Co-authored by Melissa Shive
HIV/AIDS is the leading cause of death worldwide among women of reproductive age -- a fact that resonates strongly with the theme of World AIDS Day this year: "Universal Access and Human Rights." It highlights not only the changing demographics of the HIV/AIDS epidemic globally but also the underlying challenges posed by the interactions between this disease and human rights issues like gender inequality, poverty, and stigma. While research has focused on behavioral and biomedical interventions to address the pandemic, global social and economic forces, including stigma, are key drivers that continue to fuel the spread of HIV/AIDS.
On this World AIDS Day, attention is being turned toward broadening the discussion about HIV/AIDS to include human rights issues as well as critical concerns related to national health systems, including healthcare delivery and access. Effective interventions to reduce the impact of the HIV/AIDS pandemic must address both the socioeconomic determinants of health as well as the biomedical aspects of the disease. And this approach is particularly important for our nation's and the world's women. Here's why.
In the United States, approximately 1.1 million people are living with HIV/AIDS, including 280,000 women. Women now account for more than one in four new HIV/AIDS diagnoses in America -- up from only 8 percent in 1985. HIV/AIDS also disproportionately affects women of color. African Americans and Hispanics represent only a quarter of the U.S. population, but they account for 82 percent of AIDS cases among women. Additionally, African-American women are diagnosed with AIDS at a rate 23 times that of Caucasian females and four times that of Hispanic women. Moreover, adolescent women represent 40 percent of AIDS cases reported among people aged 13 to 19 in the United States.
While HIV originally affected men in the early 1980s, the lack of prevention and treatment efforts for women has resulted in a startling development: worldwide, there are now more women than men living with HIV/AIDS -- 15.7 million out of a total of 31.3 million adults. Women are at a particularly high risk of acquiring HIV/AIDS because of a combination of biological and social factors. In Sub-Saharan Africa, women constitute 59 percent of all people infected with the disease. Among young people aged 15-24 in this region, the HIV prevalence for young women is almost three times that of young men.
The discovery of antiretroviral drugs and diagnostic tests has allowed for significant progress in the fight against HIV/AIDS over the past 28 years, but the war is far from over. There is still no vaccine or a cure. Furthermore, for every two people who are treated for HIV/AIDS, five more will become infected -- a fact that demonstrates the complexity of eradicating HIV/AIDS and the importance of investing in both prevention and treatment. A comprehensive strategy to fight AIDS must tackle a full range of issues including poverty, maternal health, stigma, and gender inequality.
In order to eradicate the epidemic, vital human rights issues and access to care must be confronted, including food security. Over 800 million people globally are chronically undernourished and lack adequate access to food, with significant overlap between those people facing food insecurity and the population infected with HIV/AIDS. Deterioration in the general health of populations in some areas of the world as a result of hunger threatens the successes made in HIV control and prevention. Undernourished women experience decreased body mass, weakened immune function, and malabsorption of fats and carbohydrates. These vulnerabilities only compound the muscle wasting and diarrhea that HIV infection causes and reduces the efficacy of HIV medication. Moreover, women who experience food insecurity and are seeking food for themselves and their families may resort to risky behaviors in order to obtain it, such as sex work.
Another key issue in the battle against HIV/AIDS in women is preventing maternal and infant mortality and improving maternal health. In South Africa, HIV/AIDS is responsible for more than 43% of maternal deaths. In the developing world, pregnant women have limited access to prenatal care, testing, and drugs to prevent mother-to-child-transmission of HIV. In a World Health Organization survey of 90 low- and middle-income countries, only 45 percent of HIV-positive pregnant women received antiretroviral therapy (ART) in 2008 to prevent mother-to-child transmission of HIV, up from 10 percent in 2004. And a significant percentage of those women did not receive the most effective ART therapy. Additionally, among pregnant women identified as HIV-positive, only 33 percent were later assessed for eligibility to receive antiretroviral drugs for the sake of their own health, rather than that of their children.
Stigma surrounding HIV in women continues to be a serious problem, leading to avoidance of testing, deferral of treatment, depression, and reduced medication adherence. With stigma comes marginalization and discrimination -- problems that many women in societies around the world already face. Stigma can further compound the gender inequality that exists in many cultures. For instance, women who live in regions or households that are gender unequal have difficulties negotiating safer sex practices. Additionally, women in these situations have a more difficult time accessing healthcare not only in times of illness but also during other life events that require healthcare, such as pregnancy and childbirth. As a result of inequities, these women may also lack the education, income, or employment needed to protect their health.
As we commemorate this year's World AIDS Day, let us remember Secretary of State Hillary Clinton's words delivered in Beijing at the United Nations 4th World Conference in 1995: "Let it be that human rights are women's rights and women's rights are human rights once and for all." This year's World AIDS Day theme underscores the importance of addressing human rights as a cornerstone in the fight against AIDS in women.
To shine a spotlight on this issue, amfAR, The Foundation for AIDS Research, is partnering with UNAIDS, the World AIDS Campaign, and Broadway Cares/Equity Fights AIDS in a campaign to keep the light on HIV and human rights. This campaign, Light for Rights, includes events held throughout the world to bring much needed attention to these crucial aspects of the fight against HIV/AIDS. Tonight in New York City, the lights on the Washington Square Park Memorial Arch will be dimmed for five minutes at 6:15 P.M. EST to symbolize how human rights infringements cast a dark shadow on the response to HIV/AIDS. The marquee lights of major Broadway theaters and the lights on the Brooklyn Bridge, Madison Square Garden, the Chrysler Building, and other New York City landmarks will also be dimmed and then re-illuminated.
To help save women's lives, it is imperative to strengthen U.S. commitments to the global AIDS response as well as invest in other global health issues like improving maternal and child health. Here in the United States, it is critical to address the special needs of women in the development of a National AIDS Strategy to eradicate this disease. For all too long, women's health has been neglected at the research bench, in clinical settings, and in the halls of government. On this World AIDS Day, it's time to commit to rectifying these longstanding inequities so that women can someday live in a world with equality for all and without HIV/AIDS.
Rear Admiral Susan Blumenthal, M.D. (ret.,) is senior policy and medical advisor at amfAR, The Foundation for AIDS Research. She also serves as the director of the Health and Medicine Program at the Center for the Study of the Presidency and Congress in Washington, D.C., a clinical professor at Georgetown and Tufts University Schools of Medicine, and chair of the Global Health Program at the Meridian International Center. She served for more than 20 years in health leadership positions in the federal government, including as assistant surgeon general of the U.S., the first deputy assistant secretary of women's health, as a White House advisor on health, and as chief of the Behavioral Medicine and Basic Prevention Research Branch at the National Institutes of Health. Dr. Blumenthal has received numerous awards including honorary doctorates and has been decorated with the highest medals of the U.S. Public Health Service for her pioneering leadership and significant contributions to advancing health in the U.S. and worldwide. She is the recipient of the 2009 Health Leader of the Year Award from the Commissioned Officers Association.
Melissa Shive is a medical student at the University of California, San Francisco. She served as a research assistant at amfAR, The Foundation for AIDS Research, and as a health policy fellow at the Center for the Study of the Presidency and Congress in Washington, D.C.