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Women and HIV
Inequalities within the family
Medical differences between HIV positive men and women
Blueprint for Action on Women & Girls and HIV/AIDS
Vulnerability of Women and HIV
There are an estimated 42 million people living with HIV in the world. Women now account for one-fifth, up from one-tenth in 1995. The face of HIV/AIDS has changed greatly since the early years of the epidemic. Western scientists first understood HIV/AIDS as a health concern of men, especially gay men. It took time and overdue research to understand that women are physiologically more vulnerable to HIV transmission than men, at least where heterosexual transmission is concerned. It took even more time to bring the world around to the idea that physiological factors were only one aspect of women's vulnerability to HIV/AIDS.
Since the beginning of the epidemic, women and girls have accounted for a steadily larger proportion of new HIV transmission, both in Canada and internationally, primarily as a result of sex with a male partner living with HIV. Not enough has been done to address the poverty, subordination, violence and human rights abuses that drive the epidemic among women and compound its impact upon them.
Domestic Violence and HIV
by Sandra K. Trisdale, Ph.D.
July 2005
Domestic violence can happen to anyone. Tragically, one in four women will be abused during her lifetime. In many parts of the world, this figure rises to over 60 percent.
What is Domestic Violence?
Domestic violence occurs when a person you are dating, living with, or married to physically injures you. It can involve mild physical harm that is difficult to prove – like pulling hair or twisting flesh. It can also involve actions that leave marks – like hitting, slapping, or beating. Sometimes it can escalate to the use of knives or guns. It can also involve rape or sexual assault (being forced into sexual acts without your consent).
Domestic violence often begins with threats or emotional abuse. While these harmful words or actions may or may not lead to actual physical harm, they can still be very upsetting, scary, and leave long-term emotional scars.
While most domestic violence involves men assaulting women, it can also involve men assaulting their male partners, or women assaulting their male or female partners. Domestic violence is more common in the lesbian community than was formerly believed.
Women, HIV, and Domestic Violence
Many women with HIV have a history of being physically or sexually assaulted prior to finding out about their HIV status. Several studies have shown that women with a history of physical and/or sexual abuse are more likely to contract HIV.
Some women become infected with HIV as a direct result of rape or sexual abuse. If a woman uses drugs, alcohol, or sex to escape the pain of prior abuse, she may be at increased risk of getting infected due to shared needles, unprotected sex, or impaired judgment.
Many women with HIV have a history of abusing drugs or alcohol, as well having relationships with other substance abusers. This increases the risk of domestic violence because both partners may have impaired judgment.
A study revealed that over one in five women with HIV had been physically harmed since their diagnosis. Of these, almost half reported that they felt that the physical aggression resulted directly from their HIV status. So even if you never faced domestic violence before, you may encounter it after you find out you have HIV.
Minimizing Risk of Domestic Abuse
There are no guarantees in this world, but you can help minimize your risk for domestic violence:
- Do your homework. To find out information on the person you are dating (such as if he or she has a criminal record), consider doing a background check. There are a number of companies that provide this service for a fee.
- Keep in touch with your support people. Whether it's family, friends, or a support group, don't let your relationship get in the way.
- Deal with your past. If you have been physically or sexually abused in the past, it is important to get help from a mental health professional or a support group. Otherwise, the past can repeat itself.
- Cut your losses. The best time to leave an abuser is the first time it happens. Whatever you do, don't keep giving second chances again and again.
- Stay informed. Learn all you can about domestic violence, even if you think you will never need to know about it.
Leaving a Violent Relationship
It is never easy to leave a relationship, even one that involves domestic violence. The key is to have a safety plan.
- Stay safe. Remember that you are most in danger of being hurt or killed as you are leaving or immediately afterward. Make your safety (and that of your children) your top priority.
- Be prepared. If you leave, don't forget your HIV drugs and any other medications you take, medical records, birth certificate, credit cards, checkbook, etc. Assume that anything you leave may end up in the dumpster. It may help to leave an emergency kit with some of these items with a trusted friend, family member, or service provider. If you don’t want to give the name of the person you’re afraid of, you can put it in a sealed envelope and ask them to open it only if you disappear or turn up too injured to identify the person who hurt you.
- Document. Get medical attention if needed and get photos of any injuries that show. Have photos signed and dated by medical or law enforcement personnel if possible. A friend or family member can also sign and date for future evidence.
- Get help. Don't try to do this alone. Go to friends, the police, family, an emergency room, or a local shelter.
