By Naina Khanna, U.S. Positive Women’s Network Coordinator and WORLD Policy Director and Sonia Rastogi, U.S. Positive Women’s Network/WORLD Advocacy Coordinator
This National Women and Girls HIV/AIDS Awareness Day, U.S. Positive Women's Network (PWN)), one of two community partners for AIDS 2012, calls for full integration of HIV care and prevention with sexual and reproductive healthcare and violence prevention and counseling services. To ensure this happens, we demand the meaningful involvement of women living with and affected by HIV in the development of all policies and programs addressing the domestic epidemic.
2012 is a tide-turning year in the global history of HIV. Due to new prevention technologies and groundbreaking studies like HPTN 052, we now have the science to end the epidemic. Science has demonstrated that HIV’s trajectory can be altered by providing appropriate medical care and supportive services to keep people in care. In the U.S., the Affordable Care Act (also known as health care reform) and the U.S. National HIV/AIDS Strategy are policies that have the possibility of implementing science’s innovation.
In this science and policy context, where do the rights and leadership of women living with HIV fit?
Very little attention has been paid in the U.S. context to the myriad ways in which cultural scripts, patriarchy, and gender norms fuel women’s unique vulnerability to HIV acquisition and to poor health outcomes once diagnosed. The U.S. epidemic among women is colored by a human rights crisis. HIV-related stigma, poverty, a crumbling health care system, and gender-based violence are a few root causes that increase a woman’s vulnerability to HIV. HIV runs the well-worn path of gender inequality, similar to the global pandemic. The same women who are poor, experience violence, are homeless, and are from communities that are historically oppressed are the same women that are disproportionately impacted by HIV.
Women account for over 50% of HIV infections globally and in the U.S., women comprise over 25% of HIV infections. Black and Latina women together account for over 80% of the female HIV epidemic and heterosexual contact is by far the leading cause of new HIV infections in women. Transgender women are still identified as men who have sex with men, making invisible the devastating impact of HIV among transgender women. In addition, the epidemic disproportionately impacts the Southern and Northeast regions. 50% of new HIV cases occur in the South, despite being 36% of the U.S. population, according to the Southern HIV/AIDS Strategy Initiative Report. Ultimately, homophobia, bias against drug users and sex workers, and a lack of comfort in talking about sex, women, their medical providers, and their insurance companies have frequently underestimated a woman’s risk for HIV infection.
Upholding women’s rights and the leadership of women living with HIV is critical to curbing these trends. At a recent meeting of the Presidential Advisory Council on HIV/AIDS (PACHA), national leaders in HIV prevention, care and research for women spoke eloquently of the imperative to integrate funding and service delivery and to systematically incorporate an understanding of gender-based violence, sexual rights, and reproductive justice into national HIV prevention and care plans and metrics for evaluation.
We have the science to end the HIV epidemic, but without an integrated approach to prevention and care, that vision cannot be realized. To achieve public health goals and uphold human rights, HIV prevention and care must address the full context of women’s lives. For too many women, that explicitly includes violence, especially intimate partner violence, sexual silencing, a lack of adequate sexual and reproductive health care, and reproductive rights violations. To effectively achieve this integrated vision, women must be not just “at the table,” but meaningfully involved in the creation, writing, analysis, and evaluation of the agenda.
In Sisterhood and Solidarity,
U.S. Positive Women’s Network