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Wednesday, December 1, 2010

Women & HIV: How Culture Contributes to Crisis

By Winnie McCroy -

"The face of HIV and AIDS among women is a face of color, and very much African American."

Thus does Dr. Marjorie Hill, executive director of Gay Men’s Health Crisis, the New York City AIDS organization that is the largest such in the country, sum up the crisis of women and AIDS. Although the rate of new HIV infections in the U.S. has remained relatively stable over the past few years, according to the CDC, an estimated 56,300 Americans are newly infected with HIV each year. Women account for 27 percent of those annual infections. Women of color and younger women more likely to get HIV.

Overall, AIDS is second only to cancer and heart disease as a cause of death among women. The rate of HIV infections among Latino women is nearly four times that of white women. In New York City, groups like GMHC continue to serve the needs of women living with HIV and their families, while organizations like amfAR work to fund research for preventative measures, including vaginal microbicides.

"These women are disproportionately impacted," said Hill. In New York City, 92 percent of the city’s women living with HIV were black or Hispanic, according to the city’s Department of Health and Mental Hygiene.

GHMC long ago outgrew its name to provide help for groups other than gay men. "We have a substance abuse program, and a number of other supportive programs targeting women who are HIV positive," Hill said. GMHC now has a Women’s Institute devoted prevention and education specifically for HIV-negative women who are at high risk, or who might be positive but who have not yet had a test.

In addition to the group’s women-specific programs, GMHC also serves women who need legal services, job training programs, and families, who get meals from the group’s pantry or hot meals from the food program. Women comprise only 27 percent of GMHC’s clients but use 40 percent of its services. These women tend to come to GMHC with concerns about their kids, grandchildren, husbands, partners, or mothers. They often are accompanied by families or neighbors, who also might need GMHC’s help.

"At the same time we have a great deal of challenge getting women-specific resources," Hill said. "These women don’t have trouble finding GMHC, but sometimes funders have a little trouble finding and providing resources for us to fund women-specific programs."

Still a Stigma
On World AIDS Day, GMHC will continue its tradition of a candlelight vigil and interfaith, multidenominational service reflecting on AIDS and the resiliency of the many communities dealing with this epidemic. (The vigil will begin at 6 p.m. at the Trinity Lutheran Church of Manhattan, located at 164 W. 100th St. at Amsterdam Avenue.) A reading of names of those lost to AIDS follows.

The event is only one among a week of speaking engagements and testing events throughout the city. "Instead of World AIDS Day, this event is slowly becoming World AIDS Week," said Dr. Hill, who said that, despite the education efforts of many organizations, stigma continues to be the biggest challenge around AIDS.

"People are afraid to get tested because they don’t want to be ostracized by family members," she explained. "You can say, well, it’s 2010, but we still have clients upset and angry because their family members are making them eat off paper plates. We have women coming to us who are really distraught because their daughters won’t let them hold their grandbabies, or sisters won’t let nieces and nephews come to their house. Even though we’ve come a long way in terms of interventions and medical treatments, stigma continues to be a major problem."

Providing better options for women to prevent HIV infection across the world continues to be a mission for amfAR, the Foundation for AIDS Research. According to Dr. Rowena Johnston, vice-president and director of research, hope may be on the horizon in the form of vaginal microbicides.

Although condoms, when used correctly and consistently, can be very effective against HIV and other STDs, women are often unable to control their partner’s condom use. Vaginal microbicides, applied before and after sex, could allow women to protect themselves against HIV.

At the International AIDS Conference in Vienna this July, it was announced that research done in South Africa had revealed an effective vaginal microbicide. In addition, the recent discovery that Truvada, the tablet form of tenofovir, in combination with emtricitabine, reduces the risk of HIV infection for a great many gay men may have implications for women. Researchers hope that future studies will show comparable results among women.

"The results are cause for optimism and excitement as they bring the world one step closer to the day when antiretroviral drugs are routinely used for HIV prevention," said Dr. Quarraisha Abdool Karim, who teaches epidemiology at Columbia University.

After failed attempts with Nonoxynol-9, which actually ended up increasing the risk of HIV transmission, researchers are encouraged by the successful use of this antiretroviral to prevention HIV infection. But this finding is just the beginning.

"The research was announced in July, but the question is, what now?" asked Johnston. "If we are going to make a product to sell to people, we have to go through the FDA in America. I do believe that they are requiring another trial of this to confirm the results -- and researchers are disappointed that they can’t raise the $100 million needed for this research. Even after they clear those hurdles and do a second trial, there are regulatory agency procedures. Then there is the question of manufacturing it and supplying it to women throughout the world."

Harder for Women
"It is unequivocally great news that a success in the vaginal microbicide field has been found," said Johnston. "It is a step in the right direction, but we’re just not at the finish line yet."

For now, she said, women should rely on the male condom, reducing the number of partners, and delaying sexual debut, which are very effective in reducing the lifetime risk of HIV. But these methods may not always be under a woman’s control. Among lower socio-economic groups, women may trade sex for money or goods. Young women may negotiate their education through sexual favors to an older teacher or headmaster, which puts them at much higher risk.

"The economic empowerment of women cannot be understated," said Johnston. This is as true in here in the U.S. as it is across the developing world.

Until the time that a safe, effective vaginal microbicide is released onto the market, women should take steps to protect themselves with those tools available. On World AIDS Day, those with the means can still help fight HIV infections in New York and across the world by donating to the care and research efforts made by groups like GMHC and amFAR.
Winnie McCroy is a freelance writer based in New York City. She has written for publications including The Village Voice, The Advocate, Curve Magazine, Gay City News, and GO NYC. 

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