy organization for women at risk of HIV
infection. “Women’s social status is not a backdrop for HIV’s spread,
but is instead its undergirding cause.”

The Easiest Targets

From the moment a woman first encounters HIV, the odds are stacked against her.

HIV is transmitted from men to women much more readily than it is
from women to men, making females especially vulnerable during the
heterosexual contact that accounts for 80 percent of their infections.
An HIV-infected woman with half the amount of the virus circulating in
her bloodstream as an infected man will progress to a diagnosis of AIDS
in about the same time, reports the Rockville, Md.-based National
Institute on Drug Abuse.

In both genders, HIV
hijacks the immune system, swelling the lymph nodes, devouring fat
stores and causing joint pain, fatigue and nausea. In women, however,
it triggers more secondary complications such as pneumonia, rashes,
liver problems, yeast infections, and susceptibility to other
sexually-transmitted infections (STIs).

these physiological differences, women’s socioeconomic status boosts
their risk. A woman earns 76 cents for every dollar a man earns,
reports the Washington-based Institute for Women’s Policy Research.
Women are 50 percent more likely than men to forgo medical screenings
because they can’t afford them, notes the Kaiser Family Foundation in
Menlo Park, California.

These inequities are
especially pressing when it comes to senior women and women of color.
While 7 percent of all women live in poverty, 13 percent of women over
age 65, 25 percent of African-American women and 20 percent Latinas do
so, reports the U.S. Census.

With race, age,
money and health care intertwined as they are in the U.S., Hispanic
women are five times more likely to contract it than white women;
African American women are 23 times more likely to do so; and HIV has
spiked 50 percent among senior women in the last decade

Making Love in the Dark

Like biology and money, mass ignorance of HIV’s threat puts women in its direct line of fire.

Less than a third of American women discuss HIV with their spouse or partner, according to the New York-based American Foundation for AIDS Research.

percent of men who have sex with men also have sex with women, reports
the Atlanta-based Centers for Disease Control and Prevention. “Many
women believe they’re in monogamous relationships with such men—or with
men who are also having sex with other women,” says Dixon Diallo of
SisterLove. “They don’t take steps to protect themselves because they
don’t even know they’re at high risk.”

women try to protect themselves, but are ignorant of how to do so
correctly. “I know an HIV patient who thought she was being careful but
contracted the disease using a lambskin condom,” says Terri Wilder, a
columnist for the HIV/AIDS web resource “No one ever told her these condoms are porous and don’t protect against this virus.”

sex, only using latex condoms, dental dams, and taking care not to
exchange blood or semen can prevent HIV transmission: facts not taught
in abstinence-only sex ed programs prevailing in U.S. schools. Thanks
to President Bush’s tripling of abstinence-only sex ed funding,
students absorb HIV teachings that a Congressional report found “false
or misleading” 85 percent of the time.

Like the
failure of sex education, the shortcomings of the U.S. health care
system also keep women in the dark. Doctors are not required to take
special training in HIV/AIDS medicine, and HIV screening is not a
routine part of women’s health care—even though amfAR surveys show 67
percent of women mistakenly assume they’re tested when they are
screened for other STIs.

“My doctor never thought
to discuss HIV with me because I didn’t fit the stereotype of someone
at risk,” says 73-year-old Jane Fowler, who was infected on a date at
age 50 and now runs the Kansas City-based HIV Wisdom
for Older Women. “I didn’t use condoms because I was post-menopausal
and from a generation that thought condoms were just for birth control.
If I hadn’t taken a blood test required to get a new health insurance
policy, I would never have known I was positive.”

so few women and so few doctors are effectively guarding against
HIV/AIDs, an estimated 25 percent of HIV-positive American women don’t
even realize they’re infected

A Blind Eye

Just as mass ignorance has fueled HIV infection among women, authorities’ indifference is allowing its continued spread.

crushed hopes that diaphragms and the spermicide nonoxynol-9 could
protect women against HIV/AIDS and a vaccine lies more than ten years
in the future. Women’s health advocates are now battling to develop
microbicides: colorless topical products that prevent HIV from
infecting a woman’s cells and give her more control over prevention
than condoms do.

To date, the Bethesda-based National Institutes of Heath has devoted only 2 percent of its AIDS budget to microbicide research.

“This funding amounts to little more than peanuts,” says Anna Forbes, deputy director of the Washington-based Global Campaign for Microbicides. “Authorities
don’t perceive these products as big money-makers. And they don’t
perceive them as important. They don’t realize that if you’re a victim
of domestic violence, which half of HIV positive women are, asking your
partner to use a condom can get you a fist in your face.”

account for 27 percent of HIV infections, but they account for only 17
percent of HIV/AIDS study subjects. Although women’s health needs are
just as pressing as those of men, research shows female patients are
less likely than their male counterparts to receive the most effective
drugs: protease inhibitors and newer medications called antiretroviral
drugs. A UCLA study conducted in 2007 found women were less likely to
receive life-saving medications called “highly active antiretroviral
therapy” (HAART). In the concluding words of their study, researchers
underscored the need for “policies that reduce the income and education
inequalities on health care and that narrow gender disparities.”

A Call for Change

they can feel frustrated by the challenges facing HIV-positive women,
health advocates are taking heart in some victories achieved so far.
Thanks to new “rapid” blood and saliva tests, diagnosis that once took
two weeks now takes 20 minutes. And thanks to new drugs, HIV is no
longer the death sentence it was when the first American woman was
diagnosed with it in 1982.

Last year, Congress
approved $600 million in HIV/AIDS funding (via the Ryan White
Comprehensive AIDS Resources Emergency Act) and ramped up support for
the largest women’s HIV/AIDS research project to date (the Women’s
Interagency HIV Study).

Even so, the strongest
push to help HIV-positive women may be at the grassroots level, where
many women leading this charge are HIV-positive themselves. From her
home in Charlottesville and office in Atlanta, Dawn Averitt Bridge (the
mother infected by a rapist at age 19) oversees an educational resource
call the Well Project. In Miami, Sheri Kaplan counsels other young women at The Center for Positive Connections.

in Baltimore, Marilyn Burnett is involved in a flurry of initiatives.
“Women with HIV are giving talks at community centers and churches and
sending vans into the streets to do on-site AIDS testing,” says
Burnett. “We’re running discussion groups, creating advocacy programs,
and organizing conferences.”

Activists are
fighting to offer infected women better treatment—and to free them from
stigma. Surveys by amfAR show HIV-positive women face more prejudice
than male patients, often concealing their diagnoses so others won’t
avoid them or judge them as promiscuous or immoral. One recent amfAR
report found that 20 percent of Americans would not be comfortable
having an HIV-positive woman as a close friend, 59 percent would not be
comfortable having her as a childcare provider, and 14 percent would
not support her decision to have children of her own.

advocates are lobbying Congress to pass the Microbicide Development Act
(which would boost funding and preserve a microbicide branch at the
National Institutes of Health) and to include funding for HIV
initiatives in the next revision of the Violence Against Women Act,
which supports programs for domestic violence survivors.

say these and other initiatives will succeed best on one condition: if
we right the balance of power so women have political clout, economic
muscle and better medical care.

“When it comes
to HIV, the real crux of women’s risk is not the virus itself,” says
Forbes. “The real problem is the gender, social and economic inequality
that we must all fight to overcome.”

This article first appeared in On the Issues Magazine, a feminist, progressive magazine newly launched as an Internet publication.

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