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Urgent
call for global strategies and resources to confront the rapid "feminization"
of the AIDS pandemic
News-Medical.Net
June 10, 2005
http://www.news-medical.net/?id=10884
A Johns
Hopkins physician and scientist who has spent
a quarter-century leading major efforts to combat HIV and AIDS worldwide
has issued an urgent call for global strategies and resources to confront
the rapid "feminization" of the AIDS pandemic.
In an article
appearing in the journal Science
online June 10, Thomas C. Quinn, M.D., professor of infectious diseases
at Hopkins and a senior investigator at the National
Institute of Allergy and Infectious Disease,
reports that women have in the last 20 years moved from those least
affected by HIV to those in whom the disease is spreading fastest.
"There has been a shift in the AIDS pandemic, and the victims are
different now," says Quinn, senior author of the Science article.
"Women make
up nearly half of the 40 million people worldwide currently infected
with HIV, the virus that causes AIDS, and in some developing countries,
women represent the vast majority of those living with HIV/AIDS,"
Quinn writes, whereas, at the start of the pandemic in the early
1980s, men accounted for almost 90 percent of cases in developed
countries. In the United States from 1999 to 2003, the yearly increase
in AIDS cases rose by 15 percent, but only by 1 percent in men.
"HIV/AIDS first
targeted gay men and hemophiliacs in the early 1980s, then subsequently
spread most quickly among intravenous drug users and heterosexuals,"
he adds. "Now, it is having the most profound impact on women."
Internationally,
Quinn and his team have led clinical trials of the first effective
treatments that prevent HIV from replicating, helped establish laboratory
and treatment facilities in the Democratic Republic of the Congo,
India and Uganda, and counseled other governments across Africa
and Asia about control efforts.
In the new article,
he argues that women deserve a separate strategy because of the
increasing and disproportionate numbers becoming infected, and the
social consequences of so many young mothers dying and leaving behind
children who may also be infected as well as orphaned. He also points
out that medical research suggests hormonal and developmental factors
place young women at greater risk than men for contracting the virus
when exposed to it.
In sub-Saharan
Africa, 60 percent of people living with HIV are female, Quinn says,
and in South Africa, Zambia and Zimbabwe, young women ages 15 to
24 are three to six times more likely to be infected than men. Women
make up half the adult population living with the virus in the Caribbean
and one-third of those in Latin America.
The reasons
for the rise in female cases differ among countries, with 97 percent
of female HIV infections in the United States due to heterosexual
transmission (81 percent) and intravenous drug use (16 percent).
In the developing world, heterosexual transmission is responsible
for nearly all of the infections among women, and mother-to-child
transmission during childbirth further contributes to the spread
of the disease. Women are particularly vulnerable to such cultural
factors as their relative lack of power in sexual relationships,
widespread poverty, policies that deny women an education and tolerance
of violence against women.
Excessive biological
vulnerability to HIV among young women, although not fully understood,
is believed to be due to an immature genital whose mucosal lining
is easier for the virus to penetrate; to hormonal factors, such
as the use of birth control pills; and to a high incidence of sexually
transmitted diseases, which inflame the female genital area and
provide additional target cells for the virus to infect.
According to
Quinn, "societal changes will help over the long run, but immediate
and faster action requires coordinated efforts to focus on women,
develop effective microbicides that women can use themselves and
a gender-specific vaccine program that takes into account the different
immune responses between women and men."
Also needed,
he says, are cultural programs for reshaping gender roles, such
as educating more women about safe-sex practices, use of condoms,
lessons on negotiating safe sex, and awareness campaigns about where
to seek testing and treatment.
"Women are different
when it comes to HIV infection," says Quinn. "If medical progress
is to continue on how best to prevent and treat the disease, then
developing specific strategies that empower women will be key to
its success."
http://www.hopkinsmedicine.org/
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