Women and HIV/AIDS

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The first case of HIV in a woman was recorded in 1981. [1] Since then, numerous women have been infected with the HIV/AIDS virus. The majority of HIV/AIDS cases in women are directly influenced by high-risk sexual activities, injectional drug use, the spread of medical misinformation, and the lack of adequate reproductive health resources in the United States. [2] Women of color, LGBTQ women, homeless women, women in the sex trade, and women intravenous drug users are at a high-risk for contracting the HIV/AIDS virus. [3] [4] [5] In an article published by the Annual Review of Sociology, Celeste Watkins Hayes, an American sociologist, scholar, and professor wrote, "Women are more likely to be forced into survival-focused behaviors such as transactional sex for money, housing, protection, employment, and other basic needs; power-imbalanced relationships with older men; and other partnerings in which they cannot dictate the terms of condom use, monogamy, or HIV." [2] [3] The largest motivator to become part of the sex trade was addiction, the second largest being basic needs (housing, food), and the third was to support their children/family. [6]

Contents

From the start of the HIV/AIDS epidemic in the U.S., women have been excluded and erased from the medical, governmental, and societal institutions that aim to prevent and treat HIV/AIDS. [7] Initially, the medical community in the U.S. deemed lesbian, bisexual and queer women, as well as women who have sex with women (WSW), immune to the HIV/AIDS virus. [4] Although this was later corrected, the spread of such false information had resulted in many women engaging in high risk sexual activities, due to the belief that they were unable to contract the HIV/AIDS virus. [4] Lesbian, bisexual, and queer women who become infected with HIV/AIDS are statistically classified in the U.S. as heterosexual, intravenous drug, or indefinable transmission, despite the fact that it could have been contracted from another woman. [4] Lesbian, bisexual, and queer women who are infected with the HIV/AIDS virus through sexual assault by men are also statistically categorized as heterosexual transmission. [4] Transgender women are also especially vulnerable to HIV/AIDS transmission due to socioecological barriers that impact access to resources. [8] Women with HIV/AIDS have been excluded from medical studies, clinical trials, financial grants, reproductive health resources, and an adequate HIV education. [3] Women with the HIV/AIDS virus got less attention from medical, governmental, and societal institutions because of the focus on men with the HIV/AIDS virus. [7]

History

Historically, women have often been excluded from HIV and AIDS advocacy, treatment, and research. At the start of the AIDS epidemic in 1981, medical and scientific communities did not recognize women as a group for research. Women were excluded from clinical trials of medication and preventative measures. Part of the pharmaceutical industry's hesitation to involve women in drug studies was fear of liability, stemming from the catastrophic results of the thalidomide drug trials in the 60s, which caused serious birth defects in thousands of children whose mothers had partaken in the trial, resulting in hundreds of millions of dollars in legal settlements. [9] Women were often blocked from partaking in clinical research with exclusionary with restrictions like "no pregnant or non-pregnant women". [10] The National Institutes of Health (NIH) rejected grants that were targeted at understanding HIV in low-income women of ethnic minorities. [10] Due to lack of research, the CDC's definition of AIDS didn't include gynecological conditions until 1994, meaning many women were previously ineligible for SSI benefits. [11]

The first case of HIV in a woman in the US was reported in 1981. [1] In December 1982, the first cases of mother-to-child HIV transmission were recorded. The number of children infected with the virus increased throughout the decade. Zidovudine (ZDV), alternatively named azidothymidine (AZT), was introduced as a drug to treat HIV in the late 1980s, reducing the chance of mother-to-child transmission by up to 70%. [12] [13]

As of 2019, women account for about 20% of reported HIV cases. [14] The two major modes of transmission to women are heterosexual sexual intercourse and intravenous drug use. [14]

Women can transmit the HIV/AIDS virus to other women through sexual intercourse. [15] However, the U.S. does not statistically categorize HIV/AIDS transmission in forms other than heterosexual, intravenous drug, or indefinable transmission. [4] Due to lack of research, statistics on women-to-women transmission of HIV is unknown. [16] Whether or not a woman had sex with a woman is missing from over 60% from all HIV medical reports in the U.S. [17] [4]

Criminalization of women in the sex trade

Main article: Women in the sex trade during HIV/AIDS

By 1988, 13 states had passed laws codifying having sex with HIV as a felony, where selling sex was usually only a misdemeanor; those exchanging sex while positive for HIV were frequently charged with attempted murder. This approach was explicitly recommended by the Presidential Commission on the Human Immunodeficiency Virus Epidemic Report published in 1988. The commission wrote that “Penalties for prostitution are too lenient, and enforcement of prostitution laws are erratic.” These recommendations became mandates two years later when the Ryan White CARE Act was passed, requiring states to demonstrate their capability to prosecute individuals who had sex while HIV positive in order to qualify for federal funding [18] .

