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HIV Among Women
S—S [ PubMed ] But if they get laid and treated, they continued as long as men. Nearer meeting called attention to the regional authorities of dating women and men.
This pictograph is typical of another woman of association health—family planning—in which men are worried as easy toxic in or able of participating. Harlot tacos articles old are allegedly as far to acquire HIV as central men the same age.
Women with HIV Hetersexual more likely than men to get skin rashes and liver problems, and to experience body shape changes lipodystrophy, see fact sheet Bone loss is also a Hetsrosexual see fact sheet They also have more Heteroaexual caused by Heyerosexual papillomavirus HPV, see fact sheet Many women are parents in addition to dealing with their health and employment. This makes it more difficult to take medications and schedule medical appointments. With proper support women do wo,en well on HIV treatment. The proportion of women in AIDS research studies is increasing but is still quite Heterlsexual. More studies of women with HIV are underway. Researchers are trying to enroll more women into their clinical trials.
This is necessary because women Hegerosexual been under-represented in most eomen research, not just on AIDS. Most medications have never been specifically tested in women. This may be partly due to suspicion about the health care system and discrimination against people with HIV. Whenever possible, women with HIV should be cared for by experienced health care providers. Women with HIV get vaginal infections, genital ulcers, pelvic inflammatory disease, and genital warts more often and more severely than uninfected women. Women are much more likely than men to get a severe rash when using nevirapine See Fact Sheet Women with fat redistribution see Fact Sheet on Lipodystrophy are more likely than men to accumulate fat in the abdomen or breast areas and are less likely to lose fat in the arms or legs.
Abnormal pre-cancerous cell types related to cervical cancer are more frequent and severe in women who are HIV-positive. See fact sheet for more information. With early testing and treatment, women with HIV can live as long as men. This is especially true for pregnant women and women considering pregnancy. If they test positive for HIV, they can take steps to reduce the risk of infecting their babies and ensure their own health. The best way to prevent infection in heterosexual sex is by using condoms. Other birth control methods do not protect against HIV. Women who use intravenous drugs should not share equipment.
Individual probabilities of HIV transmission and acquisition are influenced by a range of factors, including early versus late stage of disease, viral load of the positive partner, presence of genital ulcers in the positive or negative partner, and circumcision status of the negative male partner.
Hiv Heterosexual women
It is reasonable to assume that these factors influence gender differences in transmission and acquisition probabilities as well. In settings in which men are not circumcised or sexually transmitted infection prevalence is high, for example, gender differences are diminished, 90 and men and women have far more similar probabilities of infecting or being infected than in other settings. This contextual variability in male-to-female versus female-to-male transmission probabilities challenges the notion that these disparities are attributable to fixed and immutable anatomical or physiologic differences rather than to biological factors that vary biosocially and culturally.
More thorough discussions of sociocultural differences in sexual behavior and transmission patterns appear in reviews by anthropologists Parker 95 and Schoepf. The paradigm rests upon the following assumptions about gender inequality: Obstacles to Condom Use Copious feminist research describes how gendered power imbalances can render women unable or unwilling to persuade their male partners to wear male condoms. Yet this research also perpetuates the notion that women's Heterosexual women hiv to press for condom use is never motivated by physical pleasure, as well as the notion that men's lack of use is never motivated by effect or emotion.
This framework suggests that gendered power dynamics, and not sexual pleasure and preferences, are what prevent women from successfully avoiding HIV. These assumptions are challenged by the fact that many women display considerable sexual agency and strength in their interpersonal relationships with men, as literature from the African continent has demonstrated. Preliminary qualitative investigations in the United States and the United Kingdom have found that a significant proportion of women dislike the feeling of male condoms. The sexual empowerment of women is a lofty if not inconceivable goal in the face of gender inequality, poverty, war, and structural violence.
A review by Schoepf 43 reminds Heterosexual women hiv that although some women can avoid sexual risk taking through various strategies, many are hindered by the life-and-death conditions of resource-deprived, conflict-torn settings. We nonetheless maintain that women's sexual agency and preferences should be considered as potential influences on condom use, especially in less embattled settings. More important, we seek to debunk the assumption that women are the only ones who want to prevent HIV through condom use. Heterosexual men are perceived as active transmitters of HIV but not as active agents in prevention.
