The feminization of AIDS

Lois Crenshaw, an AIDS activist, former Chicago police officer, and Minneapolis resident, is one of the estimated 1,367 Minnesota women living with HIV, who represent 23% of all cases of HIV or AIDS in Minnesota. Crenshaw contracted HIV when a man raped her while she was on vacation in the Bahamas in 1994.

The Minnesota AIDS Walk takes place May 18.

“It’s like the flu.” Lorraine Teel, executive director of the Minnesota AIDS Project, says, “If you’re in an area with a lot of flu [cases], chances are you’ll catch the flu.” The disease is less prevalent among white women only because there are fewer carriers of the virus to pas it around.

These Minnesotan women of color are experiencing the full force of what physicians and activists say is an ever-increasing “feminization” of the AIDS pandemic worldwide that preys on women’s unique biological and social vulnerabilities. Rape is the most emblematic female vulnerability. Lorraine Teel, executive director of the Minnesota AIDS Project, says the factors driving the feminization of HIV/AIDS are much broader, and extend to all women.

According to Teel, the influence of messages women receive growing up about how much power they have to control their sex lives is “quite intense.” Rape is an expression of this cultural attitude, but the vulnerabilities are much larger and broader.

“At the very heart, it’s an issue of power,” Teel says.

Generally speaking, says Abdulahi Sheik of the Minneapolis Urban League’s African Wellness Program, women are made vulnerable through less access to economic power and education, national cultural norms that do not value women’s full control over their sex lives, as well as the culture and environment of their immediate families. In addition, women are much more vulnerable biologically to sexually transmitted diseases – the vagina and uterus are much more penetrable by bacteria and viruses than is the penis.

“Don’t let someone else’s past catch up to you!” Crenshaw exclaims, when asked about advice she gives young women. In her lectures and activism, she says, one of the most important things she teaches is “empowerment” – changing those messages women of all ages hear, and teaching them to stand up for themselves in sexual situations as a way to change the underlying culture.

To Crenshaw, being empowered means knowing about safe sex, being able to demand a condom, and knowing if one’s HIV status (positive or negative) as well as one’s sexual partner’s HIV status.

According to Pat Daoust, the AIDS Campaign director for Physicians for Human Rights, the HIV/AIDS pandemic in Minnesota and Sub-Saharan Africa share “underlying similarities”, leading to similar rates of infection. In Sub-Saharan Africa, women are over 60% of all cases.

In both contexts, Daoust says, a woman is generally somewhat economically dependent on her male partner, and is forced to give up some control over her sex life to men. In addition, though, in Sub-Saharan Africa the sheer number of cases strains countries’ healthcare systems, compounding the limited access most women have to good healthcare.

In many Sub-Saharan countries’ healthcare systems, according to Daoust, HIV testing, support, and treatment are not linked with the women’s health issues – family planning, pre-natal and post-partum care – that typically bring women to seek out a doctor, nurse, or traditional medical providers. This not only makes it extremely difficult for women to access AIDS care, but also leaves their babies vulnerable to contract HIV during childbirth because expectant mothers do not get access to the drug cocktails that significantly reduce the risk of mother-child transmission.

The U.S. foreign aid program to combat AIDS is not set up to support an integrated treatment approach. The President’s Emergency Program For AIDS Relief, or PEPFAR as it is commonly called, provides funds for education programs that promote abstinence, marital fidelity, and condom use, and has scored some successes over the past five years. With PEPFAR up for renewal this year, PHR is lobbying Congress extensively to support changes to the program that would not only link HIV/AIDS testing, counseling, and treatment with women’s health issues, but also would set aside money to train 140,000 African doctors and nurses and give them meaningful salaries if they returned to work in their home countries, in order to improve indigenous healthcare systems.

In Minnesota, many activists also say women’s socio-cultural and economic disempowerment are truly what drive the feminization of HIV/AIDS, and thus continue to drive the epidemic. But many activists focus their efforts on breaking down social and cultural stigmas around HIV/AIDS.

Just getting the message of HIV/AIDS education across without upsetting the applecart of cultural taboo or popular myths is a step forward in giving women of all ages an awareness of the risk of contracting HIV/AIDS or other STDs, and a knowledge of what kinds of protection to demand from their male sexual partners.

Most grassroots HIV/AIDS activism in Minnesota today is focused on this kind of basic sexual health education. According to Dr. Omobosola Akinsete of HCMC, one of the leading HIV/AIDS clinicians in the state, the hope is that more awareness will help lessen the stigma of discussing one’s HIV/AIDS status, leading people to get tested frequently, and leading both men and women to less risky sexual behavior either out of fear of contracting HIV/AIDS or fear of transmitting it to others.

James Sanna (james.sanna@gmail.com) is an intern and writer at the Daily Planet