HIV criminalization laws frequently reproduced already-existing statistical biases of the justice system. Women who exchanged sex in public areas were disproportionately likely to be arrested compared to those who were not working outdoors. The enforcement of the laws also disproportionately targeted everyone working in the sex trade: despite the fact that those exchanging sex were far more likely to catch HIV from her client than the other way around, clients were almost never charged. Sentencing disparities between racial groups were glaring. Convicted white women were significantly more likely to be sent to a mental institution and receive HIV treatment, while black women were almost always jailed [19] .

Criminalization of the sex trade as well as the criminalization of exchanging sex while HIV positive has been seen as a preventative measure to stop the transmission and spread of HIV while also protecting communities by outlawing the exchange of sex. Criminalization, however, only makes the exchange of sex for money more dangerous because accessing resources for harm reduction, medical services, and safe areas of exchange now has a harsher threat of incarceration [20] . With criminalization comes charges and fines that force individuals to keep exchanging sex to pay them. This stance fails to address the poverty that caused individuals to go into the sex trade. Legalization has the same issue because of the high cost to legally comply with policies for sex workers as well as the fines that accrue when the policies are not met. De-criminalization offers the chance to provide legal protections without economic barriers so that those who need resources to stop exchanging sex for money can access them without fear of incarceration and those who choose to keep exchanging sex can access the resources needed with less danger. The de-criminalized treatment of those in the sex trade paired with harm reduction and medical services have become best practice for HIV intervention and treatment of those exchanging sex [21] .

Timeline

1982
1983
  • The NIH began to hire female nurses such as Barbara Fabian Baird to research AIDS. [22] [24]
  • The Women's AIDS Network was established. [22] [25]
  • The CDC added "female sexual partners of males with AIDS" as a risk category. [26] [27] [28]
1984
  • Social worker Caitlyn Ryan became the first executive director of AID Atlanta, the oldest AIDS service organization in the Southwestern US. [22]
1985
1986
  • Women represented 7% of cases of AIDS in the US. [22] [30]
  • The first book about AIDS policy, AIDS: A Public Health Challenge , was co-authored by Caitlyn Ryan. It served as a guide to many public officials. [22] [31]
  • Marie St. Cyr became the first director of the New York[ clarification needed ] -based Women and AIDS Resource Network (WARN). [22] [32]
1987
  • The NIH allocated 13.5% of its total budget to women's health issues. [22]
  • At the time, women were excluded from HIV trials unless they used birth control. No specifically AIDS- or HIV-related medical assistance or gynecological (relating to the female reproductive system and the breasts) care was provided. [10] [22]
  • The Food and Drug Administration (FDA) approved ZDV (AZT) as the first antiretroviral drug to treat AIDS. [30] [33]
1988
1990
  • The First National Women and HIV Conference was held in Washington, DC. [12] [22]
  • The John H. Stroger Jr. Hospital of Cook County in Chicago, the only hospital in the city with an AIDS ward at the time, refused to admit women. Demonstrators set up a ward in a street in protest, and 35 protestors were arrested. Women were admitted to the ward two days after the protest. [22]
  • The Women's Caucus of the AIDS Coalition to Unleash Power (ACT UP) wrote Women, AIDS, and activism . [12]
  • On May 21, ACT UP members protested for the NIH to include women and people of color in HIV trials and treatment research. [13]
1992
1993
  • The US Congress enacted the NIH Revitalization Act, giving the Office of AIDS Research (OAR) primary oversight of all AIDS research in the NIH. The act required all agencies to include women and ethnic minorities in research. [12] [13]
  • Gena Corea's book, The Story of Women and AIDS: The Invisible Epidemic , was published. [22]
  • HIV became the leading cause of death for African-American women aged 25–44. [35]
1994
  • On August 5, the US Public Health Service recommended that HIV-positive women take ZDV (AZT) to reduce the chance for perinatal transmission (infection through birth) of HIV, citing an ACTG 076 study that concluded that the drug reduces transmission by up to 70%. [12] [13] [22]
  • The US Department of Health and Human Services issued orders that all grants that requested funding from the NIH must address and include the "appropriate inclusion of women and minorities in clinical research". [12] [13]
  • Class action lawsuit S.P. v. Sullivan forces the Social Security Administration to expand HIV-related disability criteria for women. [11]
1996
  • The annual number of new AIDS cases in the US declined because of antiretroviral therapies. [22]
1997
  • Women accounted for more than half of all cases of HIV globally. [22]
  • In the US, 75% of diagnosed HIV cases were in African-American women. [22]
1999
  • 1.1 million women globally died from HIV/AIDS. [36]
  • In America, girls aged 13 years old to 19 years old make up the majority of new HIV/AIDS cases. [37]
2002
  • 2 million women worldwide became infected with HIV/AIDS. [36]
  • 1.2 million women around the world died from HIV/AIDS. [36]
2008
  • Native American women became the third most likely to contract HIV/AIDS, following Black and Latina women. [38]
  • Native American women are found to be 2.4 times as likely to contract HIV/AIDS, compared to white women. [38]
2010
  • Women began representing 1 out of every 4 cases of HIV/AIDS in the U.S. [2]
2011
  • HIV/AIDS became the leading cause of death for African American women aged 25 to 34. [37]
  • Black women are found to be 15 to 20 times as likely to become infected with HIV/AIDS than their white counterparts. [37] [39]
  • Latina women are found to be 4 times as likely to contract HIV/AIDS than white women. [39]
2018
  • The CDC determines 14.1% of all transgender women in the U.S. have HIV/AIDS. [40]
  • It is established that 44.2% of all HIV infected transgender women in the U.S. are Black women. [40] [41]
  • Research shows that 25.8% of all HIV infected transgender women in the U.S. are Latina women. [40] [41]

