Women and AIDS: A Contextual AnaIpis
Jeannette R. Ickovics
Kathleen A. Ethier
An estimated 33.6 million adults are now infected with the human immunodeficiency virus (HIV; UNAIDS, 1999). With 16,000 people becoming infected daily, as many as 40 million people will be infected with HIV by the turn of the century. Women account for 44% of all estimated HIV infections worldwide, and the proportion of women infected is rapidly increasing in every geographic region. At the present rate of infection, the numbers of women and men infected will be equal by the year 2000. Currently, the ratio of female-to-male AIDS cases varies dramatically by region; in sub-Saharan Africa the ratio is 1: I, in the Carribean the ratio is 1: 3 p in South and Southeast Asia the ratio is 1:4, and in Europe, the Middle East, North America and Latin America the ratio is 1:5 (UNAIDS, 1998).
The AIDS epidemic has undergone profound demographic changes within the United States. In 1981, when AIDS was first identified, it was considered a disease of men who have sex with men; indeed, at that time, the syndrome was called “gay-related immunodeficiency disease (GRID)” (Centers for Disease Control and Prevention [CDC], 1981). In 1985, only 6.5% of newly diagnosed cases of AIDS were among women (CDC, 1986). Thirteen years later, this percentage has more than tripled to 23% (CDC, I998a). Through 1998, 109,31 1 women in the United States have been diagnosed with AIDS; more than one half have died from AIDS-related causes. Nationally, AIDS is the third leading cause of death among young women from age 25 to 44. In some U.S. cities along the eastern seaboard (e.g., Miami, New York, Newark), AIDS is the leading cause of death among women in this age group. Although AIDS-related deaths decreased 13% overall in 1996, deaths among women with AIDS increased 3% (CDC, 1997).
Epidemiological data on the numbers of those infected with HIV (as opposed to diagnosed with AIDS) is scarce; however, some studies suggest that an even greater proportion of women are infected than is reflected in the data on reported AIDS cases. For instance, 27% of HIV cases through 1998 were among women, as compared to 16% of all AIDS cases (CDC, 1998a). In a study of nearly 2,000 patients in Los Angeles County, California, women were 3.4 times more likely to be diagnosed with HIV than AIDS (Sorvillo et al., 1995). Thus, new patterns of HIV transmission are not necessarily reflected by the standard AIDS surveillance techniques.
There are two main routes of HIV transmission among women. These include the sharing of needles by injection drug users (IDUs) and heterosexual sex. Heterosexual intercourse is the main route of HIV infection among women globally, accounting for three quarters of all AIDS cases. However, in the U.S., only 39% of cumulative AIDS cases are documented as having been caused though heterosexual transmission, whereas 43% of all women with AIDS have a history of injection drug use (CDC, 1998a). The epidemiology appears to be shifting: Among YteW AIDS cases in the U.S. the number attributed to heterosexual contact exceeds the number attributed to injection drug use.
Women are more likely than men to be infected with HIV through heterosexual sex for biological, epidemiological, and social reasons (World Health Organization [WHO], 1993). Male-to- female transmission of HIV is estimated to be eight