Problems Women Face
Power Imbalance in Sex
The social expectations and norms for women in the context of sex lead to a heightened vulnerability for women contracting HIV. In Türmen’s study published in the International Journal of Gynecology & Obstetrics, the relationship between gender and HIV is discussed in detail. The study starts by defining the difference between gender and sex, and explains that sex is assigned based on biological characteristics at birth, whereas gender is the more social context that plays into roles in society. According to Türmen’s study, men have higher chances of infection due to societies that force hyper-masculinity and encourage multiple partners. For this reason, women who have sex with men are particularly likely to contract HIV because the men they are sleeping with have a higher chance of already having HIV from previous partners. In addition to societies that promote male risk taking, women are more likely to be having sex with older men. Though this is sometimes a result of maturities of men and women, these cases are particularly alarming in poverty stricken areas. In these communities, men often offer gifts or money to women in vulnerable financial positions (Türmen).
According to a study Türmen references, the threat of violence against women makes them unable to ask for safe sex practices such as condom use. This study which was conducted in South Africa, found that 30% of female participants said their first intercourse was forced, 71% had experienced sex against their will, and 11% had been raped (Türmen). Women’s inability to ask for safe sex practice and often inability to even expect consensual sex leaves them in a disadvantageous position to protect themselves.
Though Higgins’s article “Rethinking Gender, Heterosexual Men, and Women’s Vulnerability to HIV/AIDS” in the American Journal of Public Health argues that men who have sex with women are the more forgotten group of the HIV/AIDS epidemic, even she acknowledges that “both biological susceptibility and gendered power dynamics drastically disadvantage women worldwide” (Higgins et al.). Her study goes on to acknowledge that the demographic of women in America most likely to contract HIV are Black and Latina women living in the poorest U.S cities. Additionally, her study states that certain groups of women, such as pregnant women, migrant women, and sex workers were targeted as “vectors” of HIV, which Türmen’s article highlights.
The biology of women also factors into their inequality in contracting AIDS and the power imbalance between man and woman. Türmen’s study states that male to female transmission happens at a rate between two and four times higher than female to male transmission. Additionally, if women have STIs (sexually transmitted infections) they are more likely to contract the virus. Because STIs are often asymptomatic in women, there is nothing that indicates to a woman that she should go to the doctor to get a checkup. This creates a false sense of security in women as they may believe that the precautions (if any) they are taking in their sex lives are working and do not realize that they have contracted an STI. Though women are more likely to contract HIV due to biological differences, young girls are even more likely to contract HIV than fully developed women. The reason that young girls are more susceptible to HIV than women is due to the lack of maturity in their physicality. The genital tract of young girls is more likely to tear during intercourse, which makes transmission likelihood increase dramatically. (Türmen)
Lack of Education
Though people who are less educated are more likely to contract HIV now, this was not the case in the beginning of the AIDS epidemic. When HIV became a prevalent societal issue, educated members of society were the most vulnerable, but as information about prevention methods and transmission education increased, they changed their behavior and soon became the most protected from the disease by changing their behaviors, using condoms more often, and reducing the number of sexual partners they have. In the late 1980’s and early 1990’s during the height of the aids epidemic, there was a positive correlation between education level and prevalence rate. Newer studies, however, are now beginning to show a negative correlation as the behaviors of those who are socially advantaged has shifted, and education has benefited these communities more (Vandemoortele et al.).
Figure 3. Primarily in Africa, this graph shows the proportion of women who have heard of AIDS contrasted with the amount who have sufficient knowledge to protect themselves. While it is clear most women have heard of the virus, the proportions show there is a lack of information as to how to protect themselves. (Türmen)
In The “Education Vaccine” Against HIV, some interesting statistics are discussed. In order to get these statistics, the authors analyzed 32 Demographic and Health Surveys (DHS) that incorporated questions regarding knowledge about HIV and AIDS. They found that illiterate women are three times as likely as literate women to believe that if someone appears healthy externally, they cannot have HIV. Additionally, they are four times more likely to believe that there is no way to avoid HIV. Uneducated women are also three times more likely to not know that the virus can be transmitted from mother to fetus (Vandemoortele et al.).
Though lack of general education factors significantly into a woman’s perception and understanding of HIV, even classes or units that are supposed to be focusing on safe sex are failing to fully educate women and leaving out pivotal pieces of information. While there are many resources for women to use to gain education about sexual behavior, often sex education in public schools is the only that they receive. In at least one third of the United States, school districts implement abstinence only sex education. This means that the focus of the education that one third of schools provide talk most prominently about remaining abstinent until marriage and do not inform young women (or men, for that matter) about the dangers that having unprotected sex can bring. Overall, there is little to prove that abstinence based programs are effective at all, which is doing a serious disservice to the American youth (Gardner).
Though living with HIV is no longer a death sentence, there are still stigmas carried with the disease that make parenting with HIV extremely hard for women. Due to antiretroviral prophylaxis, which reduces HIV transmission from mother to fetus, more women feel comfortable with having children and are more excited to become mothers. Although the disease may not be transmitted, the mothers must still face an overwhelming responsibility that when combined with regular HIV side effects such as depression can leave children with internalized problems.
