Serious Weaknesses Plague HIV/AIDS Programs For US Women

Brook Kelly

US policy still ignores the deep structural challenges faced by women affected and infected with HIV in the United States.

On this Women and Girls HIV/AIDS Awareness Day 2010, we reflect back on the past year’s work around HIV/AIDS and women in the United States. The rate of HIV among women and girls has been steadily increasing over the years, with women of color the hardest hit.  HIV has now become the leading cause of death among Black women ages 25 to 34.

At the 2009 HIV/AIDS Prevention Conference in Atlanta, Secretary of Health and Human Services Kathleen Sebelius commented on the dramatic and disparate impact of the HIV epidemic on minority communities: “Today, African Americans make up just over one-tenth of the population. But they account for nearly half of new HIV infections. One in 30 African-American women will be diagnosed in her lifetime. One in sixteen African-American men will be diagnosed with HIV. The situation is also dire for Latinos. Think about that. Imagine if it were half the straight white women in Atlanta. Wouldn’t we be calling this a national emergency? Shouldn’t we be?”

The answer is, of course, yes we should be calling the HIV/AIDS crisis a national emergency.  

As the HIV Human Rights Attorney for the U.S. Positive Women’s Network, the only national membership organization for HIV-positive women, I have seen tremendous gains in advancing HIV-positive women’s issues to the highest policy levels. I have heard HIV-positive women’s voices where before there was only silence: in the White House, in Congress, at the tables where decisions are made.  But I am also struck by the continued blindness to the deeper structural challenges faced by women and girls affected and infected with HIV in the United States, a blindness that makes progress toward stemming the epidemic virtually impossible.

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For the first time, the Center for Disease Control (CDC) in its Women and Girls HIV/AIDS Awareness Day 2010 statement called for the promotion of women’s human rights as a key factor in reducing “the burden of the epidemic among women and girls,” here in the U.S. They addressed the most challenging structural barriers that women face in preventing HIV transmission and in caring for themselves when HIV-positive: not only our biological vulnerability as women to HIV, which can be alleviated through safer sex tools, but the crux of the issue: gender inequity; lack of financial autonomy; and sexual and domestic violence that prevents women from demanding the use of safer sex tools.

While the CDC has taken a giant step in recognizing that the HIV epidemic among women is a human rights issue, beyond increased testing, they have yet to offer solutions that account for the complex barriers to HIV prevention and treatment women face. Yet, the implementation of a human rights based solutions that take a holistic approach to HIV prevention and care is necessary not only abroad but here at home.

For the PWN, a human rights based approach means that:

  • Every woman has access to and education about high quality, culturally appropriate, accessible, and integrated HIV/AIDS and sexual and reproductive health services;
  • Every HIV-positive woman can exercise her right to decide whether and when to have a child and has access to the information and services necessary to make an informed and voluntary decision; every woman’s right to confidentiality and dignity be respected;
  • Stigmatizing laws and policies–like those that criminalize HIV transmission and exposure, or harm women in prostitution–are amended or repealed;
  • Every woman has access to safe, adequate housing and meaningful employment, opportunities;
  • HIV-positive women are meaningfully involved in all policy decisions affecting their lives; and
  • Laws and policies that intentionally, or unintentionally negatively affect the prevention, or care and treatment of women living with or affected by HIV are changed.


Although the meaningful inclusion of HIV-positive women’s voices on issues most affecting their lives has been slow coming we see that progress has been made – voices have been heard.  For the first time the U.S. is in the process of drafting our first National HIV/AIDS Strategy.

As of today, however, the newly formed President’s Advisory Council on HIV/AIDS, which will review and monitor the Strategy has no Black HIV-positive woman member despite the fact that Black women carry the greatest burden of the HIV epidemic; as of today our U.S. foreign policy on HIV has a more woman-centered approach to HIV prevention and care than our own domestic policy – the PEPFAR Five-year Plan calls for the integration of HIV and reproductive health services and care as a mandatory component of HIV prevention and treatment; as of today we are still not calling HIV/AIDS among women of color in the U.S. a national emergency.

On this National Women and Girls HIV/AIDS Awareness Day, I hope our leaders will begin to listen to the resounding voices of HIV-positive women in the U.S. who know that the best solutions to the epidemic only begin with increased testing but succeed with the recognition of and work towards realizing women’s human rights to health, dignity, and equality.

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