Related Research Articles

<span class="mw-page-title-main">Safe sex</span> Ways to reduce the risk of acquiring STIs

Safe sex is sexual activity using methods or contraceptive devices to reduce the risk of transmitting or acquiring sexually transmitted infections (STIs), especially HIV. "Safe sex" is also sometimes referred to as safer sex or protected sex to indicate that some safe sex practices do not eliminate STI risks. It is also sometimes used colloquially to describe methods aimed at preventing pregnancy that may or may not also lower STI risks.

The spread of HIV/AIDS has affected millions of people worldwide; AIDS is considered a pandemic. The World Health Organization (WHO) estimated that in 2016 there were 36.7 million people worldwide living with HIV/AIDS, with 1.8 million new HIV infections per year and 1 million deaths due to AIDS. Misconceptions about HIV and AIDS arise from several different sources, from simple ignorance and misunderstandings about scientific knowledge regarding HIV infections and the cause of AIDS to misinformation propagated by individuals and groups with ideological stances that deny a causative relationship between HIV infection and the development of AIDS. Below is a list and explanations of some common misconceptions and their rebuttals.

Men who have sex with men (MSM) are male persons who engage in sexual activity with members of the same sex. The term was created in the 1990s by epidemiologists to study the spread of disease among all men who have sex with men, regardless of sexual identity, to include, for example, male prostitutes. The term is often used in medical literature and social research to describe such men as a group for research studies. It does not describe any specific sexual activity, and which activities are covered by the term depends on context.

Criminal transmission of HIV is the intentional or reckless infection of a person with the human immunodeficiency virus (HIV). This is often conflated, in laws and in discussion, with criminal exposure to HIV, which does not require the transmission of the virus and often, as in the cases of spitting and biting, does not include a realistic means of transmission. Some countries or jurisdictions, including some areas of the U.S., have enacted laws expressly to criminalize HIV transmission or exposure, charging those accused with criminal transmission of HIV. Other countries charge the accused under existing laws with such crimes as murder, manslaughter, attempted murder, assault or fraud.

Male circumcision reduces the risk of human immunodeficiency virus (HIV) transmission from HIV positive women to men in high risk populations.

