AIDS and women in America
By 2004, the number of women living with HIV had escalated to 20 million, and the numbers are increasing continuously. If these rates of infection continue, women will soon become the majority of the global total of people infected. Globally, the major route of HIV transmission to women is through sexual contact with men (heterosexual intercourse) (The National Women’s Health Information Center, 2005).
By the end of 2002, 159,271 adolescent and adult women in the United States were reported as having AIDS. Based on cases reported to the Centers for Disease Control and Prevention (CDC) through December 2002, more than 57,376 women have been infected with HIV. Among adolescent and adult women, the proportion of AIDS cases more than tripled from 7 percent in 1985 to 26 percent in 2002. Nonetheless, AIDS cases in adolescent and adult women have declined by 17 percent and have plateaued in the past 4 years, reflecting the success of antiretroviral therapies in preventing the development of AIDS. HIV disproportionately affects African-American and Hispanic women. Together they represent less than 25 percent of all U.S. women, yet they account for more than 82 percent of AIDS cases in women.
Women with HIV infection have great difficulty accessing health care, and carry a heavy burden of caring for children and other family members who may also be HIV-infected. They often lack social support and face other challenges that may interfere with their ability to adhere to treatment regimens. In the United States, most women are infected with HIV during sex with an HIV-infected man or while using HIV-contaminated syringes for the injection of drugs such as heroin, cocaine, and amphetamines. Of the new HIV infections diagnosed among women in the United States, through 2002, the CDC estimated that 70.3 percent were attributed to heterosexual contact and 27.6 percent to injection drug use. In the United States, studies have shown that during unprotected heterosexual intercourse with an HIV-infected partner, women have a greater risk of becoming infected than uninfected men who have heterosexual intercourse with an HIV-infected woman. Approximately 25 percent of pregnant HIV-infected women in the United States do not receive AZT or a combination of antiretroviral therapies pass on the virus to their babies. If women do receive a combination of antiretroviral therapies during pregnancy, however, the risk of HIV transmission to the newborn drops below 2 percent (NIAID, 2004).
Physically, women are more susceptible than men to HIV infection through heterosexual sex, and this fact alone means that special attention must be paid to protecting them if they are not to be disproportionately affected by the epidemic. Information drawn from different studies shows that during heterosexual sex, women are about twice as likely to become infected with HIV from men as men are from women. This is a major reason why women have caught up so rapidly with men when it comes to figures for the numbers of HIV+ people. It seems very possible that, unless something is done to prevent it happening, women will soon come to overtake men in these statistics. This may already be happening – data from the CDC in America shows that among teens, girls accounted for more than half of new HIV infections reported in 2001. Globally, women make up 60% of the 15 – 24 year olds who are HIV+.
There is still much more to be done to protect women, even in the United States. There has been criticism that sex education in schools in the USA is based on the idea that sexual fidelity until marriage is the best way to prevent STD infection. This won’t protect a woman if she is infected by the man she marries, and it leaves her vulnerable and ignorant if she changes her mind, and has sex before marriage. The US government is still resistant to the distribution of free condoms, which are absolutely vital if women are to be protected from HIV/AIDS. 80% of the women infected with HIV in the US are African-American or Hispanic, ethnic groups which are also unfairly burdened with poverty and poor education.
Violence against women, discrimination, gender-based inequalities, prostitution – these are all social issues which undeniably need to be changed. Women who have HIV need to be treated immediately, and women who don’t have the virus need to be able to protect themselves. If, in the short term, it is impossible to empower women to be able to insist on condom use, then efforts must be made to find an alternative solution. Many women may not think they are at risk for HIV infection. There is still, in some places, a myth that HIV infection is something that happens to other people – to men, to injecting drug users, to people from other ethnic groups. This falsehood needs to be cleared up, and countries around the world need to empower women to be able to protect themselves (Berry, 2005).
