amfAR, The Foundation for AIDS Research

HIV’s Alarming Impact on Women of Color

January 23, 2006—In 1989, Karina Danvers received a shocking diagnosis: HIV.

“I never thought for a second I was at risk,” said Danvers, director of the Connecticut AIDS Education and Training Center at the Yale School of Nursing. “I used to say that by a certain year we'd all know someone with HIV. I never thought I'd be one of them.”

Danvers represents the changing face of AIDS. Once considered almost exclusively a white, gay man's disease in the United States, today women account for one in four new AIDS cases, more than three times the proportion they made up in 1986. And it is women of color who are disproportionately affected.

African American, Latina, Native American, and Asian and Pacific Islander women represent only 29 percent of the U.S. female population, but account for 84 percent of female AIDS cases. Black women today are 23 times more likely to have AIDS than white women, and Hispanic women are five times more likely.

On January 10, amfAR, the Society for Women’s Health Research, and Women’s Policy, Inc., held a Congressional briefing to address the underlying factors that make minority women vulnerable to HIV and to educate legislators about HIV's devastating impact on women of color.

Dr. Judith Auerbach, amfAR's vice president of public policy and program development moderated the panel.

A Changing Epidemic

“The AIDS epidemic in the United States has changed color and it's changed race,” said Dr. Lynn Paxton of the U.S. Centers for Disease Control and Prevention. Most women are becoming infected through heterosexual sex, she said. Back in 1985, more than half of women with AIDS reported injection drug use as a risk factor for the disease. Today, about 71 percent report that their risk factor is heterosexual sex.

Many of these women are completely unaware they are at risk, said Dr. Cynthia Gomez, co-director of the Center for AIDS Prevention Studies at the University of California at San Francisco.

They do not have a partner who injects drugs or who has sex with men and they say they have no idea how they became infected.

“Is it really possible that women do not know that they’re at risk for getting HIV?” Gomez asked. “Well, I assure you that all uninfected women in this room probably do know that they could get HIV. But I’m also certain that 90 percent of you would state that you don’t think you’re at risk for getting it. And this is typical around the country.”

According to the government's data, today's HIV/AIDS epidemic has major geographic disparities as well. Only about 29 percent of U.S. women live in the South, but 76 percent of women newly infected with HIV are from that region.

“Part of this is probably related to...socioeconomic challenges,” Paxton said. The South “is the area that has the highest poverty rates in the United States, the most uninsured, and the fewest high school graduates.”

The “Perfect Storm”

Infected by her husband when she was still a teenager, Karina Danvers never thought she would still be alive today. She has enjoyed good health care and access to lifesaving medications, but she knows that many women of color are not as fortunate. When a teenager asked her many years ago how she could have AIDS and look so healthy, she did not have a good answer. Today she knows why.

“Because I’m not poor,” Danvers said. “Because I have not only a good high school education but a graduate degree. Because I have good private medical insurance. Because I’m middle class. And although I’m a minority—I’m a Latina—I’m bilingual, not monolingual.”

Danvers’ and Paxton’s remarks underscore what is becoming increasingly clear about this country’s HIV epidemic: it thrives in communities already ravaged by poverty, disease, crime, violence, and drug addiction. Women’s biological vulnerability to HIV and other sexually transmitted diseases is only exacerbated in places where lack of education, economic instability, domestic abuse, and lack of control in sexual relationships are day-to-day realities.

These are just some of the factors that converge to create “the perfect storm” for HIV transmission, said Gomez.

In her research on heterosexual transmission of HIV among African-Americans in the rural South, Dr. Adaora Adimora, associate professor of medicine at the University of North Carolina at Chapel Hill, studied whether socioeconomic environment increased the likelihood of engaging in high-risk behavior and, in turn, becoming infected.

Black men and women in a study group reported extensive economic depression and racial discrimination that restricted educational and employment opportunities. Women noted how incarceration, drug addiction, and violence had greatly reduced the number of available black men, profoundly affecting the partners women chose and the type of behavior they would tolerate from their men.

The rate of concurrent partnerships—sexual relationships that overlap over time and spread HIV and other sexually transmitted diseases much more quickly than sequential partnerships—is affected by incarceration, low marriage rates, and economic instability in the black community.

“We concluded that contextual features including racism, discrimination, limited employment opportunity, and resultant economic and social inequity may promote sexual patterns that transmit HIV,” Adimora said.

Native American Communities

The socioeconomic challenges faced by black communities are not unlike those faced by the Native American population, said Karina Walters, an associate professor at the University of Washington School of Social Work who has studied HIV’s impact on Native American women as well as the social and historical context in which high-risk behaviors occur. As in other communities disproportionately affected by HIV, poverty, violence, racism, and drug use all play a major role in driving infection rates.

In proportion to their population, Native Americans are the third most affected ethnic group. In fact, the number of AIDS cases has grown more rapidly than any other ethnic group, increasing almost 800 percent between 1990 and 1999, Walters said.

“And you never hear that in the media, do you? So again, this is part of the institutional discrimination that Native people face. We are rendered invisible in the data.”

Addressing the Underlying Issues

The panelists made numerous recommendations for confronting the HIV/AIDS epidemic in communities of color. They urged enhanced STD and HIV testing and treatment efforts, greater access to lifesaving HIV/AIDS drugs, and greater social service support for people living with HIV/AIDS. Comprehensive sex education for young people was key to preventing new infections, panelists said.

"Record numbers of black and Latino youth are getting HIV, giving it to others, and many of these people are going to go on to die from it," Adimora said. "Youth need to be given the full armamentarium of information to protect themselves."

They all urged that community and political leaders begin the most difficult work: addressing the underlying issues that make women of color so vulnerable to HIV.

"The usual response to this suggestion is to sort of shrug and say, 'Well, we can't do anything. We can't change poverty and racism,’” Adimora said. “As long as we continue to accept the status quo, we need to acknowledge that we're actually just accepting racial disparities and disease rates. Racial disparity and HIV rates in the United States is a major civil rights issue, and it is, in fact, a major human rights issue."

This Congressional briefing was an element of amfAR’s Women, Sexual Health, and HIV/AIDS initiative, an effort to raise awareness about the HIV/AIDS epidemic among women and girls in the U.S. and internationally, and to promote research, education, and policy activities to address it.