Ending HIV in Women and Girls

35 years into the HIV/AIDS epidemic, I’m afraid many of us still hold the same misconceptions and stereotypes that were prevalent in the early days of this disease; such as HIV/AIDS is a disease that occurs exclusively among men who have unprotected sex with other men. And men in the United States are still diagnosed at higher rates than women. But nationally, about 25% of people livingwith HIV are women, and the vast majority of them contract the infection from heterosexual contact.  In North Carolina, 29% of those living with HIV are women, and black women have the highest rate of infection. While messages of practicing safer sex and addressing risky behaviors are good educational strategies for preventing transmission, we can’t ignore the larger cultural norms that can make women vulnerable to HIV in ways that many men may not be.

On National Women and Girls HIV Day, we take the opportunity to shine a light on this vulnerability, allowing us to develop more effective prevention methods. One vulnerability is the incidence of domestic and sexual violence many women face over their lifetimes. While men and boys can also experience this violence, women are much more likely to (particularly sexual violence). What does this mean in terms of HIV infections? Women who are in abusive relationships may have a difficult time negotiating condom use or safer sexual practices; and they may not always be able to negotiate consensual sex. Women who have experienced/are experiencing domestic and sexual violence are more likely to abuse drugs/alcohol, making them more susceptible to the risky behaviors that increase their risk of HIV infection. And in a vicious cycle, it’s been found that as women in abusive relationships are at a higher risk of contracting any STI, including HIV, those women living with HIV are also more likely to experience domestic violence.  And HIV+ women who are experiencing abuse have more health problems (such as depression) and a more difficult time managing their status than their counterparts who are not experiencing such violence.  

There are many effective strategies we can take to reduce these risk factors for women, including providing children and adolescents comprehensive, medically-accurate sex education that addresses consent and domestic/sexual violence. We also need to change our cultural norms that allow sexist and misogynistic violence to go unchallenged; and we need to hold abusers accountable for their actions. And in North Carolina, we can also expand Medicaid as an effective strategy in reducing risk. Not only will this provide women increased access to health care, HIV testing and treatment, and mental health services, but increasing access to our health care system can be an effective tool in preventing domestic violence.  35 years into this epidemic, we need to use every tool we have as we move closer to our goal of raising an AIDS-free generation.

- Tara Romano is the President of NC Women United.