Patricia Watson, Senior Staff Reporter
AS THE HIV/AIDS pandemic enters its 21st year, at least one trend is becoming obvious. Each year, more and more women are becoming infected, especially adolescents. Women now account for 50 per cent of the global AIDS cases and in some countries, the number of women infected has outstripped the men. But what is painfully clear is that the disease is not only becoming prevalent among women, but more so among women of colour.
HIV infection now disproportionately affects Black women, especially in areas where women are poor and of low status.
The statistics are clear.
In Sub-Saharan Africa, women account for 58 per cent of people living with HIV. Population Bulletin (vol. 57, no. 3, 2002) reports that in Sub-Saharan Africa, "there were 12 to 13 infected women for every 10 infected men in 2001. In addition, the article states that in some African countries, infection rates are five times higher among young girls than among young men.
As seen in the table above, women also account for 55 per cent of those living with the disease in North Africa and the Middle East. In the Caribbean, the percentage of women infected stands at 50 per cent. Already in some countries like Haiti, where six per cent of adults are infected, the percentage of women infected is higher than among men. Here in Jamaica, statistics show that up to the end of 2001, the percentage of women infected stood at 46 per cent. However, this may increase as statistics for the first half of 2002 showed that HIV among adolescent girls aged 10 -14 is two times higher than among boys the same age and among women 15 - 19, it is three times higher. AIDS is the leading cause of death among women in the age group 20 - 29 in Jamaica. For 2002, an average of 867 HIV positive women became pregnant.
In the United States, the Centres for Disease Control reported in 2002 that at the end of 2001, 63 per cent of women and adolescent girls reported with AIDS were Black as against 18 per cent whites and 17 per cent Hispanics. The rate of transmission stood at 47.8 cases per 100,000 Black women and adolescent girls. As shown in the table provided, the rate of transmission among Blacks is almost 20 times that among whites and almost four times that of Hispanics.
Most AIDS cases among women and adolescent girls in the United States were from the Northeast and the South and Blacks affecting mostly blacks. In the Midwest region, most cases were among black, not Hispanic women and adolescent girls. In the West, there was less disparity in the AIDS case counts among white, black, and Hispanic women and adolescent girls.
ARE BLACK WOMEN MORE PROMISCUOUS?
So what is the reason behind the high levels of HIV among Black women? Is it that Black women are a licentious lot, who are more promiscuous than other races?
Or is it something more sinister - a grand plan to wipe out the black race, after all what better way to do this than to attack the reproductive source?
Although this is the view of a significant number of persons, research shows this is not so. The rising number of cases among Black women is a complex mix of socio-cultural practices, economics and biology.
During unprotected vaginal sex, it is believed a woman's risk of becoming infected is up to four times higher than that of a man.
According to Dr. Yitades Gebre, senior medical officer in the HIV/STI Control Programme, the vagina has a larger mucosal surface and during the sexual intercourse, trauma to the vagina may create micro lesions, which are excellent entry points for the HIV. Young girls are especially vulnerable to this. He further explained that the semen from and HIV infected male typically contains a higher viral concentration than that of the woman, thus the higher chance of the woman contracting it.
In addition, as it regards STIs, Dr. Gebre noted that women are more vulnerable to infection if they have a history. Population Bulletin (2002) notes "research shows that an untreated STI - can increase the risk of HIV transmission as much as 10-fold. This is especially significant for women because most STI cases in women are untreated."
Socio-economic factors such as women's lack of access to education or employment makes Black women more vulnerable to HIV. Thus, many women, even though they know their men are having other relationships find it difficult to ask them to use condoms when they have to depend on them financially. Lack of employment also forces women into the sex industry, where exposure to STIs and HIV is high.
In some societies, cultural traditions such as older men's preference for young women, community leaders' rights to have sex with young girls as they come of age and society's acceptance of men having multiple sexual partners all contribute to the rising number of Black women with HIV.
HIV AND BLACK AMERICANS
In an article entitled WHY AIDS IS BECOMING A BLACK WOMAN'S DISEASE AND WHAT WE CAN DO ABOUT IT which appeared in the November 2002 issue of Ebony, the author chronicles the devastation taking place among the black communities in different areas. The article states that:
"Although African-American women account for only 33 percent of the New Jersey population, they comprise 66 percent of all AIDS cases, with the highest rates of infection in Newark, Jersey City and Paterson. In Atlanta, long considered the cultural hub of the South, Black women comprise 85 percent of all AIDS cases. In Los Angeles, at the close of the decade, 40 percent of AIDS cases were African-American women. Staggering rates of infection in New York City, Miami, Chicago and Ft. Lauderdale, Fla., have created new epicentres of HIV with the highest rates of new cases among African-American women in metropolitan cities. In some cities, AIDS is the No. 1 killer of Black women between the ages of 25 and 44."
Data from the CDC shows that HIV infects one in every 160 Black women in the USA, making them the largest-growing sector of HIV infected people. It is posited in the article that the driving forces behind the outbreak among blacks are, multiple sexual partners, needle sharing among intravenous drug users and men who have sex with both men and women. In addition, there is a large Black prison population which is believed to have entered the system negative, but come out positive and pass on the virus to their wives or girlfriends. Many of these men do not think they are gay and therefore would not seek out to have sexual relations with men on leaving prison.