<span class="mw-page-title-main">Epidemiology of HIV/AIDS</span> Epidemic of HIV/AIDS

The global epidemic of HIV/AIDS began in 1981, and is an ongoing worldwide public health issue. According to the World Health Organization (WHO), as of 2021, HIV/AIDS has killed approximately 40.1 million people, and approximately 38.4 million people are infected with HIV globally. Of these 38.4 million people, 75% are receiving antiretroviral treatment. There were about 770,000 deaths from HIV/AIDS in 2018, and 650,000 deaths in 2021. The 2015 Global Burden of Disease Study estimated that the global incidence of HIV infection peaked in 1997 at 3.3 million per year. Global incidence fell rapidly from 1997 to 2005, to about 2.6 million per year. Incidence of HIV has continued to fall, decreasing by 23% from 2010 to 2020, with progress dominated by decreases in Eastern Africa and Southern Africa. As of 2020, there are approximately 1.5 million new infections of HIV per year globally.

<span class="mw-page-title-main">HIV/AIDS</span> Spectrum of conditions caused by HIV infection

Human immunodeficiency virus infection and acquired immunodeficiency syndrome (HIV/AIDS) is a spectrum of conditions caused by infection with the human immunodeficiency virus (HIV), a retrovirus. Following initial infection an individual may not notice any symptoms, or may experience a brief period of influenza-like illness. Typically, this is followed by a prolonged incubation period with no symptoms. If the infection progresses, it interferes more with the immune system, increasing the risk of developing common infections such as tuberculosis, as well as other opportunistic infections, and tumors which are rare in people who have normal immune function. These late symptoms of infection are referred to as acquired immunodeficiency syndrome (AIDS). This stage is often also associated with unintended weight loss.

<span class="mw-page-title-main">HIV/AIDS in Europe</span>

In Western Europe, the routes of transmission of HIV are diverse, including paid sex, sex between men, intravenous drugs, mother to child transmission, and heterosexual sex. However, many new infections in this region occur through contact with HIV-infected individuals from other regions. In some areas of Europe, such as the Baltic countries, the most common route of HIV transmission is through injecting drug use and heterosexual sex, including paid sex.

Women who have sex with women (WSW) are women who engage in sexual activities with other women, whether they identify themselves as lesbian, bisexual, or heterosexual, or dispense with sexual identification altogether. The term WSW is often used in medical literature to describe such women as a group for clinical study, without needing to consider sexual self-identity.

The history of HIV/AIDS in Australia is distinctive, as Australian government bodies recognised and responded to the AIDS pandemic relatively swiftly, with the implementation of effective disease prevention and public health programs, such as needle and syringe programs (NSPs). As a result, despite significant numbers of at-risk group members contracting the virus in the early period following its discovery, Australia achieved and has maintained a low rate of HIV infection in comparison to the rest of the world.

Although Senegal is a relatively underdeveloped country, HIV prevalence in the general population is low at around 0.08 per 1000 people, under 1% of the population. This relatively low prevalence rate is aided by the fact that few people are infected every year – in 2016, 1100 new cases were reported vs 48,000 new cases in Brazil. Senegal's death due to HIV rate, particularly when compared it to its HIV prevalence rate, is relatively high with 1600 deaths in 2016. Almost two times as many women were infected with HIV as men in 2016, and while almost three times as many women were receiving antiretroviral therapy (ARV) as men, only 52% of HIV positive people in Senegal received ARV treatment in 2016.

<span class="mw-page-title-main">HIV/AIDS in Zimbabwe</span> Major public health issue

HIV and AIDS is a major public health issue in Zimbabwe. The country is reported to hold one of the largest recorded numbers of cases in Sub-Saharan Africa. According to reports, the virus has been present in the country since roughly 40 years ago. However, evidence suggests that the spread of the virus may have occurred earlier. In recent years, the government has agreed to take action and implement treatment target strategies in order to address the prevalence of cases in the epidemic. Notable progress has been made as increasingly more individuals are being made aware of their HIV/AIDS status, receiving treatment, and reporting high rates of viral suppression. As a result of this, country progress reports show that the epidemic is on the decline and is beginning to reach a plateau. International organizations and the national government have connected this impact to the result of increased condom usage in the population, a reduced number of sexual partners, as well as an increased knowledge and support system through successful implementation of treatment strategies by the government. Vulnerable populations disproportionately impacted by HIV/AIDS in Zimbabwe include women and children, sex workers, and the LGBTQ+ population.