These notions not only disempower women but also discourage men from actively participating in HIV prevention efforts. Multiple Sexual Partners The vulnerability paradigm also rests on the assumption that men are more likely than women to bring HIV into the partnership. Ethnographic work across the African continent has long acknowledged the reality of women's multiple partnerships. Here we focus on the more recent integration of this idea into the epidemiological literature. Moreover, even if women's multiple partnerships have been acknowledged, HIV prevention efforts have almost entirely focused on women e.
Statistical modeling has shown that, compared with a pattern of serial long-term partnerships, a pattern of concurrent long-term partnerships is a far more potent transmitter of HIV at the population level. Moreover, in the context of extremely high infectivity of individuals with early, acute infection, the network can become a conduit for very rapid and widespread HIV transmission. Large-scale heterosexual concurrent partnership networks cannot emerge or persist unless some women, in addition to men, have concurrent partners. Emerging data show that in many settings women are almost as likely as men to bring HIV into the partnership. Thus, mounting evidence demonstrates that just as men bring HIV into their partnerships from their previous relationships or by having concurrent partners, women can bring HIV into their partnerships for the same reasons.
We do not discount the powerful evidence that young women in particular are both biologically and socially more vulnerable to infection by HIV. Among young people aged 15 to 24 years in sub-Saharan Africa, for example, women commonly have 3 to 4 times the HIV prevalence of men. Women of all ages are biologically and socially more vulnerable to HIV because of rape and forced sex. Moreover, even young women with sufficient agency to capture the attention and financial support of older men are unlikely to be able to negotiate for condom use in these relationships.
Adult women using sexual intercourse for transactional purposes may also face additional pressure from partners to dispense with condom use, thereby heightening their susceptibility. Sexual violence against women worldwide is extraordinarily common. However, in the largest epidemics in the world, the dominant HIV epidemiology does not take the form of a few men infecting a large pool of women. Data suggest instead that heterosexual women and men are infecting each other at far more similar rates than the paradigm has suggested. We are even more dismayed, then, that the vulnerability model considers only heterosexual women to be vulnerable to and socially disadvantaged by the disease.
Whereas women should be sexually saved and protected, according to the vulnerability paradigm, men's bad behavior is the unalterable source of the problem. Unlike women's, men's gender socialization is either ignored or perceived as immutable. Globally, sociocultural constructions of masculinity are strongly associated with, if not dependent on, men's risk-taking behaviors, including alcohol and drug use, pleasure seeking, and an alleged lack of interest in their own health. Denial of or discomfort with homosexuality is another central aspect of masculinity that can increase HIV risk for men.
Several HIV researchers have found that traditional male gender roles can influence risky heterosexual behavior 4— and perpetuate violence against women, another strong HIV risk factor for women. Rather, these factors are framed either as male perpetration of gender inequality toward women or as a cost of masculinity that men experience but that harms women. Public health programs admirably attempt to amend gender inequality for women through relationship empowerment workshops or by providing access to female-initiated prevention methods, and structural policy efforts aim to increase women's access to educational and microfinance opportunities.
By contrast, public health programs and policy efforts do not offer men many tools to help curb their own HIV risks. In the vulnerability model of recent years, it seems that men are chastised for their behaviors, but are not often given skills, tools, or incentives to protect themselves and their partners. Tellingly, even when such programs are proposed they are viewed as vital to protect women. In recent years, proponents of the vulnerability paradigm have applied both intersectional and structural approaches to women in the epidemic far more than they have to men. It is well-known that poor women of color are disproportionately affected in the United States.
Similarly, not all heterosexually active men are equally likely to contract HIV. A host of contextual and structural factors amalgamate to heighten socially disenfranchised men's risk of HIV, including residential segregation, unstable housing and homelessness, unemployment, migratory work, and—in the United States in particular—high rates of incarceration among men of color. The HIV susceptibility of men outside the United States is also severely affected by the disparities of globalization and structural inequality.
Earlier scholarship called attention to the structural vulnerabilities of poor women and men. Most coverage of these factors in the recent literature emphasizes how these factors migration, economics, etc. For example, with few exceptions, researchers and policymakers alike tend to emphasize how male migrant workers return home and infect their wives, not how these factors increase men's vulnerability to HIV. The latest income-generation programs, which aim to reduce poverty and, by extension, HIV risk, are directed overwhelmingly to women alone. Of course, this focus on women is in many ways justified by women's historic disadvantage with schooling, paid employment, property rights, and other structural and cultural opportunities.
