Securing Care for Women Living With HIV
Despite the significant epidemic among U.S. women -- it is estimated that 300,000 women are living with HIV in the U.S., and 25% is no minor proportion -- the National HIV/AIDS Strategy, released in July 2010, failed to articulate a single goal specifically for women. It does not detail how to reduce new HIV infections among women, to increase access to care, or a strategy to improve women's health outcomes. The Strategy similarly failed to articulate the relationship between violence or trauma and HIV for women. And nowhere in the Strategy was the need to strengthen sexual health and reproductive choice for women living with HIV even mentioned.
And just this year, although the President's proposed domestic HIV budget for FY 2013 was relatively good, the Part D program was the only part of Ryan White for which a decrease was proposed. Part D is the only program within Ryan White specifically designed to meet the needs of women, youth, and families. This is indicative of an alarming trend away from women-centered care and supportive services when they are more critical than ever.
Thus, not only are we faced with a well-documented social and political "war on women" from the far right, with all women's rights and body sovereignty being utilized as a political football in the 2012 election cycle -- but women living with HIV are literally facing disproportionate wars: violence, and a battle for their lives, health, and dignity in their own communities, neighborhoods, and homes.
And in the midst of all this, somewhere along the way we lost our will to address the gender nuances of the domestic HIV epidemic.
2011's HPTN 052 results demonstrated that achieving viral suppression in people living with HIV can effectively reduce onward transmission of HIV. Thus, ensuring high-quality care and access to voluntary treatment for people living with HIV should be one of our primary goals as an HIV community -- to achieve the National HIV/AIDS Strategy's prevention and care goals.
In July, the International AIDS Conference (AIDS 2012) returned to the U.S. after a 22-year absence. The theme of AIDS 2012 was Turning the Tide Together -- meaning that we have the science to end new HIV infections and to keep people living with HIV healthy. Now we have to muster the political will and resources to make this possibility a reality. Just last June, the Supreme Court of the United States upheld the Affordable Care Act (ACA) -- a piece of legislation that holds great promise for all women, and especially for women living with HIV. But HIV care and treatment is more than just medication and more than just medical care, especially for women. It must be coupled with services designed to uphold sexual and reproductive rights and to address the impact of violence and trauma in women's lives. Women living with HIV still face unique vulnerabilities in 2012 and turning the tide on the epidemic for women will require a gender-sensitive response.
Because women's access to health care and ability to adhere to medication is related in large part to other life factors, including our physical, psychological, and emotional safety, addressing logistical barriers to care and promoting safety for women is central to achieving the National HIV/AIDS Strategy's goals and to achieving the promise of the Affordable Care Act for women.
Through ACA implementation, we must also keep in place services that facilitate access to care for women living with HIV, including but not limited to psychosocial support, peer-based services, transportation, and childcare.
Thankfully, President Obama's March 30 release of a memorandum establishing a federal interagency working group to address the intersection of HIV/AIDS, violence against women and girls, and gender-related health disparities presents a new opportunity to align the domestic HIV response with international standards and to rectify some of these serious oversights.
The workgroup is charged with, among other things:
- Integrating sexual and reproductive health services, gender-based violence services, and HIV/AIDS services, where research demonstrates that doing so will result in improved and sustained health outcomes.
- Promoting research to better understand the intersection of the biological, behavioral, and social science bases for the relationship between increased HIV/AIDS risk, domestic violence, and gender-related health disparities.
- 2012 marks a critical moment in the global HIV response. It's time we truly commit to upholding women's rights and the rights of all people living with and disproportionately impacted by HIV as an essential component to turning the tide of the epidemic. This must include:
- Meaningful and visible leadership of women living with HIV in all aspects of decision-making.
- Research on and funding for women-controlled prevention options -- tools which a woman can use without the consent or even the knowledge of her partner, and which uphold our full rights to sexual pleasure and sexual and reproductive health.
- Bold action, including a plan and a timeline from the White House Office of National AIDS Policy to address the intersections of violence against women, HIV, sexual and reproductive rights, and women's health.
Naina Khanna is the policy director at Women Organized to Respond to Life-threatening Disease (WORLD) in Oakland, California and coordinates the U.S. Positive Women's Network (PWN). She was appointed to President Obama's Advisory Council on HIV/AIDS (PACHA) in 2010. She has presented and advised on women's rights and achieving gender-sensitive, human rights-grounded policies informed by people living with HIV. Ms. Khanna was diagnosed with HIV in 2002.
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