The impact of AIDS on women is growing rapidly, particularly among African American women and increasingly among Latinas. In 2003, women accounted for 26% of reported AIDS cases, of which 63% were African American and 18% were Latinas.¹ As a group, women were 30% of all reported HIV infections in 2003. Most women become infected through vaginal sex (75%), followed by injection drug use (25%).²

Factors to Consider When Promoting and Providing HIV Prevention and Treatment

Sexism and Abuse

Some women, including those who suspect that their partners are at-risk for HIV infection, may be reluctant to discuss condom use with their partners out of fear of emotional or physical abuse or the withdrawal of financial support.⁵ Furthermore, some fear their partners may interpret a positive HIV result or the simple act of testing as a sign of infidelity, which could result in relationship problems, abuse and violence.⁴ Many women are infected by male partners without having any awareness of being at risk of infection and are often unlikely to seek testing until symptoms appear.

Women's Health

Lack of awareness of women's risk of HIV infection -- even among health care providers -- often means that women are tested and diagnosed later in their infection. Some women find out their status during pregnancy, often with limited counseling and education.

Pregnancy and Child Rearing

Until recently, the desire to have children posed a unique dilemma for HIV-positive women and their partners. However, due to the availability of antiretroviral treatment in the U.S., the risk of transmission during pregnancy has almost been eliminated.³ Nonetheless, some women don't benefit from treatment because they lack access to affordable medical care and appropriate testing and counseling early in the pregnancy. For many, particularly low income women, testing for HIV may not be a priority or easily accessible⁴ as their time is occupied by taking care of their family and homemaking, in addition to holding a paid job.

Safer Sex Challenges

Research has shown that many women face gender-specific factors that explain their risk-taking behavior when having sex with men. For example, some feel they have no control over their partner's use of condoms and some fail to protect themselves for HIV because they are using other contraceptive methods.⁴ In addition, the need for intimacy and trust and lack of assertiveness may keep women from maintaining safe sex practices.

Suggestions for Effective Services and Campaign Messages

• Successful services and messages targeting women must address the impact that oppressive gender roles and double messages regarding sexuality have on their ability to practice safe sex.

• Address relevant social issues such as HIV-related stigma, immigration-related issues, homophobia and disclosure issues.

• Some individuals don't test or return for their results for fear that a positive result will damage their self-image and their family and social relationships.⁴ Counseling staff should be trained to discuss this issue.

• Include women living with HIV in prevention and testing campaigns, as visibility helps reduce stigma.

• Consider implementing prevention and testing campaigns in collaboration with OB/GYN or family planning providers in your community.

• As you design and implement services, collaborate with trusted agencies, schools, businesses, religious institutions, etc.

• Offer voluntary HIV counseling and testing services during days and hours that make it easier for busy women and single mothers to access services. Offer childcare services whenever possible.

• Promote testing where women socialize, including schools, beauty salons, daycare centers, night clubs, etc.

• HIV testing and counseling programs should develop protocols to provide medical, mental and social service referrals specific to the populations they serve, so as to create a continuum of care.

• This is a culturally diverse population, and prevention efforts must be tailored to reach each specific target group as there is no single approach that will effectively reach all groups.

• Provide staff training as needed.

References

1. CDC, HIV/AIDS Surveillance Report, Vol. 15, December 2004.

2. NIAID, HIV/AIDS Statistics, July 2004.

3. The Henry J. Kaiser Family Foundation, The HIV/AIDS Epidemic in the United States, March 2004

4. CDC, Best Practices in Prevention Services for Persons Living with HIV, December 2004.

5. CDC, Fact Sheet: HIV/AIDS Among Hispanics, November 2004.