40% of new infections globally are now occuring in women, according to American epidemiologist Prof. Kenrad Nelson. It is well known that the gender disparity seen in the early days of the pandemic has disappeared, and in some developing countries women now out-number men in the AIDS statistics. Gender equality in HIV/AIDS cases also appears to be directly linked to gender inequalty at a social, economic and sexual level.
In a panel discussion on the growing Asian HIV epidemic among women, Professor Dr. Alaka Deshpande reviewed her clinical experience at the main research hospital in Mumbai, India. Cases have risen dramatically – she was seeing 9 female patients with HIV in 1991, and in the first half of 1999 has seen over 300. The social background of these women has also shifted substantially. In the early days the majority of her clients were women working in the sex industry – now the vast majority are housewives.
Reviewing the history of 370 HIV-positive women reported in 1998, she identified that 350 were infected by their husbands. 64% of these women are aged 21-30, and 20% of them have already been widowed by AIDS. This is consistent with data presented elsewhere in the Congress, for example Newmann et al report that 88% of HIV-positive women in South India report a history of only one lifetime sexual partner. Deshpande highlighted some of the disturbing practices underpinning the epidemic in India, in particular the continued practice of child marriage. Young girls have particular physical vulnerabilities to HIV given that the immature reproductive tract is easily traumatised by early sexual intercourse, increasing the risks of HIV acquisition.
In addition to this Deshpande reported extremely high rates of STIs, with 88% of women showing up as experiencing Pelvic Inflammatory Disease, yet few complainig of symptoms. Indeed, one of the critical compounding variables for these STIs is the fact that they are asymptomatic. Work published by Joshi (also from Mumbai) shows that, among 300 HIV-negative women, 55% had bacterial vaginosis, 45% Trichmoniasis, 40% monilliasis, 27% chlamydia, 17% herpes simplex virus and 15% Human papilloma virus. HPV is one of the prime causes of cervical cancer, and this is as strongly associated with increased rates of cervical pre-cancers among HIV-infected women in the Asian region as has previously been extensively reported in Europe and the US. Confronting HIV in women is complex, and Deshpande clearly identified how most current models exhibit significant gender bias, for example exhortations to practise monogamy are meaningless when most women are infected in monogamous relationships. She defined an action agenda for women thus: Reproductive Health services; Health Care at the doorstep, Early Detection, Education, Social Support, Political Partnership, Empowerment.