Preventing HIV Infection in Women and Girls

College of Health Sciences faculty member Dr. Richard Jimenez presented “Deepening the Cooperation in the Fight Against HIV/AIDS” at the U.S. Embassy in Buenos Aires for staff members, the Argentine Ministry of Health, and local AIDS organizations on World AIDS Day in December 2014. In honor of National Women and Girls HIV/AIDS Awareness Day on March 10, Spotlight on Walden spoke with Dr. Jimenez about the particular vulnerabilities faced by women in the pandemic.

How are women and girls affected by HIV/AIDS today?
The first cases of AIDS in the U.S. were reported by the Centers for Disease Control and Prevention (CDC) nearly 34 years ago. The CDC’s HIV Among Women fact sheet reports that today, women account for one in four people living with HIV in the U.S., with African American and Latina women disproportionately affected. According to amfAR, women account for 50% of all people living with HIV worldwide and it is the leading cause of death for women ages 15–49.

How has the AIDS pandemic affected healthcare systems, both in the U.S. and abroad, and impacted women?
The disease has highlighted the challenges and shortcomings of our healthcare and preventive health services systems not only in the U.S. but also in other parts of the world. While the AIDS pandemic has posed significant challenges, such as disparities in access to healthcare and lack of mechanisms to access hard-to-reach populations, there have been advances in how we examine and understand HIV/AIDS as a public health issue.

One significant advance in prevention services and intervention and treatment is the adoption of the socioecological model to address HIV/AIDS and examining “environments of risk” that focus on the biological causes of HIV/AIDS and the social and environmental conditions that influence adverse health outcomes. Traditional models of disease prevention focus on biological or individual behavioral factors, but the new socioecological model allows us to take into account the total environment where individuals and groups live and how the various levels of environmental structures and elements affect health, in this case, transmission of HIV. HIV is the biological agent that causes AIDS, but the physical and cultural environments influence disease transmission as much as biology.

How does the concept of environmental risk apply to HIV/AIDS and women?
Preventing HIV infection in women comes with special challenges. The study Rethinking Gender, Heterosexual Men, and Women's Vulnerability to HIV/AIDS found that the reasons that many women become infected include not just personal behavior and biological susceptibility but, in many cases, societal and community factors that make them particularly vulnerable to infection.

For instance, in societies and communities where women are not valued as equal partners with men, or occupy less powerful roles than men, as dictated by cultural norms, it is difficult for them to exert control and sexual behavioral decision making to protect their health and well-being. In many communities and cultures, women are considered less than virtuous if they even broach the subject of HIV and/or HIV risk reduction through the use of condoms and safer sex practices. In many cases, women who attempt to take the initiative to protect themselves and their children from exposure to HIV suffer both mental and physical violence and abuse.

There is still a stigma associated with HIV/AIDS, causing both women and men not to reveal infection status and to delay treatment. That and poor access to healthcare in many communities result in higher rates of AIDS-related mortality. It can be said that women are more vulnerable to HIV infection and therefore live in environments of higher risk than their male counterparts.

The socioecological model can be used to understand the total environment in which women and girls live and the combination of societal and community risk factors that can make them vulnerable to HIV infection. The model can help in the development of effective HIV prevention initiatives and interventions that consider personal behavior, biological vulnerability, and social and cultural norms that put women at risk for HIV infection.

What is on the horizon in terms of HIV prevention for women and girls?
Education and information remain the most effective tools in preventing HIV infection. We cannot afford to become complacent—antiretroviral therapies can prolong and increase the quality of life in people living with HIV, but there is still no cure for AIDS or a viable vaccine. The rates of new cases of HIV infection are increasing in certain populations, including among women of color. We must continue to develop effective and sustainable prevention interventions that will see us through the long haul, until a vaccine can be developed.