One thing many of us forget is that most women living with HIV are mothers. This caretaking role can make it difficult for an HIV-positive mom to balance a strict medication schedule with the typically busy childcare schedule.
In addition, the virus that causes AIDS can be transmitted from an infected mother to her child during two key times: during delivery, when the newborn is exposed to the mother's blood; and after delivery, when the baby is breastfeeding. Without any treatment, about one out of every five babies born to HIV-positive mothers also end up with HIV. But thanks to short-term HIV medication intervention, Cesarean sections and the use of formula instead of breastfeeding, that risk has been cut to 1 to 2 percent in the United States.
In addition, research shows that being pregnant doesn't make a HIV-positive woman sicker, plus a woman can take the majority of available HIV medications without any negative effect on her baby. All this has led to a sort of baby boom among women with HIV/AIDS.
In fact, not too long ago, two doctors wrote in The New England Journal of Medicine that HIV-infected women have a right to infertility treatment; this has led some fertility clinics to begin allowing HIV-positive women to use their services. HIV stigma may still be strong in the United States, but as our understanding of HIV and pregnancy grows, so has society's affirmation of an HIV-positive woman's right to have a baby.
Older Women and HIV/AIDS
Age is no vaccine against HIV. According to the CDC, some 120,000 men and women 50 years of age and older had developed AIDS as of 1999, with approximately 15,000 over the age of 65.
The number of women over 50 with HIV/AIDS is on the rise in the United States. That may be because post-menopausal women, no longer worried about getting pregnant, may be less likely to ask men to use a condom -- in fact, they are one-sixth as likely as their children and grandchildren to use one, according to a survey by University of California-San Francisco researchers.
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Older women with HIV face unique challenges. Many already have chronic illnesses such as diabetes, high blood pressure, heart disease, high cholesterol and obesity. Interactions between medications for these conditions and HIV medications can be problematic. In addition, older women are in general poorer, and less likely to join support groups or have support systems than younger women and, unlike younger patients, they often can't turn to parents or grandparents for help.
Lesbians and HIV
Because of the way records are kept, it's difficult to pin down figures on female-to-female HIV transmission. For instance, if an HIV-positive woman reports having sex with many women but just once with a man, for statistical purposes, she is considered heterosexual.
The CDC has documented a handful of cases of female-to-female HIV transmission. HIV transmission between women is possible because HIV is present in vaginal fluids and menstrual blood. That said, the risk of HIV transmission during sexual contact between women is substantially lower than when two men have unprotected sex, or when a man and a woman have unprotected sex. Studies have been launched to examine female-to-female transmission further.
What Lies Ahead?
As we improve our understanding of the complex factors that continue to propel the HIV pandemic, it's become almost universally accepted that we, as a global society, must work to fundamentally change the societal and cultural norms that put women at risk for HIV.
Holding out for scientists to develop a cure does nothing to save the lives of women who become HIV positive today. For that reason, many advocacy groups, including UNAIDS, have made recommendations on how everyone from political leaders to the girl (or guy) next door can slow the spread of HIV among women. These recommendations include:
- Get the word out. Education -- for communities and leaders as well as individuals -- about HIV prevention, transmission and treatment should be presented in a way that takes into account the cultural norms of the audience and gives women the ammunition to be advocates in their own defense.
A big advance is the use of the Internet. The Web allows people to stay discreet when they otherwise might not feel comfortable reaching out for help at all. They can have their questions about HIV and HIV treatment answered; find out about the latest clinical trials; or connect with other HIV-positive or at-risk women. Web sites are an especially attractive option for women who are busy raising children or isolated geographically.
- Establish more women-friendly medical services. Clinics where women feel they are being treated respectfully are a necessity, so that they keep coming back.
- Develop female-controlled prevention methods. Although the female condom has proved extremely unpopular in the United States, microbicides are much more promising. They can be delivered in gel, cream, sponge, vaginal ring or vaginal wipe forms; some may be able to prevent STDs -- including HIV -- but still allow women to become pregnant if they'd like. However, microbicides are not yet available commercially. For a look at the latest research on these methods, click here.
- Encourage women's economic independence. More than two-thirds of the world's women are illiterate and 70 percent live in poverty, keeping many dependent on men either through marriage or by being forced into commercial sex work. Even small, seemingly unrelated solutions -- such as providing basic education to girls in far-flung villages, or establishing microcredit systems for women-owned businesses in the developing world -- can have a huge impact on HIV prevention by giving women the knowledge and power to make their own decisions. Women's economic status is no less crucial in the United States.
- Re-examine and change social/cultural expectations and behaviors. Risky actions -- including women's sexual subordination, rape, prostitution and a double standard for marital fidelity -- are encouraged when women's rights are ignored. Anything that holds back women's rights should be changed.
"The slow, piecemeal reform we have seen in the past is not sufficient if women's rights and needs are to be taken seriously," says UNAIDS' Piot. "Equity in all fields -- health, education, environment, the economy -- are essential if women are to act to protect themselves when it comes to HIV and AIDS." This applies to women everywhere. Women who are empowered are women who can protect themselves -- whether in Africa, Asia, Europe, the United States or anywhere in the world.
However, it is a tall order to ask disempowered women to change society on their own; it is incumbent on the rest of the world to do its part to help. Stephen Lewis, who for many years was the United Nations Special Envoy for HIV/AIDS in Africa, has been a staunch advocate of the establishment of an international agency that specifically advocates for the 52 percent of the world's population that is female. Such an organization would be a major step forward in fighting the "untrammeled oppression of women in so many countries on the planet," Lewis said. We hope he gets his wish.