The Rising HIV Rates Among Young Women and Girls of Color: What's Going On? Part One
January 25, 2011
Even though African-American women and Latinas ages 13-24 account for only 32 percent of the U.S. female youth population, they account for roughly 83 percent of new HIV infections among young females in the U.S. In addition, black women account for 62 percent and Latinas for 19 percent of cumulative AIDS cases among women 13 to 24. Numerous studies have found that the major mode of transmission in this population is heterosexual contact.
What exactly is contributing to these numbers?
In this exclusive, two-part roundtable discussion, we attempt to explore the pressing issues that are increasing HIV risk among young girls and women of color. We look at what is working, what is going terribly wrong and what is being overlooked in terms of HIV/AIDS prevention, education, testing and outreach.
Kellee Terrell: The CDC [U.S. Centers for Disease Control and Prevention] released some surveillance data showing that among teens and young women 13 to 24, rates of HIV infections are going up. We also know that those numbers are being largely driven by young women of color, especially among African Americans.
The first question I want to throw out is to Jennifer. What is not working, in terms of prevention toward this demographic, looking at the work you've been doing at HEAT?
Jennifer Irwin, Deputy Executive Director at Health and Education Alternatives for Teens
Jennifer Irwin: What we're seeing in terms of young girls that come through our doors is a couple of things. One, in terms of prevention -- and I guess this determines whether or not you view testing as prevention -- but a lot of the young women that we deal with are hesitant to get an HIV test. One reason for that is a lot of these young women don't view themselves at risk, in terms of their behaviors. A lot of them still tell themselves "I'm not a young, gay male. I'm having heterosexual sex, therefore I really don't need to get tested."
Another issue that comes up with a lot of young women is condom use. First, there's sort of an assumption amongst these young girls that if the male doesn't want them to use a condom, they don't need to use a condom. And then for those girls who want to use condoms [even when their partners don't want to], they are having serious difficulty negotiating condom use. With our clients, a lot of them have partners that are considerably older than them, and that creates this whole power dynamic that spawns fear, on their part that they'll be rejected, or they will be perceived to have something and not be quote-unquote clean if they use a condom.
Kellee Terrell: Tracie, just coming from WISH, what are you seeing that is going wrong on a policy level?
Tracie Gardner, Founder and Coordinator of the Women's Initiative to Stop HIV/AIDS NY at the Legal Action Center
Tracie Gardner: Well, at WISH we help policymakers who are responsible for funding and programming that would address the epidemic among young women understand the challenges and the dimensions of the problem. They include the issues that Jennifer spoke of, but at the policy level, it comes down to the politics of who makes the most noise; who has the ear of the decision makers; who's perceived to be at risk versus who actually is; and their ability to articulate in the policy arena. [Some of the issues we see] are policies that are in place that don't really work. For example, the siloing of HIV from other health and social services that young women use, so there's almost an AIDS, Inc., if you will, that exists completely outside of the realm of other issues that young women care about, need, depend on.
And we miss logical opportunities to integrate HIV testing and the idea that knowing your status is part of good health. One of the ways that we do that that's problematic is the bifurcation between HIV services and STI [sexually transmitted infection] services, which means that we're having young people getting treated for STDs [sexually transmitted diseases] -- and certainly in the areas in the city where there's high prevalence of HIV, there's also high prevalence of STDs -- but we have separate systems, separate funding, separate programming that doesn't fully integrate the awareness of sexually active young people. And the opportunities, when they come into care, are opportunities that have to be fully exploited in order to really take advantage of the opportunity. And we don't have things in place that do that.
So there's that, at the program and ground level, and bubbling up to the policy and legislative and funding level. The funding is also siloed, and so it makes it hard to deal with different components of people when, in fact, we need to be dealing with people's holistic self. Everything that goes on below the bellybutton is what we should be attending to, in one fell swoop, in one visit, in one engagement -- if not repeated engagements.
Kellee Terrell: Claire, Tracie just brought up a really good point: Who cares about young girls? Who is advocating for them? Who's the mouthpiece for them?
Claire Simon, Co-Director of the Young Women of Color HIV/AIDS Coalition
Claire Simon: I think for the women who are advocating for younger women, it's because: One, they come to us. And they don't feel that they have a voice in this process.
I also feel like many providers don't think young people should be having sex. So, as a result, they don't address the issues that a young person may come to them with. And the messaging that they're getting from many adults about sex is not to do it. But then the mainstream media tells them to "do it all the time" and "this is how you're going to get accepted." From all the teenybopper shows, to anyone; there is sexuality, there are things that are in their face, but no one's talking about it to them.
I think the beautiful thing about the coalition is that we have a group of young women who are interested in these issues, who are talking about it, who are sharing the message, and giving voice to it from a youth perspective. That's very powerful and impactful. Because having a peer who can say to you, "Have you thought about this? Have you thought about that? Let's talk about these issues," can propel other young people to feel comfortable talking about it.
Kellee Terrell: Jennifer, when looking at sex education in this country, do you feel like it incorporates those contradicting attitudes?
Jennifer Irwin: It depends. The whole sex-ed thing is an issue in itself. But I think one of the problems in New York City with sex-ed is that, although there's a curriculum, it's often not taught in the schools. It's really at the whim of the principal -- if the principal feels comfortable having it taught, it gets taught. And because there is not an emphasis on sex-ed at all, a lot of teachers either rush through the curriculum, or they allot one health class to it.
In my program, we do a lot of workshops in high schools and middle schools. But even in that there are issues. For example, there are plenty of times when a teacher will call us and say, "We'd really love for you to come do an HIV 101, or an HIV/STD workshop." And they will come right out and say, "But listen. This is not really OK with the principal; we're going to kind of do this on the sly. Don't bring condoms. Don't do a demonstration about how to properly wear a condom."
So, sure, you can talk about sex. But you can't actually show youth how to protect themselves having sex.
I think that part of it is that the teachers out there -- those that are supportive of it -- are up against a lot of battles in their schools with parental involvement. There are a lot of parents making noise, a lot of principals that aren't necessarily supportive of it. I also think a downfall in our current curriculum is that oftentimes it doesn't take into account cultural issues, religious issues, and other important issues that impact young women living in New York City, such as different social and economic issues that they deal with around sexual education in school. I think that kind of rubber-stamp, one-size-fits-all approach doesn't work as well when you have such a varied population of young women.
What I really want to stress as well is that sex-ed needs to start at a much younger age. That's part of the big problem: A lot of the youth who are part of our program will say that they never got it, or they got a few classes in it in a health class. Or they'll say that they didn't get anything until high school. We're having young women who are HIV positive at age 12. And so there is clearly a huge disconnect, in terms of these young women getting sexual health information, either at home, or at school, or in another forum. It's just not happening in an effective way at all.