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Why so many women have HIV/AIDS and how Christians can respond
By Arthur J. Ammann, MD
Several years ago, the worldwide HIV/AIDS epidemic underwent a significant change. There are now more women infected with HIV than men, a trend that will continue indefinitely. The reason for this has to do with justice and equity – things that the Scriptures tell us are at the very heart of God.
Twenty-five years have passed since the acquired immunodeficiency syndrome (AIDS) was first described. Research and clinical studies produced some of the most remarkable advances in the history of medicine. We know more about the human immunodeficiency virus (HIV), the cause of AIDS, than any other virus. We have more than 20 drugs to treat HIV - more than any other viral infection. We know how to prevent every means of HIV transmission.
In spite of all this knowledge, we are failing to control the relentless increase in infections that now accounts for 5 million new infections each year - more than 50 percent in women. HIV infection is lifelong regardless of treatment. Thus, it has the potential for lifelong HIV transmission, which accounts for the cumulative escalation of the epidemic to its present level of 40 million individuals living with HIV/AIDS.
The shift of the epidemic, from a majority of men in the 1980s to a majority of women and young girls beginning in 2001, has been called the “feminization” of HIV/AIDS. In the U.S., the number of HIV/AIDS cases in women tripled from 1986 to 2004.
Young girls between the ages of 13 and 19 years represent more than 57 percent of new infections among teenagers. In sub Saharan Africa, 65 percent of the infections are in women. The majority of the 20 million women who are HIV infected worldwide are of childbearing age. Approximately 2 million HIV infected women become pregnant each year, contributing to the dramatic increase in the estimated 12 million orphans and vulnerable children.
Why more women are infected
A woman is eight times more likely to become infected from a sexual act with an infected man than a man is likely to becoming infected from a sexual act with an infected woman. Several factors contribute to this enhanced susceptibility, including the large surface area of the vagina, which increases the opportunity for the virus to access the blood stream, and the presence of sexually transmitted infections (STIs), which allows the virus to enter the blood stream via sores and ulcerations. Young girls are at greater risk than older women due to differences in the development of the vaginal epithelium.
Some religious and cultural practices also contribute to increased rates of HIV infection in women. Wife inheritance by brothers, following the death of a husband, increases the potential of introducing HIV into another marriage relationship. Some cultures practice sexual cleansing following the death of a husband; the widow is required to have sexual relations with male relatives to “cleanse” her from the spirit of her dead husband.
Several cultures and religions encourage early marriage of young girls. Frequently the husband is an older man who is sexually experienced and HIV infected. Polygamy, sex outside of marriage, and extramarital sex during pregnancy are additional factors that contribute to higher rates of HIV infection in women. Male dominance over sexual decisions prevents women from protecting themselves from HIV infection. If a woman refuses to have sex or asks that a condom be used, she may be subjected to sexual and physical abuse.
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| "I came across this sculpture in a peaceful garden and was struck how it symbolized so many of the issues of women in a world of poverty and suffering." Arthur J. Ammann | Because of poverty, families may sell their daughters into prostitution. The rate of HIV infection among prostitutes is up to 10 times greater than women in the general population. When girls become HIV infected, they are no longer profitable to the sex industry. They are dismissed and return to their families, but are often rejected because they are an economic burden and in need of health care. "Sugar daddies" prey on girls and women who trade food for unprotected sex. Higher premiums are paid for sex without a condom or with a young virgin girl. Sex becomes a means of immediate survival while increasing the risk of long-term disease and death from HIV.
Political and legal indifference and permissiveness contribute to the sexual abuse of women and their lack of control over sexual decisions. There is reluctance to accept the purposefulness of sexual abuse and rape during times of conflict or to equate it with a form of genocide. Yet behind the deliberate rape of women is the intent to render her stigmatized and useless to her husband, family, and community. Rape by an HIV-infected soldier is an insidious means of planting “viral landmines” known to have their impact long after armed conflict has ceased.
International public health may fail to fully implement the traditional cornerstone for controlling sexually transmitted diseases - routine diagnostic testing, partner notification, and contact tracing. In resource poor countries, men access antiretroviral drug treatment (drugs that treat HIV) more readily than women. However, many international public health programs do not require that an HIV infected man notify his partner. Now that life-saving treatment is available, it is not medically or ethically justifiable to treat one sexual partner and leave undiagnosed and untreated the other sexual partner. Several clinical studies indicate that HIV infected women are less able to access treatment and have poorer survival rates than men. The need for advocacy for equal access to antiretroviral drugs to treat women is great.
Issues of injustice increasingly focus the HIV epidemic on human rights abuses of women. Throughout all societies, cultures, and religions, women are most often viewed as subservient to men. A woman’s right not to have sex or become pregnant has long been an issue. The right not to become infected with a lethal virus such as HIV must also be an issue. Tragically, no country or culture seems to be immune to these destructive forces.