- If you become a victim of domestic violence, always remember – it is not your fault. It can happen to anyone. Anyone who physically attacks another person is responsible for his or her actions. The most important thing is to get safe and stay safe.
Inequalities within the family
In some societies, women have few rights within sexual relationships and the family. Often men make the majority of decisions, such as whom they will marry and whether the man will have more than one sexual partner. This power imbalance means that it can be more difficult for women to protect themselves from getting infected with HIV. For example, a woman may not be able to insist on the use of a condom if her husband is the one who makes the decisions.
Marriage does not always protect a woman from becoming infected with HIV. Many new infections occur within marriage or long-term relationships as a result of unfaithful partners. In a number of societies, a man having more than one sexual partner is seen as the norm.
Frequently asked questions about pregnancy and HIV
I am pregnant or thinking about having a baby. Should I be tested for HIV?
If you are thinking of having a child or you are already pregnant, it is important that you get tested for HIV. There are many pregnant women who are HIV positive and do not know about it.
If you are HIV positive and you are aware of this infection, then there are very good prevention strategies available to decrease the risk of your child becoming infected. Without any kind of prevention strategy, the risk of mother-to-child transmission is about 25%. However, if prevention strategies begin in sufficient time, this risk can be reduced to 1%.
Learn about HIV testing during pregnancy in Canada at Caring for Kids - Testing for HIV
I am/we are HIV positive. Is it possible to conceive safely?
There is information available to help infected partners or couples take protective measures to help reduce the risk of transmitting HIV infection to their partners and babies. The counsellors and health professionals at our toll-free Motherisk HIV Healthline can provide you with information and written resources to minimize the risk to non-infected partners.
The reproductive options of HIV-infected couples and more specific information for couples when the male partner is infected and the woman is not, can be found at:
The Body - Reproductive Options
HIV In Site
I am/my female partner is HIV positive. Is pregnancy harmful to the health of women with HIV infection?
Studies indicate that pregnancy does not harm the health of women with HIV infection or increase the chance of women developing HIV related illnesses. Additional information about planning for a healthy pregnancy for women with HIV infection can be found at Project Inform
I am HIV positive and pregnant. Will my baby be infected as well?
Most babies born to HIV-positive mothers will not get HIV. But some will. A baby can get HIV from its mother during pregnancy (before birth), during delivery (the most common way babies get infected), and through breast feeding.
There is approximately a one-in-four chance of mother-to-child transmission of HIV infection without any treatment. But, treatments and interventions exist that have been shown to significantly reduce the risk of infection to babies. If you would like to learn more about mother-to-baby HIV infection, register with MEDSCAPE and use their search engine to find articles on "Perinatal HIV."
During pregnancy and delivery, you can take antiretrovial drugs to reduce the risk of transmission. If you take a combination of antiretoviral drugs during pregnancy and delivery, and your newborn receives one of these drugs, the chance of transmission drops to about 1%.
Other strategies that can help to reduce the risk of infection include a shortened delivery time, and in some circumstances delivery by Cesarean section. Additional information about reducing the risk of HIV transmission to babies can be found at:
The Body - pregnancy and HIV
The Body - Antriretoviral Therapy
If I am HIV positive and pregnant, should I deliver the baby by cesarean section?
Whether you should deliver by Cesarean-section or vaginally depends on your HIV viral load level (how much of the virus is circulating in your blood) at the time of delivery.
If you are not taking any medication to lower your viral load or if you are just taking zidovudine, it is likely that your viral load will not be low enough to deliver vaginally without a significat risk of transmission of HIV to the baby. In this case, a Cesarean section would reduce the risk of transmission by half.
However, if you are taking a combination drug therapy to control your infection and the amount of virus circulating in your blood is undetectable, then there is no clear advantage to a Cesarean delivery compared to vaginal delivery. You should talk to your doctor, who can look at your particular situation, and provide appropriate advice concerning the mode of delivery for you.
If I take antiretroviral drugs during pregnancy, will that hurt my baby?
The use of antiretroviral drugs in prevention programs began around 1994, therefore, the number of women who have taken these drugs is still small and the babies born to these women are still young. It is too early to say for sure that there will be no problems. Until now, no major problems have been identified in children exposed to antiretroviral drugs.
If you have any further questions about taking HIV drugs during pregnancy, or want specific information about particular drugs or drug interactions you should call The Motherisk HIV Healthline 1-888-246-5840. You can visit CATIE and HIV Medication Guide
If I am HIV positive, can I breast feed my baby?
