The theme for this year's National Women and Girls HIV/AIDS Awareness Day, "HIV is Right Here at Home," hits close to home here in New York City, where 10% of all women living with the virus in the United States reside.
It's the largest population of women with HIV in the country. If all 30,000 of these HIV-positive women and girls were to come together and walk down Fifth Avenue, the crowd would approximate the swell of runners in the NYC Marathon. They could sell out Radio City Music Hall five times over and occupy more than half the seats in Yankee Stadium. A disproportionate number of these women--90 percent--are black and Hispanic; over half, or 68 percent, are over the age of 40; and more than a third, or 41 percent, were infected through heterosexual activity. This is the same female face of HIV that we have been seeing since the epidemic first began to be acknowledged in women in the 80s.
The report that my organization, The Women's HIV Collaborative of New York (WHCNY), is releasing today, Women Living with HIV and AIDS in NYC: A Mapping Project and Literature Review, reveals that 60% of all of NYC's HIV-positive women reside in just four areas of Brooklyn, the Bronx, and Manhattan.
Not coincidentally, the report also finds that these same areas are home to some of the city's highest rates of poverty, incarceration, unplanned pregnancies, and sexually transmitted diseases, as well as low numbers of high-school graduates. Women's health advocates have been arguing for decades that women's biological risk for HIV is intensified by socio-economic stressors including poverty, domestic violence, depression, homelessness, substance abuse, lack of access to adequate health care, sexual health information, or childcare, and incarceration.
If a woman is struggling to protect her children from an abusive partner, or scrambling to keep some kind of roof over their heads, or wrestling with her own addiction or depression, she isn't spending much time thinking about condom negotiation: it's not even a real option. If a woman living with HIV/AIDS is struggling with any or all of these issues, or even choosing between keeping her doctor's appointment or taking her children to theirs, her HIV status is likely be the last item on her list of priorities. That's why once women contract HIV, they become sicker faster and die sooner than men.
Our report offers a way out. It identifies down to the ZIP code those areas with the highest concentrations of HIV-positive women. It then overlays readily accessible maps of this 'hot spot' data with other maps that indicate those areas with high levels of socio-economic distress. In doing so it provides a virtual road map of NYC's areas of greatest need.
Our report's recommendations for action suggest that the time has come to enact reform in areas such as housing, education, health care, and the correctional system, and target services to these areas of highest need. What if the New York State Education Department followed the WHCNY's suggestion and issued a state mandate to teach comprehensive sexuality education in schools? Imagine the effects on neighborhoods with high rates of unplanned pregnancy and sexually transmitted diseases--of which HIV is one.
Or if the Centers for Disease Control followed the WHCNY's recommendation to change the way they track transmission risk so that their numbers would more accurately reflect the number of women contracting the virus through heterosexual sex? (The CDC provides funding in proportion to the numbers of people being infected through a given kind of transmission: a more accurate count of women being infected through heterosexual sex would result in more funding and better programming geared towards this populations.)
Until we begin understanding HIV as a problem of communities rather than individuals, and begin addressing it with services and systems, the numbers of women living with the virus will keep growing, and the female face of HIV will continue to be poor and of color (and increasingly both younger and older). Our hope is that local politicians, advocates, and service providers will find Women Living with HIV and AIDS in NYC: A Mapping Project and Literature Review and WHCNY's recommended actions helpful as we all work together to curb the epidemic and heal our neighborhoods and communities.
To download the full report, click here.