HIV/AIDS epidemic among women in the United States

¶ … HIV / AIDS on Women in the United States

Introduction and Statement of Purpose

The Centers for Disease Control and Prevention reported that more than 58,000 women in the United States had been diagnosed with AIDS by 1994 (Hackl, Somlai, Kelly & Kalichman, 1997). By 1996, for people aged 25-44 years, AIDS was the leading cause of death for men and the third leading cause among women, with the largest increase in AIDS cases among teenagers and young adults, most of that from heterosexual transmission, a transmission rate representing an alarming 130% increase during the period from 1992-1993 (Lather & Smithies, 1997). Moreover, minority women who liven major urban areas have been particularly at risk for HIV / AIDS; in fact, as of 1994, more than three-quarters (76%) of all reported AIDS cases in women were in women of color; 54% were African-American, 20% were Hispanic, and about 2% were Asian or Native American (Hackl et al.). In addition, while Latinas and Latinos comprise just 11% of the United States population, this segment of the U.S. population accounts for fully 20% of HIV / AIDS cases (Ortiz-Torres, Serrano-Garcia & Torres-Burgos, 2000). According to these authors, "The situation in Puerto Rico and the Caribbean is also alarming. In Puerto Rico as of November 1998 more than 20,000 AIDS cases had been reported, of which 64% have died. Since 1990, AIDS has become the leading cause of death for males and females 25-29 years of age in Puerto Rico" (Ortiz-Torres et al., p. 859). In fact, women represent more than 20% (21%) of the total number of AIDS cases in Puerto Rico, and more than half (58%) report having been infected through heterosexual contact (Ortiz-Torres et al.). Indeed, in some parts of the world women are more vulnerable than men and twice as likely to being infected with HIV / AIDS through sexual transmission, a risk exposure that is frequently exacerbated by the lifestyle choices and beliefs of their male counterparts (Kang, 2005). Today, the U.S. Centers for Disease Control emphasizes that, "HIV and AIDS were originally thought to affect mostly gay men. However, women have always been affected too. And even though more men than women have HIV, women are catching up. In fact, if new HIV infections continue at their current rate worldwide, women with HIV may soon outnumber men with HIV" (HIV / AIDS and women, 2008). According to these authorities, in many ways, HIV and AIDS affect women in almost the same way they affect men; for instance:

Women of color (especially African-American women) are the hardest hit;

Younger women are more likely than older women to get HIV; and,

AIDS is a common killer, second only to cancer and heart disease for women (HIV / AIDS and women). Women in the United States acquire HIV / AIDS in two primary ways: (a) heterosexual sex with a partner who has HIV; and (b) sharing injection drug works (needles, syringes, etc.) used by someone with HIV (HIV / AIDS and women).

Statement of Purpose.

The purpose of this study was to provide an overview of the historical and current impact of HIV / AIDS on women in general and those in the United States in particular, including the political and economic perspectives on the issue, and what type of integrated response is required to effect improvements in the existing situation.

Section II: The Political Perspective on the Issue

According to Hak-Su (2004), "Two decades ago, when it was first discovered. HIV / AIDS was a mysterious, little known disease. Today, it is a rampant menace to all of humankind. Yet, to discuss how it is transmitted and how we should respond is to touch on issues that we find difficult to discuss in public -- issues of sex, drugs and deep-rooted prejudices about personal behavior" (p. 51). It is a sad commentary on the United States that such lingering prejudices continue to adversely affect the ability of women to gain access to the healthcare resources they need when they learn they have become infected with HIV / AIDS, or which prevent their gaining access to the educational resources they needed to prevent becoming infected in the first place. By any measure, enormous strides have been made in recent years in the area of civil and women's rights and the United States has overcome many of the past disparities in the treatment of these groups; however, there are some significant constraints that remain firmly in place throughout the country that adversely affect the ability of researchers and clinicians to obtain funding unless the problems they face are framed in the appropriate political terms.

