Women and HIV in America: Making AIDS History

In observance of Women's History Month, there is much progress to mark for women and HIV/AIDS in America since the emergence of the epidemic three decades ago.
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By Susan J. Blumenthal, M.D., and Jennifer A. Sherwood, M.S.P.H

In observance of Women's History Month, there is much progress to mark for women and HIV/AIDS in America since the emergence of the epidemic three decades ago. Recently the Centers for Disease Control and Prevention (CDC) announced that HIV diagnoses among females in the United States declined by 49 percent from 2002 to 2011. Additionally, as a result of effective treatment of HIV-positive pregnant women, mother-to-child transmission of HIV has been virtually eliminated in the U.S.

This progress is no small accomplishment, considering the fact that in the early days of the AIDS epidemic, the scientific and medical community failed to recognize women as a target population for research, and they were excluded from clinical trials of HIV/AIDS medications and preventive interventions. This omission proved to be a major public health oversight, and led to a rapid rise in the number of HIV cases among women, who contracted the disease primarily through heterosexual sex. Today, women account for one in four of the 1.2 million people living with HIV in America.

In the U.S., there are striking racial and geographic disparities in new HIV infections and outcomes. While African American women represent just 13 percent of the female population, they constitute 64 percent of new HIV infections and are 14 times more likely to die from AIDS-related causes than white women. Southern states contain 37 percent of the U.S. population but represent 50 percent of new HIV infections. AIDS-related mortality is also highest in the South. Contributing factors are high poverty rates, lower educational attainment, violence, and lack of access to healthcare. New HIV infections are also concentrated in urban areas, such as Washington, D.C., where 1.6 percent of women are HIV positive, a prevalence that is higher than for females living in Ethiopia, the Democratic Republic of Congo, Mali, and Liberia.

In addition to being more biologically susceptible to HIV infection than heterosexual men, women's vulnerability to HIV is also driven by social and economic factors. Poverty, sexism, stigma, discrimination, and violence increase risk for infection and are among the many structural barriers that prevent women from getting the information and services they need to prevent HIV or to seek proper care if they are HIV positive.

In spite of so much progress, the majority of women living with HIV in the U.S. are not engaged in regular medical care. It is estimated that of all women living with HIV in America, 88 percent have been diagnosed, but only 45 percent are engaged in care and just 32 percent have achieved viral suppression. When virally suppressed as the result of effective, consistent therapy, transmission of HIV to others can be reduced by as much as 96 percent. Since treatment is prevention, the low percentage of virally suppressed women in America represents a missed opportunity for dramatically reducing the spread of the disease.

If we are to end AIDS among women in America, preventing new HIV infections is essential and there are a range of tools that can help, including targeted education, pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP), male and female condoms, and harm reduction services for people who inject drugs. To maximize reductions in new HIV infections, a high impact strategy must be employed to use the most efficient, evidence-based, cost-effective and scalable prevention methods to target those at highest risk in the most affected areas. Women and girls, particularly vulnerable groups such as African-Americans, sex workers, women who inject drugs, and transgender women, need better, targeted information, as well as nondiscriminatory HIV prevention and treatment programs.

Routine testing for HIV is now covered as a preventive benefit under the Affordable Care Act (ACA). The legislation also provides women with unprecedented access to lifesaving medications and other interventions to treat and prevent HIV infection, an important reason why implementation of the ACA must be supported, including Medicaid expansion across all states.

For too long, women's health was neglected in AIDS research, in clinical settings, and in public policies. Now, as a result of an increased focus on women's health and HIV/AIDS, there are hopeful signs of progress. To make further gains, a fast-tracked, comprehensive strategy is needed, mobilizing all sectors of society to prevent HIV infections in women, their partners and children, provide testing and early treatment to all those in need, combat discrimination and stigma, and eliminate violence against women. Additionally, more research on women and HIV/AIDS is urgently required, including intensified efforts to discover a cure and a vaccine.

The tide is turning. Working together and with these investments, we can achieve an HIV-free America and make AIDS history in the years ahead.

Rear Admiral Susan Blumenthal, M.D., M.P.A. (ret.) is the Public Health Editor of The Huffington Post. She is Senior Policy and Medical Advisor at amfAR, The Foundation for AIDS Research in Washington, D.C. Dr. Blumenthal also serves as a Clinical Professor at Tufts and Georgetown University Schools of Medicine and is a Senior Fellow in Health Policy at New America. Admiral Blumenthal served for more than 20 years in senior health leadership positions in the Federal government in the Administrations of four U.S. Presidents including as Assistant Surgeon General of the United States, the first Deputy Assistant Secretary of Women's Health, and as Senior Global Health Advisor in the U.S. Department of Health and Human Services. She also served as a White House advisor on health. She convened the first NIH conference on Women and AIDS and an HHS Task Force with membership of more than 60 organizations. Prior to these positions, Dr. Blumenthal was Chief of the Behavioral Medicine and Basic Prevention Research Branch and Chair of the Health and Behavior Coordinating Committee at the National Institutes of Health. She has chaired numerous national and global commissions and conferences and is the author of many scientific publications. Admiral Blumenthal has received numerous awards including honorary doctorates and has been decorated with the highest medals of the U.S. Public Health Service for her pioneering leadership and significant contributions to advancing health in the United States and worldwide. Named by the New York Times, the National Library of Medicine and the Medical Herald as one of the most influential women in medicine, Dr. Blumenthal was named the 2009 Health Leader of the Year by the Commissioned Officers Association and as a Rock Star of Science by the Geoffrey Beene Foundation. She is the recipient of the Rosalind Franklin Centennial Life in Discovery Award. Her work has included a focus on HIV/AIDS since the beginning of the epidemic in the early 1980's.

Jennifer Sherwood is a Policy Associate with amfAR, The Foundation for AIDS Research in Washington, D.C. She conducts research analysis, develops policy briefs, infographics and writes scientific articles. Jennifer served as an Allan Rosenfield Public Policy Fellow at amfAR and received an MSPH from Johns Hopkins Bloomberg School of Public Health. Jennifer has worked in West Africa, in collaboration with local ministries of health, to understand the social and structural factors related to STIs/HIV. Her research interests include the health impact and prevention of gender-based violence, sexual and reproductive health and rights, and HIV.

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