The Rising HIV Rates Among Young Women and Girls of Color: What's Going On? Part Two
February 10, 2011
Kellee Terrell: Jennifer, what are your thoughts?
Jennifer Irwin, Deputy Executive Director at Health and Education Alternatives for Teens
Jennifer Irwin: Tracie's spot on about this. I think the girls that we see, a lot of them have lived in the neighborhoods that they have lived in their whole lives. They don't venture far from their neighborhood. I mean, they may go to the store, or they may come to an appointment. Once in a while, they'll venture to a club, or something else. But really, their social relationships are often in the neighborhood that they live in. And the boys that they've been fooling around with off and on for years, whether they're with them or not, are these same boys that are going in and out of jail, coming back into the neighborhood. That is extremely common: the closed, kind of locked in -- like Tracie said, the landlocked way in which a lot of our young women socialize.
Going back to your comments about these false perceptions of promiscuity, one thing that we see a lot of with our young women is that, when you talk about the other issues that are going on, it's not necessarily about promiscuity. It's so many other things. A large portion of the girls that we see have dropped out of school. Some may have a GED [General Educational Development; the GED is a national high school equivalency exam for those who have not earned a high school diploma]. Many don't have one. And it ties right into self-value and self-worth and, also, their feeling of lack of choice. I think a lot of these young women are smart enough to know that their choices are limited, which is why certain decisions that they make are based on: "OK, my choices are limited. What's the best choice for me to get what I need?" And it may be the best choice for them at the time, even if it's not the healthiest choice, or the best choice for their life. But it works for them at that time to get what they need.
Also, I think it comes down to a lot of other issues as well. A lot of our young women have been in and out of the foster care system, and so they have an entire life and history of being in and out of multiple homes. Not to mention, many of them have had a lot of sexual trauma in these foster care homes. And then when they turn 18, a lot of them transitioned out of foster care and have absolutely nothing. I think that's a big piece. The whole misconception that transitioning out of foster care is a great thing, when in reality some of these young women have never been taught life skills. So they leave foster care settings with no ability to be able to function very well on their own.
This is all happening at the same time that they're getting pregnant, or wanting to have babies. And so that's another added element to it.
A lot of our young women are also unstably housed. And so in an effort to have a roof over their head, or in an effort to have somewhere to sleep, they're making certain choices or decisions that work for them in the moment so that they all can get a good night's sleep somewhere. And it goes back to that point about limited choices.
Also, I think a lot of our women -- it's not just the men -- a lot of our young girls have been in and out of the juvenile justice system. I know a big focus is on the men in the community coming in and out of the juvenile justice system, and maybe the types of crimes men commit are a little different than the crimes that young women commit. But a lot of our young girls have some experience with the juvenile justice system at one point or another in their lives.
Now, put all of these issues together: poverty, sexual abuse and trauma, foster care, juvenile justice system, lack of education and limited choices. You almost have this overwhelming feeling of doom as you're thinking about it. The cards are stacked so high up against these young women in some of these neighborhoods. Go down the checklist of social issues, and these girls can check nine out of 10 of the things that they're dealing with on that. Their circumstances set them up so much for making decisions, or for being in situations that are putting them at risk, whether they are aware of it or not, or whether they're feeling empowered about it or not, or making a conscious decision about it or not.
But they don't have the support system. They don't have the safety net or the fallback that a lot of other young women have. And so I think, when you add all that up together, sometimes it's not so much like "Why do they have HIV?" It's almost like, "How could they not have HIV?"
Kellee Terrell: That's a really profound point: HIV really does prey on the vulnerable.
I think that researchers and a lot of HIV folks are trying to solve this problem with the clinical approach: Well, if we just throw microbicides at people, if we can get that going, this will work. Or if we can pass out female condoms, maybe that will work, maybe that will empower them. You can't necessarily empower disenfranchised people with items, even if these items were created to protect and keep people safe. That's not going to change their situation.
What is going to change their situation is dealing with the social oppression they're facing that's putting them in a situation that makes them vulnerable to HIV. It's simple: Better the lives of women and girls, and you better the lives of the entire community. It still frustrates me that this disconnect still exists, even 30 years into the epidemic.
Tracie Gardner: Right. This approach works internationally.
Claire Simon, Co-Director of the Young Women of Color HIV/AIDS Coalition
Claire Simon: Right. It's working internationally. But domestically, we haven't gotten that message.
Tracie Gardner: We see ourselves as somehow above that, but it's the same fundamental issue. When the women and the girls in the community are healthy and taken care of, and generally self-sufficient -- meaning educated, can control their reproductive destiny and all of that good stuff -- the whole community benefits.
Claire Simon: Exactly. And I think when people look at developing countries, there is more of a sense of urgency to help. But in terms of micro-enterprise opportunities, it's not done here, because America is seen as the land of opportunity. Americans can go to school for free. What's the issue? You can access services. There are services up the wazoo. So what's the issue?
Kellee Terrell: Our culture is very judgmental when it comes to poverty. If you're an American and you're poor, it's your fault. Because people believe that the "American Dream" is so attainable. And for some it is, but for so many, it is not.
Jennifer Irwin: When we see HIV now in 2011 and beyond, we're going to know that we're not addressing these structural deficiencies well. Because, as you said, Kellee, it seeks out vulnerabilities. It shows you when systems aren't working, because when you think about it, we're talking about new infections and how to prevent them.
We haven't really talked extensively about the things that are happening that are good. New York enjoys a complete advantage over a lot of different places around the country, in terms of the treatment that has not only been pioneered here, but that's available. We have almost no pediatric HIV cases because of the intervention that can happen to reduce transmission between mother and child. We have adolescent, young-adult, HIV-positive folks having their own uninfected children.
There has been a whole health care system in New York and other places that has been built on the funding that AIDS has created the necessity for, and yet -- and still -- we are 15 years behind in prevention. We can deal with the sick and tertiary care; we don't do preventative care. Not just in HIV; overall, we don't do it. We don't do it well.
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