Testing positive for the HIV virus generates many feelings. These patients may experience fear, anger, guilt, surprise, sadness, or relief. Recent medical advancements have made living with HIV more manageable. People often cite fear of rejection, lack of understanding, or burdening family and friends as primary reasons not to disclose their diagnosis. Coping with HIV can be more difficult when also struggling with drug or alcohol use. Some people turn to drugs or alcohol as a method of blocking out difficult feelings or hiding from their HIV diagnosis. However, this is ultimately self-destructive behavior. Many studies have shown that patients with substance abuse problems are much more likely to miss medication doses and to get sick (Teeters, 2005).
People with HIV face a number of medical, social, legal, and emotional issues associated with their diagnosis. Twenty years ago, in the beginning of the epidemic, HIV/AIDS was considered a fatal diagnosis. The so-called face of HIV/AIDS has changed with the support groups and networks flourishing to meet those social and emotional needs.
Women now account for more than 25% of AIDS cases in the US. These women are primarily of childbearing ages and, many times, are caught completely off-guard at their initial diagnosis. Finding coordinated and comprehensive care for women and children remains a challenge. Poor women with HIV face a wide range of barriers to care. Welfare reform and anti-immigration legislation have served to deny health care access and services. Women with HIV/AIDS are often diagnosed late in the course of their illness. They usually delay seeking treatment or simply give up because of the time constraints thrust upon them by their traditional roles as caregivers to others. Women are often financially dependent and isolated, and the chores of caring for spouses and children interfere with their ability to seek assistance for themselves. Women worry about how they will be provided for financially and how they will take care of their children. Even women in higher socioeconomic situations feel ashamed and anxious about their ability to provide for themselves and their families.
Stressors and knowledge of past coping skills need to be explored in order for the social worker to assist clients in developing good coping skills for the present and future. Many of the HIV infected women yearn for human touch, but feel frightened of having intimate relationships and of being rejected. Trust issues are important and must be repeatedly reinforced. Alcohol, drug use, and other possibly harmful behaviors should be addressed. Common emotions like anxiety, depression, and despair — coupled with fear of abandonment — can be overpowering and require the skills of a trained mental health professional. Individual therapy, appropriate medication, and support groups are all essential interventions (Newman, 2001).
The socioeconomic problems associated with poverty, including limited access to high-quality health care and HIV prevention education, directly or indirectly increase HIV risk. A recent study of HIV transmission among African American women in North Carolina found that women with HIV infection were more likely than non-infected women to be unemployed, receive public assistance, have had 20 or more lifetime sexual partners, have a lifetime history of genital herpes infection, have used crack or cocaine, or have traded sex for drugs, money, or shelter (CDC, 2005). Hence it becomes one of the most important issues facing the society to control the spread of this epidemic. Proper education and awareness among the economically backward class women could help prevent the spread of HIV/AIDS infection.
Berry, S. (July 26, 2005). Women HIV and AIDS. Retrieved November 10, 2005, from http://www.avert.org/women.htm
CDC, (2005). HIV transmission among black women—North Carolina, 2004. MMWR 2005;54:89–93.
Newman, T.E. (November, 2001). Emotional Issues of Women with HIV/AIDS. The Body. Retrieved November 10, 2005, from http://www.thebody.com/cfa/alerts_nov01/emotional.html
NIAID, (November 18, 2004). HIV Infection in Women. Retrieved November 10, 2005, from http://www.niaid.nih.gov/factsheets/womenhiv.htm
Teeters, C. (2005). HIV/AIDS – How Social Workers Help. Healthology, Inc. Retrieved November 10, 2005, from http://www.helpstartshere.org/health_and_wellness/hiv/aids/how_social_workers_help/hiv/aids_-_how_social_workers_help.html
The National Women’s Health Information Center, (April, 2005). Women and HIV/AIDS. Retrieved November 10, 2005, from http://www.4woman.gov/hiv/world.cfm