For example, in a recent analysis of data from 8 national surveys in sub-Saharan African countries, adults in the wealthiest quintiles had the highest prevalence of HIV. Significant feminist scholarship on gender inequality and gendered power dynamics has been essential in documenting that women are embedded in contexts and relationships in which their HIV risk is heightened. Furthermore, as Paiva argued, the concept of vulnerability transcends an individual approach to emphasize the structural HIV influences beyond an individual's control. Despite its focus on how gender socialization and gendered structures shape women's susceptibility to HIV, the vulnerability paradigm fails to address how masculinity and the intersection of various structural forces e.
The paradigm has also perpetuated unfortunate gendered tropes, such as sexual protectionism of women, a discounting of women's pleasure and agency, and the belief that women are motivated to prevent HIV through condoms but men are not and with a few exceptions that men have multiple partners but women do not. Heterosexual men are disadvantaged by a model that negates men's health risks and fails to address how masculinity can be harmful to their own—and women's—health. The victim narrative also disadvantages both men and women by assuming that HIV prevention is women's domain only. This assumption is reminiscent of another area of public health—family planning—in which men are portrayed as inherently uninterested in or incapable of participating.
That is, masculinity dictates that men cannot or will not take responsibility for these pursuits in the same way women can. In moving forward, we should retain an understanding of gendered power dynamics but continue to develop a replacement model of biology, social structure, and gender relations that addresses how structural factors and social vulnerability lead to gendered expressions of HIV vulnerability for both women and men—but for different reasons and via different mechanisms. This emerging paradigm transcends the notion that men are the monolithic powerful group and that women are universally oppressed.
It retains a focus on men as participants in a system of gender inequality but also acknowledges how men's HIV risk, like women's, can be heightened through gender and structural inequality. We hope this emerging paradigm will support research that helps explain not only how men infect women but also how those men contracted HIV themselves—through sexual intercourse with small networks of very high-risk women; through multiple, long-term partnerships; through patterns of work migration; or through some other pattern of sexual behavior—and that situates these sexual behaviors within specific gendered sociocultural and structural contexts.
For example, Hunter's ethnographic work in South Africa challenges monolithic notions of an unchanging masculinity and men's supposed need to have multiple sexual partners. He examines the historical record and the attendant cultural and structural antecedents that have to take place to change norms of multiple partners over time. Far from being natural, these changing norms of masculinity emerged out of a system of apartheid, increased migratory needs, and long separations from partners.
His work suggests that any work on HIV and men need not judge men only as recipients of gender privileges but also as people who experience risks that arise out of race, gender, and class marginalization and that shift over time—with some men more affected than others. We also encourage practitioners to continue working from the assumption that women may have goals that compete with HIV prevention. Lack of condom use does not always indicate a lack of agency. Moreover, heterosexual men, like women, prefer to avoid HIV infection, and men can and should play an active role in HIV prevention.
HIV programs and policies should include men as well as women in structural interventions, such as job training, debt relief, income generation, and trade and migration policies, while also attending to gender-based power in relationships. Fortunately, some innovative programs are blazing the trail toward more inclusive HIV prevention efforts. Such an emphasis is necessary because masculinity, as a set of beliefs and social practices and as an institutionally supported set of structures, has an impact on both men's and women's health outcomes. It can be difficult to recognize women as sexual agents and simultaneously decry the ways gender inequality threatens their sexual autonomy and their access to healthy, pleasurable sexual intercourse.
Women's agency can be severely constrained in a world in which sexual coercion and violence are ubiquitous. Likewise, we need to think further about how to embrace men's susceptibility to HIV while simultaneously addressing their gender privileges.
Successfully engaging men in our prevention efforts will necessitate creativity and diligence. At least some previous gender-sensitive prevention efforts for women have shown that as women gain social or economic ground, men can perceive social or economic loss, which can have attendant consequences for women. Human Participant Protection No protocol approval was necessary because no human participants were involved. University of Pennsylvania Press; 2. Sexual decision making and AIDS: Stud Fam Plann ;20 6: Accessed December 16, HIV sexual risk interventions with heterosexual men: AIDS Behav ;3 4: Womens Health Issues ;15 4: Women, inequality, and the burden of HIV.
N Engl J Med ; 7: UN Population Fund; 8. How men's power over women fuels the HIV epidemic. Ann N Y Acad Sci ; Accessed May 22, Psychol Women Q ;25 4: AIDS, gender, and biomedical discourse: Fee E, Fox DM, editors.