July 14, 2004
By George E. Curry, NCM

BANGKOK, Thailand -- Although African-American and Latino women represent less than a quarter of all women in the United States, together they make up 80 percent of AIDS cases among women in the country, according to a report made public here July 14.

The report, titled "Women and HIV/AIDS: Confronting the Crisis," draws on an array of federal and international statistics to track the spread of the virus.

"According to the US Centers for Disease Control, the proportion of AIDS cases among adults and adolescent women in the United States has more than tripled since 1985," the report says. "The epidemic has increased most dramatically among African American and Hispanic women. Together, they represent less than one fourth of all women in the US, yet they accounted for 80 percent of AIDS cases reported among women in 2000."

AIDS is the leading cause of death for African-Americans aged 25-34. Overall, while women have become a larger share of AIDS cases in recent years, there are considerable racial differences. Black women represented nearly a third (34 percent) of newly-reported AIDS cases in 2001, compared to 15 percent for White women.

Experts note that many African-American women do not engage in high-risk behavior, but contract HIV through unprotected sex with male partners that either inject drugs or have sex with other men.

Phill Wilson, executive director of the Black AIDS Institute, says he is not surprised by the figures.

"Because of the disease's presence in our community, there is a higher viral burden," he says, noting that approximately half of all new HIV infections in the U.S. are among African-Americans. "People don't like to talk about it but the family structure is less stable. Therefore, Black women are more likely to have more partners throughout their lifetime than White women and that's not a [negative] commentary on Black women."

Because of the disproportionate number of Black males that serve time in prison, that, too, is a contributing factor, Wilson says.

In what is being called the "feminization" of HIV/AIDS, scholars and academics are paying increasing attention to the role gender plays in the spread of HIV/AIDS.

"Globally there are now 17 million women and 18.7 million men between the ages of 15 and 49 living with HIV/AIDS," says the report issued by the Joint United Nations Programme on HIV/AIDS (UNAIDS), the United Nations Development Fund for Women (UNIFEM) and the United Nations Population Fund (UNFPA). " Since 1985, the percentage of women among adults living with AIDS has risen from 35 percent to 48 percent."

In its 2004 report, on global AIDS, UNAIDS observed: "Nowhere is the epidemic's ‘feminization' more apparent than in sub-Saharan Africa, where 57% of adults infected are women, and 75% of young people infected are women and girls. Several social factors are driving this trend.

Young African women tend to have male partners much older than themselves – partners who are more likely than young men to be HIV-infected. Gender inequalities in the region make it much more difficult for African women to negotiate condom use.

Furthermore, sexual violence, which damages tissues and increases the risk of HIV transmission, is widespread, particularly in the context of violent conflict."

The problem is so serious in some countries that up to 60 percent of today's 15-year-olds will not live to celebrate their 60th birthday.

"Strong leadership at all levels is required to address gender inequality as a central driver of the HIV/AIDS epidemic and to reverse the spread of the disease," the new jointly-issued report says. "Heads of State, government officials, policy makers and community and religious leaders must speak out strongly and urgently on the need to protect women and girls from violence and discrimination and to make gender and HIV/AIDS a highly visible priority."

In his address Sunday opening the 15th international conference on AIDS here, United Nations Secretary General Kofi Annan noted gender differences that contribute to the growth of HIV/AIDS.

"Why are women more vulnerable to infection?" he asked, rhetorically.

"Why is that so even where they are not the ones with the most sexual partners outside marriages, nor more likely than men to be injecting drug users?"

Answering his own question, he continued: "Usually, because society's inequalities put them at risk – unjust, unconscionable risk. A range of factors conspires to make this so: poverty, abuse and violence, lack of information, coercion by older men, and men having several concurrent sexual relationships that entrap young women in a giant network of infection.

"These factors cannot be addressed piecemeal. What is needed is real, positive change that will give more power and confidence to women and girls. Change that will transform relations between women and men at all levels of society."

Rather than initiate institutional change, however, many policymakers have adopted simplistic approaches to addressing the AIDS pandemic.

"The ABC approach – Abstain, Be faithful, use Condoms – is not a sufficient means of prevention for women and adolescent girls," UNFPA Executive Director Thoraya Obaid says in a statement. "Abstinence is meaningless to women who are coerced into sex. Faithfulness offers little protection to wives whose husbands have several partners or were infected before marriage. And condoms require the cooperation of men."

She adds, "The social and economic empowerment of women is key. The epidemic won't be reversed unless governments provide the resources needed to ensure women's right to sexual and reproductive health." Recommendations included:

• Establishing programs that responds to women's needs in prevention, treatment, community-based care, education, violence and human rights;
• Undertaking gender analysis at every stage of policy design, implementation and evaluation to ensure that all forms of gender discrimination are eliminated and to protect and promote women's human rights;
• Ensuring that adolescent girls and women have the knowledge and means to prevent HIV infection;
• Empowering women economically by providing them with access to credit and business and leadership skills to break the cycle of poverty, gender inequality and vulnerability to HIV transmission and
• Promoting zero tolerance of all forms of violence against women and girls;

The report concluded: "…Without leadership and political will, without the necessary funding, the situation for women and girls will continue to deteriorate and the hope of achieving the Millennium Development Goals by 2015 – particularly reducing extreme poverty – will not be fulfilled. We can no longer look at women as victims; it is time to recognize and build on their strengths. Strategies to reverse the AIDS epidemic cannot succeed unless women and girls are empowered to claim their rights."