WP: The Impact of AIDS on Girls and Women

[Guest guest]

<http://www.washingtonpost.com/> washingtonpost.com

The Overlooked Victims of AIDS

By Judith D. Auerbach

Thursday, October 14, 2004; Page A31

In last week's vice presidential debate, moderator Gwen Ifill talked about

the disproportionate impact of HIV-AIDS on African American women and asked

what role the government should play in slowing the growth of this domestic

epidemic. Both candidates displayed an alarming ignorance of the reality of

the crisis in the United States, choosing instead to focus their comments on

AIDS in Africa, which Ifill had explicitly asked them not to do.

What is inexcusable among the nation's top policymakers is a persistent

problem in the general public as well: a failure to recognize that AIDS now

disproportionately affects women.

According to the Centers for Disease Control and Prevention, the proportion

of all AIDS cases reported among adolescent and adult women in the United

States has more than tripled since 1986. AIDS is the fourth-leading cause of

death among women in this country between the ages of 25 and 44, and is the

leading cause of death among African American women ages 25 to 34. Black

women represent about two-thirds of all new HIV infections among adult and

adolescent females.

Globally, about half of the 12,000 people ages 15 to 49 infected every day

are women. Sixty-two percent of those ages 15 to 24 living with HIV-AIDS are

girls and women. In South Africa, that figure climbs to 77 percent. Most

women worldwide, including in the United States, acquire HIV infection

through heterosexual intercourse.

Why is this " feminization of AIDS " occurring? The answer lies in the complex

ways that sex and gender intersect, conferring increased vulnerability to

HIV infection on women and girls. Biological, sociological and political

factors interact differently for women and men, leaving women more

susceptible to viral transmission, more distant from prevention and care

services, farther away from accurate information, and far more vulnerable to

human rights violations. Here are some of the specifics:

* Women are more vulnerable to HIV infection than men. The physiology of the

female genital tract makes women twice as likely to acquire HIV from men as

vice versa. Among adolescent girls, this effect is even more pronounced.

* Poverty is correlated with higher rates of HIV infection all over the

world. Globally, more than half of the people living in poverty are women.

In the United States, nearly 30 percent are African American women.

* Lack of education is associated with higher HIV infection rates. Girls in

developing countries are less likely to complete secondary education than

boys, and almost twice as likely to be illiterate.

* Early marriage is a significant risk factor for HIV among women and girls.

In developing countries, a majority of sexually active girls ages 15 to 19

are married. Married adolescent girls tend to have higher HIV infection

rates than their sexually active unmarried peers.

* A significant risk factor for HIV infection is violence, to which women

are more susceptible in virtually all societies. In a South African study,

for example, women who were beaten or dominated by their partners were 48

percent more likely to become infected than women who lived in nonviolent

households.

* Rape of women has been used as a tool for subjugation and so-called ethnic

cleansing in war and conflict situations. Of the 250,000 women raped during

the Rwandan genocide, about 70 percent of the survivors are HIV-positive.

The experience of women and girls in the HIV-AIDS epidemic in the United

States and around the world highlights how social arrangements, cultural

norms, laws, policies and institutions contribute to the unequal status of

women in society and to the spread of disease. Together they undermine the

capacity of women and girls to exercise power over their own lives and to

control the circumstances that increase their vulnerability to HIV

infection, particularly in the context of sexual relationships. For African

American women, gender inequalities are exacerbated by persistent racism.

It is only when this unhealthy mix is acknowledged and addressed --

particularly by the highest levels of government -- that we will be able to

stem the alarming increase of HIV-AIDS among more than half the world's

population.

The writer is vice president for public policy of the American Foundation

for AIDS Research.

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