But probably one of the clearest factors driving the infection among blacks in the US, is the feeling of security many women who are in stable monogamous relations have. These women do not believe they are at risk of contracting HIV because they are in love and their partner is only having sex with them.
Marcy Moore, programme director of the AIDS Foundation of Chicago, in the article also pointed to a reluctance to use condoms as a reason for the high levels of HIV among Black American women.
"When the mood is set and the time is right, we don't want to create an uncomfortable moment by bringing up the 'condom issue.' We avoid the subject altogether out of fear of rejection or what our partner may think of us," she is quoted as saying.
She however adds that "one uncomfortable moment sure beats the many uncomfortable moments you will certainly have if you become infected with HIV." Miss Moore explained that Black women need to take charge of their lives and be more responsible for their own health if the incidence of HIV is to be reduced.
WOMEN IN AFRICA
In her article, "AIDS into the 21st Century: Some critical Considerations" in Reproductive Health Matters (vol. 8, no.15, 2000), Elizabeth Pisani noted that the pattern of HIV infection among various populations is quite unpleasant. She said a significant number of girls are infected during their teens and before marriage by men much older than themselves. For instance she noted that studies in two West African and two East African cities revealed that in Kisumu, Kenya, 23 per cent of girls aged 15 - 19 were infected compared with only eight per cent of boys. Among women in their 20s, the same pattern was obvious with 38 per cent of women 20 - 25 infected as against 12 per cent of men the same age. The same trend was evident in other selected areas in South Africa, Zambia, Zimbabwe, Cameroon, Tanzania and Benin.
"The age disparity in HIV infection rates indicates that young women must be having sex with men much older than themselves," Pisani said. As such she explained that teaching young women to negotiate condom use with their peers may not help as the major threat comes from older men.
THE SITUATION
IN JAMAICA
Although the percentage of women infected hovers below 50 per cent in Jamaica, indications are that this could increase and possibly overtake the number of men infected in a few years time.
"In the last five years, we have seen a significant increase in the number of women becoming infected in the region. What we see in Jamaica is a narrowing between men and women, in the first few years, it was mainly among men. This began to change in the mid 1990s when women began narrowing the gap," Dr. Gebre told Outlook.
He explained that as in the US and in Africa, one of the major reasons behind the rapid infection rate is the situation where men tend to have more than one sexual partner, with the blessing of the wider society.
This was supported by Dr. Robert Carr, Executive director of the Jamaica AIDS Support (JAS).
"A lot of middle class men in Jamaica feel that having more than one woman makes them more masculine. What puts women at risk is that they put their total trust in these men. The feeling of being in love allows them to have unprotected sex," he said.
Dr. Carr also explained that many women although they know their men may be having sex outside their relationship fear violence being introduced and so refuse to insist on condom use.
"In Jamaica, it is very popular for men to have unprotected sex and it is considered degrading to ask your man to use a condom as it is saying he is 'dirty'," he stated.
Another driving force behind the increasing number of women in Jamaica becoming infected, Dr. Carr revealed is both biological and cultural.
"Jamaicans believe in rough sex. It is culturally acceptable that sex must be rough or it isn't sex. When the vagina becomes traumatised during the sexual act, the likelihood of infection is increased."
Women are also expected to have relations with or marry older men, who are more experienced, and logically speaking, more likely to be infected. In addition, Dr. Gebre pointed out that there is evidence that older men are preying on young girls hoisting the incident of HIV among this group. Many of these men are seeking younger and younger partners in order to avoid infection and in the belief that sex with a virgin cures AIDS and other diseases.
Dr. Gebre was however, not able to pinpoint what was the major driving force behind the epidemic in women.
"It is very hard to say which the major driving force behind the epidemic is. When it comes to individual decision making though, women could play a greater role in protecting themselves," he stated.
TO ADDRESS CULTURAL ISSUES
"We need to address cultural issues where men having multiple women are accepted. Surveys have shown that 30 per cent of men with STDs never attended a health facility, so we need to not only address the women but also the health seeking behaviour of men."
Poverty reduction, he explained must form a part of the solution as poverty is believed to be putting many women at risk of contracting the disease.
Financial or material dependence on men, Dr. Gebre said, means that women cannot control when, with whom and in what circumstances they have sex. In addition, a great deal of women have to exchange sex for material favours in order to survive daily.
"Eighty per cent of young people report that their first sexual activity was forced. Thus, in many instances, sexual activity is usually ahead of sexual knowledge for many young girls in Jamaica," he further explained.
This he said must be addressed. Parents, guardians, teachers and pastors must talk to young people about sex, thus empowering them to deal with situations which may arise for instance being forced to have sex.
Based on what is happening, Black women need to take control of their lives to ensure better health. It is obvious that we cannot depend on our men to protect us from the deadly HIV, so that leaves only us. Women especially married ones or those who believe they are the only ones need to be particularly careful.
Ask your partner questions, quit having sex in the dark where you cannot examine your partner to see if there is something wrong. Demand that your partner use a condom, if you suspect he is having an affair and if he insists on not using the condom, leave.
As one writer says, Black women need to realise that HIV is no longer knocking at the door, but has entered the home, robbed the food from the refrigerator and is now sleeping in your bed.
