As the International AIDS Conference took place this week in Washington, many advocates said that governments and the medical community still had far to go to address women’s needs amid the sea of problems associated with the epidemic that began around three decades ago.
Half the people in the world living with HIV and AIDS are female, and globally the pandemic is the leading cause of death for females aged 15 to 49.
Advocates said the estimated 16.7 million women who were living with HIV often faced challenges in disproportionate numbers: Many have trouble getting tested because they aren’t considered “high-risk,” or have no idea of the HIV status of their partners. Many live in poverty, struggle with domestic violence or work in the sex industry, putting them more at risk. And those challenges, advocates said, can make it tough not only to prevent HIV infection among women, but also for them to get treatment once they’re infected.
“We don’t lose clients to HIV; we have clients pass because of violence in their homes, because of abuse either current or past, or we have women die because of stigma,” said Naina Khanna, an HIV-positive woman who’s the policy director for the U.S. Positive Women’s Network, a national group of women with HIV that focuses on human rights and gender equity.
She said there were three major challenges the community faced: a lack of women in positions of power in the medical and political frontier, an effective female method of HIV prevention and an alarming level of violence.
“There’s no reason for people to be dying of HIV in the U.S.,” Khanna said. “We have access to treatment; we have access to care.”
In the United States, around 25 percent of new HIV infections occur among women, and about two-thirds of women infected are black. Poverty and homelessness are also rampant among women affected by HIV.
“Among women who have HIV, some of the strongest predictors are around poverty,” said Elise Riley, an associate professor of epidemiology at University of California, San Francisco. Not having access to basic necessities makes focusing on HIV prevention difficult because it isn’t seen as a pressing problem in comparison, she said.“Sure, you might go to your doctor, but you might not do it consistently because you have other survival needs in mind,” Riley said. “Or you might get that medication, but if you can’t keep it refrigerated or if you can’t take it consistently because you’re moving around from place to place, then is it really doing you much good?”
Sally Hodder, a professor of medicine at the New Jersey Medical School, said doctors and advocates needed to work within the context of patients’ lives.
“If someone is really worried about having a roof (over) their head tonight, that is really going to take precedent over anything else,” she said. “If a woman has children to feed, she’s going to really have to figure out how to feed these children.”
A joint UNAIDS and World Health Organization study estimated last year that of the approximately 6,000 new HIV infections per day among people 15 and older, nearly 47 percent of them were among women.
Globally, females ages 15 to 24 have HIV infection rates that are twice as high as those of males the same ages, UNAIDS reports.
In Washington this past week, advocates and policymakers at the International AIDS Conference paid special attention to women.
“When women are identified as HIV-positive and eligible for treatment, they are often referred to another clinic, one that may be too far away for them to reach,” Secretary of State Hillary Clinton told conference delegates Monday. “As a result, too many women never start treatment.”
Despite announcements and motivational speeches by Clinton and others, many advocates said they thought that the challenges that HIV-positive women faced weren’t being addressed properly.
Kathleen Griffith of Galesburg, Ill., a member of the U.S. Positive Women’s Network steering committee, said grants for HIV testing, for example, ought to do more to include women.
“Some people are in relationships that are the direct source of an HIV infection,” she said. “Some people stay in violent relationships because they’re HIV positive.”
Though much of the AIDS conference focused on research breakthroughs, Khanna said that women living with HIV needed more than science to get past many of the obstacles in their lives.
“Even though we have the science and we have the research that shows that we can turn the tides on the epidemic, we will not be able to do that for women until we achieve gender equity, until we uphold women’s rights, until we end the war on women,” she said.