In order to participate in this study conducted by Ruth Muze and Elijah O. Onsomu for the Journal of Community Health Nursing, participants must fulfill the following criteria: 19 years old, mother with full-time care of one uninfected preschool-aged children, diagnosis of HIV status, self-identifying as African American, diagnosis at least 12 months prior, and affiliation with the Positive Wellness Alliance (Muze and Onsomu).
The mothers said that their emotional and personal lives in addition to the way they raise their children is affected by their health and well-being. Their involvement with their children day to day helps to act as a distraction from their illness. Additionally, being a single mother makes things even harder, but they do everything they can to carry out all childcare tasks.
“It’s like trying to organize things in the morning by trying to follow through all that needs to be done for my daughter and trying to plan all her meals. … It wears me out; sometimes, I just can’t get up to take care of myself because of her.”
There is a large sense of isolation among the women that is associated with HIV, that is especially prevalent with the support of friends and family is not present.
“You just wish that somebody would call and try to rescue you or something. Of course, taking care of my child throws off my whole day because the focus is on my child.”
The overall experiences of the women in the study regarding parenting their children were consistent within the group. Through all the challenges, their overall goal was to fulfill their children’s needs. Parenting intervention programs would ease the struggle to meet these responsibilities. The struggles of mothers are often underestimated, especially of those living with illness. Women with HIV who have children often put their kids first, and sometimes even compromise their own health to do so. This is just another example of why women do not necessarily receive or upkeep the same level of care for themselves as male counterparts (Muze and Onsomu).
In a longitudinal study conducted by Meyer et al. for the American Journal of Public Health focusing on how gender is correlated with treatment after release from jail, 867 participants were divided by gender and then interviewed at two separate points to determine what HIV treatments they had received and their compliance with them. The two points the study was most focused on were baseline and 6-month treatment outcomes. By this six-month period, women were significantly less likely to have received optimal treatment outcomes in terms of both continuation of care and prescription of accurate antiretroviral drugs. The care was assessed on the following
1. Retention in care: women 50%, men 63%
2. Antiretroviral therapy prescription: women 39%, men 58%
3. Optimal antiretroviral therapy adherence: women 28%, men 44%
4. Viral suppression: women 18%, men 30%
One sixth of people who have HIV/AIDS are admitted into correctional facilities annually. In correctional facilities, they treat men and women living with HIV differently because the experiences between gender vary. Women in jail are twice as likely to be infected as men in jail, and are fifteen times more likely than women who are not incarcerated. This is partially due to the way women contract the virus about their social circles. As discussed in the study, the sexual partners of women are likely to overlap with the people they get drugs from or use drugs with. whereas men often have two separate circles for these groups. In these intimate relationships that are based on sex and drugs, women’s criminal activity is very intertwined (Meyer et al.).
Though women can now take medication that will prevent transmission to their fetus, at the beginning of the AIDS epidemic the technology to do so had not been developed. Even after the medicine became more prevalent, it was not necessarily accessible to it in low income communities. Additionally, the uneducated demographic of women was not included in the group that was privileged enough to receive this medication. Minority populations were disproportionately affected by the spread of HIV, but are often forgotten when speaking about the victims.
The authors “Impact of the Human Immunodeficiency Virus Epidemic on Mortality in Children, United States” analyzed the mortality rates of children younger than 15 years of age in the year 1988, which was the most recent these statistics were available. The statistics are derived from the population of children younger than 15 years old at the time of death who resided in America (but not territories). All statistics were prepared by the National Center for Health Statistics of the CDC in 1988 (Chu et al.).
This death rate was highest between 1 to 4-year-old children in the black and Hispanic communities. By 1988, HIV/AIDS had become the leading cause of death for children aged 1 to 4 in these race groups in New York. While children were in no way the most affected group for HIV, the problem of AIDS in children grew rapidly. In 1998, HIV was the ninth leading cause of death among children, and was even as high as the sixth leading cause when this group was reduced to only include black children between 1 to 4 years of age. In 1988, 249 deaths in children younger than 15 were due to HIV. The majority of infants who died were black, but as the children moved into the 5 to 14-year-old age group they were more often white. Additionally, the death rate for HIV/AIDS among children younger than 15 was almost 6 times higher than that rate among white children (Chu et al.).
In addition to race, regions also played a part in the rate of death. The highest rates were found in the South and northwest. This was a change from the year before, 1987, as the percentage of deaths in the South increased from 24% to 33%, where the rate in the West decreased from 20% to only 8%. The highest rates of death were found in New York, Florida, and New Jersey. Despite differences in regions however, black and Hispanics were disproportionately affected in all regions (Chu et al.).
During the years 1989 and 1990, 1399 new cases of HIV were reported in children younger than 15 years of age. 1989 is the year Jazzy Mae was born, so it is clear to see that the time she was born was one of the highest points for infant mortality due to HIV. In the pictures, Jazzy appears to be a child of color, and although her race is not identifiable just by the pictures, all research shows that basically anyone in a community other than white people were disproportionately affected by HIV. The statistics and time frame of this source really put the tragedy of Jazzy’s story in perspective. Higher infant mortality rates in these communities are likely due to the lack of education that all my other sources have proven exists (Chu et al.).