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Genderizing HIV/AIDS

By Pamela Leong

June/July 2002

Article: Genderizing HIV/AIDS

Significant progress in women's rights has been made in the United States. However, there is still a long way to go.

Society continues to be structured in ways that favor men, not the least of which has to do with earning power. Men continue to receive higher wages than women for comparable work, and men continue to dominate the more prestigious, higher-authority, and higher-paying positions.

In large part, this is due to society's prevailing assumptions about women's "natural" maternal or mothering tendencies. Many employers, for instance, assume women are unreliable workers, due to frequent absenteeism and work disruptions associated with leaves for pregnancy, childbirth or for various childcare-related issues. As a result, women are still segmented into employment positions that are stereotypically associated with "wifing" or "mothering" skills, such as nurses, secretaries and teachers.

These positions, however, are considered less prestigious, with lower pay and fewer benefits than positions held by their male counterparts. But because many women, regardless of their education level, are steered to these low-paying, less-prestigious positions that are traditionally associated with women, a noticeable division between men and women's labor appears.

The segregation of men and women in the labor market leads to a considerable gap between men and women's income level, and this discrepancy in income, in turn, translates to differences in overall social value of men and women in a society that tends to place primary value on how much income a person generates.

HIV/AIDS further complicates women's lives. In the United States, HIV infection among women has increased dramatically over the last decade. In just over a decade, according to the Centers for Disease Control and Prevention, the proportion of all AIDS cases reported among adult and adolescent women more than tripled, from 7 percent in 1985 to 23 percent in 1998. While AIDS-related deaths among women are decreasing largely as a result of advances in HIV drug treatment, HIV/AIDS remains among the leading causes of death for U.S. women between the ages of 25 and 44.

The epidemic has increased most dramatically among women of color, with African-American and Hispanic women disproportionately affected. African-American and Hispanic women together represent less than 25 percent of all U.S. women; yet they account for 77 percent of AIDS cases reported to date among women in the United States. According to Sarah Abrams, a publications manager at Harvard University's John F. Kennedy School of Government, African-American women are 20 times more likely than white women to contract HIV/AIDS, and Latinas are seven times more likely than white women to contract the disease.

The CDC reported that most women with HIV/AIDS are infected through heterosexual contact, with injection drug use the second leading exposure category for women. The heterosexual exposure category suggests continuing gender inequality. In the 21st century, the notion that a woman's happiness and wholeness depend entirely on her affiliation with men remains a common perception. That is, according to feminist poet and essayist Adrienne Rich, we are still trained to think that women need men as "social and economic protectors, for adult sexuality, and for psychological completion"; that the heterosexual nuclear family is the primary social unit; and that there is something so fundamentally abnormal or deviant about women whose primary affiliation or attachment is not to men. Simultaneously, society continues to perceive women as sexual objects for the control and consumption by men. The high rate of heterosexual transmission of HIV/AIDS, thus, implicates the prevalence of traditional sexist thinking, fostering women's continued dependence on men and continued sexual objectification of women.

Women who are highly dependent on men for social and economic support may find limitations in their ability to negotiate in heterosexual relationships. This has serious implications in terms of HIV prevention. For male-dependent women, condom negotiation may not be feasible if women perceive that their male sexual partner(s) will respond negatively to the suggestion of condom use. As a result, these women may find that participation in unprotected sex is a better option than an estranged relationship.

Injection drug use, on the other hand, seems to exemplify one response to the poverty conditions that women face at increasing rates. In conditions of poverty, injection drug use may represent one coping mechanism to deal with economic deprivation, although high-risk sex may also represent another coping mechanism. All of these conditions, in turn, not only complicate women's lives on a daily basis, but in the age of AIDS, the continuing gender inequalities and the growing poverty conditions women increasingly confront place all women -- but especially women of color -- at greater risk for HIV infection.

Social expectations about women place all women at risk for HIV. According to Carole Campbell, professor and AIDS specialist at California State University Long Beach, women may engage in unprotected sex with men to attain social status, fulfill emotional needs, and achieve economic stability. Because women are commonly expected to negotiate issues inherent in sexual relationships (such as condom use by their male partners), the responsibility of HIV prevention falls on women.

But this expectation ignores the fact that men and women do not have equal power in relationships. The expectation further ignores how, in the United States and in other cultures, we tend to celebrate and encourage displays of male virility through sexual acts. Placing the responsibility of HIV prevention on women, moreover, ignores the violence that is pervasive in our culture. It also ignores the existence of "compulsory heterosexuality," which is what Adrienne Rich defines as "the ideology that demands heterosexuality." In other words, compulsory heterosexuality is the need to openly display one's heterosexuality through participation in heterosexual sex. Finally, most cultures cast women as the primary caretakers and nurturers of men and children. Because of this expectation, women are often expected to sacrifice their own needs for others. As a result, women frequently sacrifice their own needs, including health care needs. For heterosexual women, this means placing themselves at risk for HIV infection, through unprotected sex, in order to satisfy the sexual needs of their male partners. The health needs of HIV-positive and HIV-at-risk women, then, are often subordinate to the needs of men, but this, of course, may ultimately prove consequential to women's health.

Article: Genderizing HIV/AIDS

For HIV-positive women, HIV/AIDS is just one of many obstacles that they must contend with on a daily basis. But because they are women, women with HIV nevertheless are expected to not only continue with their daily caretaking rituals of others, but they are, to some degree, expected to cope with HIV/AIDS casually, as if it were a routine illness. Hence, in many respects, all those individuals in a woman's custody -- that is, all those for whom she is responsible in terms of caretaking -- reap the benefits from the labor of the woman, but their benefits come at the expense of the woman's own health and general wellness.

The AIDS epidemic necessarily implicates gender. The increasing rates of heterosexual transmission of HIV among all women highlights profound gender inequality, illuminating the presence of culturally enforced attitudes and expectations that continue to perpetuate the subordinate status of women. To prevent further spread of HIV among women, we, as a society, must enable all women -- regardless of person or situation -- greater access to education, information, and participation in all levels of the labor force. Education and greater earning power, in turn, are associated with both increased self-awareness (including a greater awareness of the injustice of social inequality) and independence, characteristics that allow women not only to more effectively negotiate personal relationships but to resist attempts to subjugate women physically, psychologically, or in other respects.

Pamela Leong is a doctoral student in sociology at the University of Southern California. She can be reached at

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This article has been reprinted at The Body with the permission of AIDS Project Los Angeles (APLA).

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