Today isn’t December 1st, you say? Does it matter that this post is a bit late? I think not, as recognition and discussion of the epidemic, the pandemic, of HIV/AIDS that dominates in groups of women, should not be dedicated to one single day. Women of color, women of geographic location, women of profession, women of economic status, and people of all of those categories are adversely affected not only by HIV, but by the structures, politics, gender battles, economics and biology of the disease. Let’s talk about what is going on related to women, HIV, and AIDS in 2012. Ready, set, go.
Recent news related to women and HIV
From the introduction:
“…Globally, young women aged 15–24 are most vulnerable to HIV, with infection rates twice as high as in young men, at 0.6%. This disparity is most pronounced in sub-Saharan Africa, where 3.1% of young women are living with HIV, versus 1.3% of young men. Each minute one young woman acquires HIV, accounting for 22% of all new HIV infections (1), with sexual transmission being the dominant mode of infection (2). Much remains to be done to ensure that young people are able to correctly identify ways of preventing the sexual transmission of HIV.
Even in cases where HIV knowledge exists, harmful gender norms can act
as barriers for women to negotiate condom use and otherwise protect themselves from HIV (3, 4, 5, 6). Surveys show that in 12 of 19 countries with available data, less than 75% of women believe that a woman is justified in refusing to have sex with her husband when she knows he has sex with other women (Fig. 1.2). As a 2005 WHO multicountry study (7) showed, there is a close link with violence. The proportion of women physically forced into intercourse ranged from 4% to 46%, while 6% to 59% of the women reported sexual abuse by a partner. This high rate of forced sex is particularly alarming in the light of the AIDS epidemic and the difficulty that many women have in protecting themselves from HIV infection…”
Coverage of the report’s release is available here.
Yemen’s women talk HIV: female support squad take on the stigma – Nadia Haddash at Albawaba
“…“When colleagues at work came to know about my infection with AIDS, I felt as if I had fallen in an abyss because I was fired at once and many of my friends ignored me,” S.A., a Yemeni women, said.
The workshop addressed several studies about the stigma toward Yemeni women with HIV/AIDS and the obstacles of therapeutic and prevention services usage for people affected with the disease…”
…“I believe that, generally speaking, we tend to associate violence with manifestations of physical and sexual violence, and that we as women tend to overlook many additional forms of violence. In my own case, the fact that my husband’s [HIV-positive] diagnosis was deliberately concealed from me constituted an act of violence,” affirms Guiselly Flores, director of the Peruvian Network of Women Living with HIV (RPM+)…”
One.org’s “It starts with me” campaign
Photos: World Aids Day 2012 – The Advocate
“Indian nursing students hold a candlelight vigil on the occasion of World AIDS Day in Amritsar on December 1, 2012. The UNAIDS agency says some 2.5 million Indians are living with HIV, many of them ostracised by their communities.”
A few websites for updates related to women and HIV
…”As we commemorate World AIDS Day, we recognize the tremendous progress made to reduce new HIV infections and improve the health and quality of life for women and girls with innovations ranging from female condoms to anti-retroviral drugs to micro-finance initiatives. We celebrate the progress that has been made and continue to harness new momentum for increased funding and greater political support for gender-transformative HIV responses. It is therefore imperative that undertakings like the UNAIDS Agenda for Women and Girls and the Global Plan towards Elimination of New HIV Infections among Children and Keeping their Mothers Alive continue to thrive and give women and girls better health and greater hope for brighter tomorrow’s.
While we know that bio-medical interventions are crucial, we also highlight the need for social, economic and legal remedies that identify and address the underpinning social drivers that make women and girls disproportionately vulnerable to HIV. The HIV and the Law Commission report, Risk, Rights, Health states that, “Laws and legally condoned customs – from genital mutilation to denial of property – produce profound gender inequality; domestic violence also robs women of personal power. These factors undermine women and girls’ ability to protect themselves from HIV infection and cope with its consequences.”…
I used to work for an organization called The Alliance for Microbicide Development, which organized and supported various groups conducting research on vaginal and rectal microbicides. Microbicides are lubricants (among other formulations) that an individual could use, with or without the knowledge of a partner, to protect themselves against HIV, and possibly other STIs. Given that male and female condoms are currently the only option for HIV prevention for sexually active people, and worldwide research affirming the dislike of condoms for use across a sexual lifespan, more products are needed. Microbicides could very well be the covert, empowering, baton-passed from the condom marathon, shining star of HIV prevention in this decade.
