When HIV and AIDS started to spread in the U.S. in the 1980s, AIDS was seen as a “gay disease” because it primarily affected men who have sex with men.
The misconceptions and severe stigma that arose from this idea were pervasive, and they continue on today. The risk of contracting HIV remains most severe for men who have sex with men, particularly young black men, but the virus is not just a problem in the queer community. In the U.S., about one in four people living with HIV are women, and about one in five of the approximately 50,000 people who contract the virus each year are women. Most women living with HIV are low-income women of color, and HIV is also prevalent among transgender women (again, trans women of color are at higher risk). Because HIV status is correlated with race and class, it ties in with many of the most important issues facing our society.
So what should we know about how HIV affects women? Of course, it would take more than a blog post to go over the whole topic, but here are a few areas of focus.
Historically and currently, HIV-positive women are sometimes deprived of their right to choose when and how to engage sexually. This comes back once again to discrimination and stigma, as women living with HIV are desexualized or not treated as sexual beings with a right to have the kind of sex life they want. They may also face a variety of discrimination and mistreatment in medical settings, including being tested for HIV during pregnancy without consent, and even being sterilized during labor and delivery without informed consent. (Worth noting: with proper care, it is entirely possible to prevent mother-to-child transmission of HIV.)
Healthcare providers may not even be fully informed about female patients’ HIV-related needs, so they may not offer the necessary information to women who may be at risk. This ignorance also means providers may not screen their HIV-positive female patients for gynecological and other complications that are more likely for women living with HIV. Incarcerated women do not have access to the health services they need, from pregnancy care to cervical and breast cancer screenings. And reproductive justice is not limited to sexual activity, contraception and pregnancy; HIV-positive women are often discriminated against as parents, as well. It is not uncommon for a woman’s HIV status to be used as evidence in court that she is unable or should not have the right to custody of her children. Holistic reproductive justice should be accessible for all women, without exception.
Violence Against Women
Over half of women living with HIV have experienced intimate partner violence. This is almost twice the rate for the general population of women, and both numbers are too high; they reflect our society’s willful ignorance and normalization of violence against women, particularly women of color, queer women, and transgender women. Women who have experienced intimate partner violence are also more likely to report HIV risk factors. In 2014, the Positive Women’s Network founded a National Day of Action to End Violence Against Women Living with HIV. They write, “The Day of Action, conceived entirely for and by women with HIV, was created to raise awareness about the effects and prevalence of violence against women living with HIV, break through the culture that keeps this issue in silence, and push for structural change, including policy changes to eliminate this disparity.” As conversations about sexual violence and intimate partner abuse come to the forefront, this issue must be included in the conversation.
The criminalization of HIV is an important factor in the way that violence and abuse play out in the lives of women with HIV. Many states have laws or statutes that impose criminal penalties on people living with HIV for exposing others to HIV or for transmitting it, including through consensual sex with condoms and behaviors like spitting and biting that do not pose a realistic risk of HIV transmission. These laws increase stigma and discrimination, as well as causing people to avoid getting tested for fear of future prosecution; and rather than protecting people, criminalization laws often allow a woman’s partner who knows her HIV status to further abuse, coerce, and harass her if she tries to end the relationship. Abusive and dangerous laws enable abusive and dangerous behaviors, and they actually hinder the fight against HIV and AIDS.
Research, Prevention, and More
HIV research today is looking more and more at the experiences of women living with the virus, and how to gear prevention efforts toward women specifically. A variety of innovations are being developed in HIV prevention in particular, including the already available daily pill Truvada, commonly known as “PrEP” (pre-exposure prophylaxis) as well as an exciting new HIV preventative ring that is currently being tested. The best way to fight HIV and AIDS is through a holistic approach that addresses the structural factors at play in our society’s systemic racism, classism, sexism, and more. The issues mentioned here, and the details I’ve included, barely scratch the surface of this issue. To learn more, check out the CDC, the U.S. Department of Health and Human Services, the Kaiser Family Foundation, and the Positive Women’s Network – among many other resources!
COVER IMAGE COURTESY OF GETTY IMAGES.