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Securing care for Women living With hiv Challenges and solutions for Hiv-positive women by NaiNa khaNNa FIVE YEaRS ago, womEn HaD THE DUBIoUS distinction of surpassing men as the majority of people in the world living with HIV. And in some countries, including Cambodia, Mozambique, and Rwanda, women now comprise nearly two-thirds of people living with the virus. In the U.S., the HIV epidemic looks very different. Women comprise over a quarter of the estimated 1.2 million people living with HIV in the U.S.—not including transgender women, for whom no accurate data are available. In 1984, women represented only 8% of HIV infections in the U.S. Thus, even at a national level, the trend is troubling. Data from 2012 show that in the District of Columbia, rates of new HIV diagnosis among black women have doubled. In Maryland, 35% of all AIDS diagnoses are among women, and in the U.S. Virgin Islands, 36.4% of people with an AIDS diagnosis were women in 2009. And when you drill down further, particularly in the U.S. South, in some counties, HIV infection rates among females may be even higher. Let’s be clear: this is not a numbers game anyone wants to win. Of even more concern, in the United States, HIV acquisition among women is correlated with race, poverty, experience of trauma, mental illness, substance use, and vulnerability to assorted social stigmas—the same factors that reduce likelihood of positive health outcomes in people living with HIV. That is, these socioeconomic factors increase vulnerability to poor health outcomes, with or without an HIV diagnosis. U.S. women living with HIV are disproportionately likely to be women of color (over 80%), especially black and Latina, and living in poverty, compared to men living with HIV. According to the HIV Cost Services and Utilization Study (HCSUS), 64% of HIV-positive women in ongoing medical care had annual incomes under $10,000, compared with 41% of HIV-positive men in care. More than twice as many HIV-positive women (76%) as HIV-positive men (34%) are living with and caring for at least one child under the age of 18. Thus, care systems for HIV-positive women must account for caretaking responsibilities, including provisions for minor children. Alarmingly, data show that ad<strong>here</strong>nce to anti-retroviral therapy tends to decrease among women living with HIV as the number of children under 18 living in the home increases. This is no real surprise. As women, we tend to prioritize caring for others over ourselves. Sometimes it’s a matter of practicality—we only have so many dollars to go around and hours in the day and bus vouchers. Sometimes it’s a matter of stigma—we don’t want others to see us taking our meds or going to medical appointments. And frequently it’s a reflection of how we value ourselves, especially as poor women, women of 22 SEPTEMBER+OCTOBER 2012 POSiTivElyAwARE.COM PHoTo: © IaS/STEVE SHaPIRo-commERcIaLImagE.nET ORGAnIzInG PRInCIPAL: Megaphone in hand,
Naina Khanna, Director of Policy and Community Organizing, WORLD, rallies demonstrators at the International AIDS Conference in July. color, women living with HIV. We have internalized that our health, our wellness, our wellbeing is too often not a priority for our society and political leaders—so why should we make it a priority for us? Transgender women are especially likely to live in extreme poverty, to face exceptional barriers to safe housing, employment, and access to quality health care, and, if HIV-positive, are less likely than other populations to receive antiretroviral therapy and more likely to experience negative interactions with health care providers. Transgender women are also disproportionately likely to face violence in their communities. Although researchers within the U.S. and internationally have known for years that women who have experienced violence and trauma are at elevated risk of acquiring HIV (even in non-conflict settings), new data released in 2012 show that women with HIV in the U.S. are twice as likely to have been victims of POSiTivElyAwARE.COM SEPTEMBER+OCTOBER 2012 23
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