Vaginal and rectal microbicides are both in development. Ideally one microbicide would work for both. Want to stay in touch with the microbicide and vaccine communities? The AIDS Vaccine Advocacy Coalition (AVAC) continues the work of the Alliance’s Weekly News Digest, and you can sign up to follow it here.
The rectal microbicide community is wicked cool. Check out the latest video advertising about and informing of the work being done in rectal microbicides. A quote from cool people working in rectal microbicide research: “The video debut precedes the soon-to-be launched landmark study being conducted by MTN to test a reduced-glycerin formulation of tenofovir gel among gay men, other men who have sex with men, and transgender women for safety and acceptability.”
What else is happening? Treatment as prevention. Home testing kits. National get-tested campaigns. Vaccine research. If you’re involved in the HIV world, and at times feel as overwhelmed by the process and the scope as I did at times, here is your pep talk: you are doing great work and keep it up.
I have been thinking about World AIDS Day and this post a lot these past few weeks, as I ordered HIV tests for women seeking GYN or prenatal care, handed out male and female condoms, and discussed STI transmission and prevention. The fight is a daily one, and now as a provider to individual women in 15 minute appointment times, I struggle with my public health background and knowing that taking a step back and focusing on larger groups could have more impact.
My HIV work began upon meeting my undergraduate mentor, who welcomed me with open arms to sexual health education. Through her I applied for and accepted an opportunity to volunteer internationally with an organization doing public health work, specifically around educating rural communities about HIV. This experience dramatically altered the course of my life, and led me to an academic major in global health, and ultimately, international public health work.
I remember when I first learned about microbicides. A professor teaching a women’s studies class in undergrad, a fiery feminist who wouldn’t take any woman’s weakness as an answer, shocked and awed me at every word, and really introduced me to the power of the women’s movement. She opened my eyes to the world of microbicides, that they could be the means by which women take their HIV prevention “by the vagina,” with or without their partners knowing, and that this magical method could be an impetus for their rest of their lives’ control. Learning about women in HIV caused me to constantly struggle with the push and pull between the possibility of HIV prevention and the frustration of the “feminization” of the epidemic, as it was called at the time. In many ways this term is still applicable as women dominate the growing number of infections worldwide.
I was hired to work in microbicide research by a woman whose own anthropology research I had read while in undergrad. One of the strongest, most opinionated, most stubborn women I have ever met, and I loved every bit. I am thankful for each day that I worked for, and with, her. Being among the strongest always has a way of testing the strongest willed. There, I learned about the non-profit world, women in public health, and well-designed and community-centered clinical trials research. The large clinical trials amazed me. The groups doing it with grace really involved women participants, provided a gateway between their work in the trials and the international HIV research groups, and advertised them as the leaders in their communities that they were and are. There is beautiful work being done, with the power of women dominant throughout.
It was through public health work I learned that I wanted to work more closely with women every day, and left to study midwifery and obtain a clinical degree. Public health work can take years to affect change, but the change is often so great when it comes about, and the people working in the field are so inspiring, that the work forges on with incredible foresight. But for me, I knew I wanted a day-to-day impact, I knew that I was fueled more by individual interactions with women, answering the questions that were impacting their health and their lives right now, and supporting them in reproductive choice, that caused my career change.
