amfAR, The Foundation for AIDS Research

Women and HIV: There Is No Debate

On October 14, 2004, this editorial by Dr. Judith Auerbach, amfAR Vice President of Public Policy, appeared in The Washington Post.

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.