In this regard, Lather and Smithies (1997) emphasize that, "In the United States, talk about 'the democratization of AIDS' and 'the changing face of AIDS' attempts to make AIDS the concern of Middle America. Opinions differ as to which populations are at risk and some fear a backlash" (p. 116). These authors cite one physician that observed, "I fear the reason is we live in a racist society where the health problems of whites are considered to be more important. So we have to package this disease as a threat to the white middle class to get funding for it, to get attention, to get support" (quoted in Lather and Smithies at p. 116). Unfortunately, such politically motivated funding efforts only serve to mask the true source of the problem and its impact on those most at risk: "The message of middle-class risk flies in the face of those most afflicted -- homosexual men and needle drug users, with 51% of cumulative cases reported being the former, 25% the latter, and 7% men who have sex with men and inject drugs. Eight percent were heterosexually transmitted cases" (p. 116). Because the lifestyle patterns of male partners contributes to the at-risk condition of their female partners and heterosexual contact remains the leading cause of HIV / AIDS acquisition among American women, it is clear that the political issues involved in developing a cure and promoting effective preventive programs must be one of the first steps involved in formulating a comprehensive and integrated perspective on the issue, and the enormous economic consequences involved may help many policymakers overcome their desire for political correctness long enough to see the problem for what it is rather than what they would like to believe it is, and these issues are discussed further below.

Section IV: An Integrated Perspective on the Issue

Complex problems require complex solutions, and this is certainly the case with HIV / AIDS and women in the United States today. As Kang emphasizes, "Clearly, women are part of the HIV / AIDS transmission equation and their participation should not be overlooked. This underscores the importance of education, dialogue and prevention for both men and women" (p. 71). Unfortunately, gaining the information needed to address the problem of HIV / AIDS among American women has confounded the research to date in some profound ways. Without access to this timely and accurate information, it is difficult or even impossible to formulate appropriate interventions and develop preventive programs for whose women most at risk of acquiring these diseases. In this regard, Hackl and her colleagues emphasize, "Women who share their HIV or AIDS diagnosis with family or friends risk stigmatization (including reactions of fear, shock, and blame), isolation (as a result of others' fears of casual transmission and the possibility of desertion), and potential loss of self-esteem (lack of confidence and self-blame)" (p. 53).

The alternative to sharing their diagnosis is also not viable: "Keeping the diagnosis of HIV a secret may hinder a woman's ability to develop effective coping strategies and leave her vulnerable to fear, anger, and depression. These problems may worsen as the progression of HIV disease creates significant changes in behavior, attitudes, and physical appearance" (Hackl et al., p. 54). As Rosenberg emphasizes, though, "Medical experts know that those who get tested and counseled reduce risky sexual behaviors. Treatment also reduces the stigma of AIDS. One of the biggest reasons people don't change their sexual behavior is because AIDS is just too scary to contemplate. Where AIDS is always fatal, it is shrouded in denial. This phenomenon changes when AIDS becomes a manageable chronic illness, like diabetes" (p. 23).

According to Blumberg, Osborn, Larry and Olson (2003), policy development for human immunodeficiency virus (HIV) and sexually transmitted disease (STD) prevention requires accurate and timely data in order to develop, target, implement, and evaluate effective prevention programs; however, although there has been an increased amount of attention given to developing information on HIV and STD risk and preventive behaviors for many infected and high-risk populations, the inclusion of explicit questions on risk and preventive behaviors in general population surveys has traditionally been limited by concerns about respondents' willingness to answer sensitive questions honestly. These authors advise, "Respondents may be more willing to answer sensitive questions honestly when they believe that their answers will remain anonymous or confidential. It has been hypothesized, for example, that the greater anonymity associated with telephone interviews compared with personal contact could yield more frequent reports of risky, socially disapproved behaviors" (p. 121). In this regard, researchers have demonstrated that women are more likely to honestly answer questions concerning potentially embarrassing sexual behavior information (e.g., the number of sexual partners in the past year) in telephonic interviews than in face-to-face interviews (Blumberg et al.).