Paradoxically, in spite of the ever-expanding HIV epidemic, there are successful methods for reducing or preventing HIV transmission to women. Women who abstain from sex and couples who are faithful to each other with no other history of HIV exposure or means of HIV exposure will not become infected. Individuals whom use condoms accurately and consistently will decrease their risk of getting HIV. Testing of blood donors substantially reduces the risk of blood transfusion HIV. Treatment of HIV-infected pregnant women with antiretroviral drugs reduces the potential for HIV transmission to babies during gestation and delivery and substitution of formula feeding for breast feeding eliminates breast milk HIV transmission, although the latter has significant implications and difficulties in a developing country which has limited access to clean water and formula.
A Christian response
HIV has thrown the spotlight on the unique risks and difficulties for women. As long as women remain devalued, the HIV epidemic will persist as one predominately of women and an increasing number of orphans and vulnerable children. Scriptural instructions to honor and protect women, especially the widows and those who are disadvantaged, stand in contrast to what has happened to women in the HIV epidemic. As Christians, we must address why discrimination and stigmatization of women is so persistent and exaggerated in spite of what appears to be pervasive Judeo/Christian ethics. HIV-infected people, especially women, often identify discrimination and stigma as one of their major problems. Unfortunately, the source of the stigma can be from both their communities and their churches or mosques.
The teachings of Jesus can radically change the current feminization of the HIV epidemic. The Gospels are replete with examples of the respect that Jesus had for women regardless of their status. Women were an integral part of his ministry and he particularly defended those who were ready to be condemned by political and religious leaders.
For the Christian today, the challenge of HIV/AIDS is this: Can we have the courage of Jesus to love, to understand, and to forgive a person with a disease that we may not understand? How do our beliefs translate into action to correct the injustices related to the feminization of the HIV epidemic? Our Judeo-Christian heritage teaches us to respond to all those who are suffering - the poor, aliens, and especially widows and orphans.
During the HIV/AIDS epidemic, I have found myself grappling with the pain and suffering of this disease, the ethics, and the injustices, especially toward women and children. I have found in Jesus’ teachings some of the answers that I have been looking for. Those answers were not found, as many suppose, in the healing or touching of the lepers. I found answers in the story of a meeting that Jesus had with a woman – the Samaritan woman at the well.
In the book of John, chapter 4, we read that Jesus had to go through Samaria. There was a person there who he had to meet, who would be transformed by a singular encounter. Meeting that person - at that time, in that location, and under those circumstances - was wrong from almost every religious perspective of the day. Some would consider it even wrong today.
Jesus met a woman – the wrong sex, the wrong religion, the wrong ethnic group, and the wrong level of education. Speaking to and sharing the same vessel of water with her, a woman with many sexual partners, who today might be infected with HIV, would have been considered by religious leaders of the day an act of defilement.
In the longest discourse recorded in the Gospels, Jesus addressed the physical and spiritual needs of a woman. This woman was transformed because Jesus sought her out, and in turn she brought others to Jesus. He addressed her physical and spiritual needs. We read in the book of John that in doing this Jesus was sustained because he had performed the will of God. What we often do not understand is that it is we who are also sustained as we obey God and minister to those in need.
I believe that there are times of desperate need, both physical and spiritual, which Christians ignore because we do not see them as Jesus sees them. This is true in regard to the AIDS epidemic. The Church in America has lived outside the community of pain and suffering induced by this disease. The arm of those who are HIV positive has been severed from the Body of Christ. We have not been the salt of the earth providing an infusion of compassion and love. Rather than distinguishing ourselves as advocates for those who are HIV infected, we are living on a low salt diet, and, in doing so, we have missed the blessings of obedience.
I have been blessed, not by what I have done, but by what those who are HIV positive have done for me. Courage in our beliefs means reaching beyond the safe borders of individuals who surround us in our daily lives and reaching out to those who seem the most unlikely recipients of the love and freedom that we have been given. Courage means overcoming the curse of abundance that often blinds us to the needs of others and creating transforming relations with those who need help.
The words of Jesus are simple and unambiguous - we are to care for the needy, the suffering, the widows, and the orphans. He does not introduce a qualifier as to the cause in order for us to respond.
For Christians worldwide, the HIV/AIDS epidemic is a test of how deeply we believe in God’s justice and the teachings of Jesus. How complete is our forgiveness, how rich is our compassion, and how far does our love reach out to overcome the stigmatization and discrimination of HIV to comfort those in pain and suffering?
Arthur J. Ammann, MD, is president of Global Strategies for HIV Prevention (www.globalstrategies.org) and clinical professor of pediatrics at the University of California, San Francisco Medical Center. Global Strategies for HIV Prevention is a non-profit organization, founded in 1998, dedicated to HIV prevention and responding to the needs of HIV-infected women and children worldwide.
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