No. Breast milk is one way to pass on HIV to your baby. Your baby should receive infant formula as a safe alternative to breast milk. Studies have shown a 14% rate of HIV transmission when mothers with HIV breast feed their babies.
In Canada there are programs to provide free formula for babies of mothers with HIV. If you live in Ontario you should contact the Teresa Group at (416) 596-7703 or www.teresagroup.org to receive this service.
In other parts of Canada contact the Canadian AIDS Society (CAS) for information at (613)230-3580 or call the Motherisk HIV Healthline toll-free number at 1-888-246-5840. Additional information on HIV and breastfeeding can be found at The Body - HIV and Breast Feeding
Do babies with HIV infection look different?
No.
When will I know whether my baby is HIV positive?
Three successive blood tests are performed which taken together indicate whether the virus has been passed on to your child:
- Within the first few days of the baby being born;
- At 1 month of age; and
- At 2 to 4 months of age
If all three of these tests are negative for HIV, then the baby does not have HIV infection. If any of the above tests are positive, then another test is done. If two of the tests are positive, then the baby is infected with HIV. Additional information about HIV testing of children can be found at Canadian Paediatric Society
Medical differences between HIV positive men and women
Men and women tend to suffer from very similar AIDS related illnesses and symptoms. However, there are a few differences between men and women with relation to opportunistic infections and antiretroviral drug treatment.
Women can suffer from different opportunistic infections, such as severe pelvic inflammatory disease (PID), recurrent vaginal yeast infections and cancerous changes in the cervix. On the other hand, men are more likely than women to develop a skin cancer called Kaposi’s sarcoma.
It has been suggested that the side effects of some antiretroviral drugs may be different among men and women. Nevirapine is an antiretroviral drug that is used for the prevention of mother-to-child-transmission of HIV. It can also be used as combination therapy for the treatment of HIV/AIDS. However, nevirapine can sometimes cause some extreme side effects, such as skin rash and clinical liver toxicity, which in some cases can be life threatening. Research has indicated that these side effects are slightly more common among women20.
Many studies have reported that HIV positive women experience changes in menstrual patterns. Amenorrhea, where women experience the loss of their periods altogether, is the most common change reported among HIV positive women. Other menstrual problems include irregular periods, missed periods, abnormal bleeding and more extreme cases of premenstrual syndrome (PMS).
Preventing HIV
There are a number of issues that need to be addressed in order to prevent the spread of HIV infection. The following are relatively new preventative technologies that could directly benefit women.
- The female condom is the only female-initiated HIV prevention method presently available. These condoms can potentially help women to protect themselves from becoming infected with HIV if used correctly and consistently. However, although the female condom allows partners to share the responsibility of condom use, it still requires some degree of male cooperation.
- Post-exposure prophylaxis is an antiretroviral drug treatment that is thought to decrease the chances of HIV infection after exposure to HIV. This treatment could potentially benefit women who have been raped, if started within 72 hours of exposure. In many countries with high levels of sexual violence against women and high HIV prevalence, this treatment is not always freely available to women.
- There are plans underway to develop a microbicide - a gel or cream that could be applied vaginally without a partner even knowing and which would prevent HIV infection. Trials have been taking place for a number of years, but there is still no microbicide that actually works.
However, protecting women from HIV is not solely women's responsibility. Most women with HIV were infected by unprotected sex with an infected man. Preventing transmission is the responsibility of both partners, and men must play an equal role in this.
Women's Health in Women's Hands
Ontario Women's Justice Network
The Global Coalition of Women and AIDS
United Nations Development Fund for Women
International Community of Women Living with HIV/AIDS
Blueprint for Action on Women & Girls and HIV/AIDS
Women of all cultural backgrounds and life experiences are absent from the HIV/AIDS research agenda and research decision-making at all levels. Women lack access to testing, are denied testing, are under-diagnosed and are diagnosed too late for successful treatment interventions and lack access to gender specific community supports. This is exacerbated by racism, classism, misogyny, and other forms of discrimination against women.
The Blueprint for Action on Women and HIV/AIDS is a multi-sector coalition of HIV-positive women, Canadian and international HIV/AIDS organizations, and a variety of women’s and reproductive rights groups advocating for better prevention, services and supports for women and girls infected and affected by HIV/AIDS.
For more information on Women and/or HIV you can contact Tiff Idems at 905-576-1445 ext 12. All our services are free of charge, anonymous and confidential.