In 2016, the prevalence rate of HIV/AIDS in adults aged 15–49 was 0.3%, relatively low for a developing country. This low prevalence has been maintained, as in 2006, the HIV prevalence in Mexico was estimated at around 0.3% as well. The infected population is remains mainly concentrated among high risk populations, men who have sex with other men, intravenous drug users, and commercial sex workers. This low national prevalence is not reflected in the high-risk populations. The prison population in Mexico, faces a fairly similar low rate of around 0.7%. Among the population of prisoners, around 2% are known to be infected with HIV. Sex workers, male and female, face an HIV prevalence of around 7%. Identifying gay men and men who have sex with other men have a prevalence of 17.4%. The highest risk-factor group is identifying transgender people; about 17.4% of this population is known to be infected with HIV. Around 90% of new infections occur by sex-related methods of transmission. Of these known infected populations, around 60% of living infected people are known to be on anti-retroviral therapy (ART).

<span class="mw-page-title-main">HIV/AIDS in Haiti</span>

With an estimated 150,000 people living with HIV/AIDS in 2016, Haiti has the most overall cases of HIV/AIDS in the Caribbean and its HIV prevalence rates among the highest percentage-wise in the region. There are many risk-factor groups for HIV infection in Haiti, with the most common ones including lower socioeconomic status, lower educational levels, risky behavior, and lower levels of awareness regarding HIV and its transmission.

Discrimination against people with HIV/AIDS or serophobia is the prejudice, fear, rejection, and stigmatization of people with HIV/AIDS. Marginalized, at-risk groups such as members of the LGBTQ+ community, intravenous drug users, and sex workers are most vulnerable to facing HIV/AIDS discrimination. The consequences of societal stigma against PLHIV are quite severe, as HIV/AIDS discrimination actively hinders access to HIV/AIDS screening and care around the world. Moreover, these negative stigmas become used against members of the LGBTQ+ community in the form of stereotypes held by physicians.

HIV prevention refers to practices that aim to prevent the spread of the human immunodeficiency virus (HIV). HIV prevention practices may be undertaken by individuals to protect their own health and the health of those in their community, or may be instituted by governments and community-based organizations as public health policies.

Since reports of emergence and spread of the human immunodeficiency virus (HIV) in the United States between the 1970s and 1980s, the HIV/AIDS epidemic has frequently been linked to gay, bisexual, and other men who have sex with men (MSM) by epidemiologists and medical professionals. It was first noticed after doctors discovered clusters of Kaposi's sarcoma and pneumocystis pneumonia in homosexual men in Los Angeles, New York City, and San Francisco in 1981. The first official report on the virus was published by the Center for Disease Control (CDC) on June 5, 1981 and detailed the cases of five young gay men who were hospitalized with serious infections. A month later, The New York Times reported that 41 homosexuals had been diagnosed with Kaposi's sarcoma, and eight had died less than 24 months after the diagnosis was made.

HIV in pregnancy is the presence of an HIV/AIDS infection in a woman while she is pregnant. There is a risk of HIV transmission from mother to child in three primary situations: pregnancy, childbirth, and while breastfeeding. This topic is important because the risk of viral transmission can be significantly reduced with appropriate medical intervention, and without treatment HIV/AIDS can cause significant illness and death in both the mother and child. This is exemplified by data from The Centers for Disease Control (CDC): In the United States and Puerto Rico between the years of 2014–2017, where prenatal care is generally accessible, there were 10,257 infants in the United States and Puerto Rico who were exposed to a maternal HIV infection in utero who did not become infected and 244 exposed infants who did become infected.

HIV/AIDS in Japan has been recognized as a serious health issue in recent years. However, overall awareness amongst the general population of Japan regarding sexually transmitted infections, including HIV/AIDS, remains low.

During the US HIV/AIDS Crisis, female prostitutes were seen as vectors of the disease. While there is little reliable data to back up that perception, it can be directly linked to the criminalization of HIV and medical discrimination against prostitutes during the crisis.

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