During my time in grad school I met and worked with an awesome WHNP who ushered me into a group looking to promote female condom use in a nearby capital city. These women researchers recruited and supported a group of women in the city and encouraged their learning on advocacy, marketing, collaboration, and connectedness. Right now the female condom is the one, the only, vagina-centered option women have related to their HIV protection. It is by no means perfect, but the aspects of non-latex, durability, possible multi-use, and general interest-peaking component the words “female condom” have for many still gets the conversation going. And with this group, the beauty in bringing these women together for women’s work was the real motivator, and the female condom continues to bring women together for the cause internationally.*
And then, I remember a few years ago, working on my master’s thesis, focusing on the role of midwives internationally in the prevention of vertical transmission of HIV, and reading an article about the language of women in conversations about the HIV epidemic. Largely, this field is called “Prevention of Mother-to-Child Transmission,” PMTCT. The terminology “mother-to-child transmission” was analyzed as yet another way women were blamed as the wrong-doers, the ones from which the unborn child must be protected, the vectors of the disease. Language around women as the causes of wrongdoing. Linguistically dressing women up in a short skirt and saying they should know better. In the same way that sex workers were blamed as vectors for men bringing HIV back to their primary partners, not recognizing the culture around which women enter the sex industry, their treatment and rights in societies rampant with gender inequality especially related to intercourse. Emphasizing that women needed to negotiate condom and birth control as primary prevention methods in PMTCT, that somehow, in certain places, women have the ability, the means, the language, the safety, the knowledge, and the control to do so. And if they did not and became pregnant, the new focus was in the child, the woman already lost to the ranks of the HIV-positive. Ignoring desire for pregnancy in places where their worth is their fertility. Clearly a complicated issue, not necessarily solved by a new vagina-based condom, possibly not solved by a gel, but options, importantly effective options, likely more covert options, are needed. And those options work within a culture to enact change.
December 6th, unbeknownst to me, was the National Day to End Violence Against Women. (Also check out this great video on obstetric violence). A few years ago, an awesome PhD-turned-midwife friend of mine invited me to speak about women, HIV, and structural violence at one of the anthropology classes she was teaching. I have been out of the HIV field for a while now, but it would seem that much of the issues are the same. The anatomical and physiological susceptibility of the vagina to infection, women’s negotiating abilities in cultures where the scales of gender are incredibly unbalanced, access to financial resources, knowledge and education about bodies and health and prevention of disease, and a way to a different life: all resonate with the battle women fight against HIV now. It seemed like such a faraway conversation from the students in the classroom, such a distant possibility to their immediate lives, yet such a moment-to-moment circumstance for others. I first learned of structural violence thanks to the laudable Paul Farmer, who continues to do incredible work in this field.
The battle women fight against HIV continues. Now working in a clinical setting, it seems that women’s perceptions of their relationship with the HIV pandemic still seems as distant as to those students in the undergrad classroom. Perhaps because in the United States the incidence and prevalence rates are lower, the conversation around prevention and testing is less frequent. Perhaps in the minority communities in which I work, stigma prevails and open conversations are silenced. But it is specifically within these categories, of minority groups, of adolescent populations, of pregnant women, where screening and prevention education are the most important. I recommend HIV (and syphilis) screening for all women during their annual exam, and these screening test are almost automatic, if not legally required, when a woman becomes pregnant.
Discussions around opt-in or opt-out research continues: opt-in includes offer women the option of deciding if they want the test and/or consider themselves at risk, thereby possibly missing those who are at risk but do not believe to be; opt-out describes the test as routine and patients may voice if they want the test, possibly catching positive outcomes that would have been missed by opt-in testing, but women do not always know that declining the test is an option. Women especially may be less educated about their risk or about HIV transmission in general, and thus each type of testing provides an opportunity for discussion around risk, protection, and screening.
The bottom line is that women, on your street, in your city, in this nation and worldwide, are adversely affected by HIV, due to gender inequalities, biology, and politics. Presumed risk does not equate with actual risk; women, all women, are in a higher risk category, and should have the opportunity to know about that and then protect themselves by whatever means they desire. The fight of women against the HIV epidemic needs greater attention, needs more strategy and smart thinking, and then needs better funding. Thank you to all of those who do this work, donate, or talk about it.
Keep up the fight.
*(Note: “female” condom and “male” condom are not appropriate terminology, as gender does not equate with the organ, but as they are so named, I continue to reference them as such for the purpose of continuing their advertisement and not confusing the issue at hand, HIV.)