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    AIDS Taking on a Female Face

    Women's Issues -- in U.S. as Well as Abroad -- at Heart of AIDS Prevention

    Women's Issues Key to AIDS Prevention

    One might argue that women are nowhere more empowered than in America. But the women in America who most lack economic and social empowerment -- minority women -- are precisely those bearing the brunt of the AIDS epidemic.

    In the U.S., Quinn and Overbaugh note, AIDS is diagnosed in black women at a rate 25 times higher than in white women and four times higher than in Hispanic women. Eight out of 10 of these infections come from heterosexual sex with an infected partner.

    "The data in the U.S. in many ways reflects the issues that women in developing countries are dealing with," Priddy says. "These issues have a lot to do with women's sexual and economic power in their societies. In the reasons they have HIV, these minority women have a lot of similarities to women in resource-poor countries. I don't mean racial similarities -- I mean they experience the same social and cultural barriers to protecting themselves from HIV."

    Some of these issues are biological. A heterosexual encounter with an HIV-infected partner is more dangerous for a woman than for a man. This is particularly true for adolescents, whose immature genital tracts are especially susceptible to HIV infection. The use of hormone-based contraceptives, such as the pill, appears to heighten a woman's vulnerability to HIV infection -- and, possibly, to speed AIDS onset once a woman is infected.

    Intertwined with these biological factors are social and cultural issues:

    • Young women having sex with older men are less able to negotiate safe sex.
    • Poverty forces women to focus more on immediate needs -- food, shelter, and personal safety -- than on the more distant risk of AIDS.
    • Little access to health care means that HIV-positive male sex partners are not being tested -- or treated -- for their infections. This means higher virus levels in the positive partner, and a higher risk of passing on the AIDS virus.
    • Poor access to health care also means that many women don't learn they are infected with HIV until they develop serious AIDS-related infections.
    • A strong emphasis on having children necessitates unprotected sex.
    • Married women often cannot negotiate safer sex with their spouses. Safe sex means condom use -- a form of protection that women do not directly control. The female condom, while useful in some situations, does not fill this need.

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