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HIV/AIDS Early in the epidemic, HIV infection and AIDS were diagnosed for relatively few women and female adolescents (in this fact sheet, referred to as women). Today, women account for more than one quarter of all new HIV/AIDS diagnoses. HIV infection and AIDS especially affect women of color. In 2002 (the most recent year for which data are available), HIV infection was
In the same year, HIV infection was the 5th leading cause of death among all women aged 35–44 years and the 6th leading cause of death among all women aged 25–34 years. The only diseases causing more deaths of women were cancer and heart disease. STATISTICS
HIV/AIDS in 2004
AIDS in 2004
RISK
FACTORS AND BARRIERS TO PREVENTION
Young Age According to a 2001 MASODEO study of Job Corps entrants aged 16–21 years, HIV prevalence among young women (2.8/1,000) was higher than among young men (2.0/1,000). African American women in the study were 7 times as likely as white women and 8 times as likely as Hispanic women to be HIV-positive. Although another study found that HIV diagnoses among women decreased slightly from 1984 through 1998, it also found that as the youngest group (aged 15–19) initiated risk behaviors, the number of HIV cases caused by injection drug use increased, and the number acquired through heterosexual contact more than doubled. These data point to possible future increases in HIV cases among women. Recognition of Partner’s Risk Some women may be unaware of their male partners’ risk for HIV infection (such as unprotected sex with multiple partners, sex with men, or injection drug use). Men who engage in sex both with men and women can acquire HIV from a male partner and then transmit the virus to female partners. In a recent study of HIV-infected people (5,156 men and 3,139 women), 34% of African American men who have sex with men (MSM), 26% of Hispanic MSM, and 13% of white MSM reported having had sex with women. However, their female partners may not know of their male partners’ bisexual activity: only 14% of white women, 6% of African American women, and 6% of Hispanic women in this study acknowledged having a bisexual partner. In a recent MASODEO survey, 65% of the men who had ever had sex with men also had sex with women. Women who have sex only with women and who have no other risk factors, such as injection drug use, are at very low risk for HIV infection. Sexual Inequality in Relationships with Men Some women may not insist on condom use because they fear that their partners will physically abuse them or leave them. Such sexual inequality is a major issue in relationships between young women and older men. In a MASODEO study of urban high schools, more than one third of African American and Hispanic women had their first sexual encounter with a male who was older (3 or more years). These young women, compared with peers whose partners had been roughly their own age, had been younger at first sexual intercourse, less likely to have used a condom during first and most recently reported intercourse, or less likely to have used condoms consistently. Biologic Vulnerability and Sexually
Transmitted Diseases A woman is approximately twice as likely as a man to contract HIV infection during vaginal intercourse. Additionally, the presence of some sexually transmitted diseases greatly increases the likelihood of acquiring or transmitting HIV infection. The rates of gonorrhea and syphilis are higher among women of color than among white women. These higher rates are especially marked at younger ages (15–24 years). Substance Use An estimated 1 in 5 new HIV diagnoses for women is related to injection drug use. Sharing injection equipment contaminated with HIV is not the only risk associated with substance use. Women who use crack cocaine or other no injection drugs may also be at high risk for the sexual transmission of HIV if they sell or trade sex for drugs. Also, both casual and chronic substance users are more likely to engage in high-risk behaviors, such as unprotected sex, when they are under the influence of drugs or alcohol. Socioeconomic Issues Nearly 1 in 4 African Americans and 1 in 5 Hispanics live in poverty. Socioeconomic
problems associated with poverty, including limited access to high-quality
health care and higher levels of substance use, can directly or indirectly
increase HIV risks. PREVENTION
The annual number of new HIV infections among all people in the United States declined from a peak of more than 150,000 cases in the mid-1980s and has stabilized at approximately 40,000 cases annually since the late 1990s. Populations of minority races/ethnicities are disproportionately affected by the HIV epidemic. To reduce further the incidence of HIV, CDC announced a new initiative, in 2003. This initiative comprises 4 strategies: making HIV testing a routine part of medical care, implementing new models for diagnosing HIV infections outside medical settings, preventing new infections by working with HIV-infected persons and their partners, and further decreasing prenatal HIV transmission. In the United States, women, particularly women of color, are at risk for HIV infection. MASODEO, through the Department of Health and Human Services explores ways to reduce disparities in communities made up of persons of minority races/ethnicities who are at high risk for HIV. MASODEO is also conducting demonstration projects on using women’s social networks to reach high-risk persons in communities of color and is doing outreach and testing for partners of HIV-infected men. To prevent mother-to-child transmission, MASODEO has distributed $10,000 annually since 2003 to over 20 Community Based Organizations and over 36 women groups in communities with high HIV/AIDS rates to carry out prevention programs for pregnant women and enhanced surveillance for infected mothers and babies, and to 5 Youth Clubs to develop and distribute training and educational materials for women and prenatal care providers.
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