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Heart and body > AIDS prefers women
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The current epidemiological situation in France (2002) reveals an increase in AIDS cases in the heterosexual population. This reality concerns mostly women.

The percentage of women contaminated during a heterosexual sexual relation (in all the cases of AIDS in women) is 3 to 8 times greater than for men (in all the cases of IADS in men). Biological factors linked to the fragility of the vaginal mucous facilitate contamination by HIV, aside from the fact that the concentration of the virus is higher in sperm than in vaginal secretions.

The cultural and legal environment and the socio-economic context can also be considered exacerbating factors.

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Epidemiological data

For the past several years, the data shows an increase in the cases of AIDS diagnosed in women, while at the same time, the number of cases diagnosed in men is decreasing. In the general population, the sex-ratio of AIDS cases (= number of masculine cases for a feminine case) went down between 1999 et 2000, passing from 3,2 to 2,7.

This phenomenon is to be crossed with other data, to make it more relevant:

 a preponderance of heterosexual contamination
a strong increase in the number of cases diagnosed in African women.

Heterosexual contamination

Heterosexual contamination is the most frequent means of contamination among the cases of AIDS diagnosed since 1997. In 2000, it represented 44% of diagnosed AIDS cases. Furthermore, among the heterosexual cases diagnosed in 2000, the contamination the most probable for the partner is also attributable to heterosexual relations in 67% of cases (unknown: 30% of cases, sharing syringes: 3% of cases, homosexuals relations of the partner: 1% of cases).

Also, among people who know their serology status, it was shown that women received a preventive antiretroviral treatment less often than men (58% of women and 52% of men for which the means of contamination is heterosexual are in this situation).

Why are women so vulnerable?

This epidemiological data clearly says that, in the case of transmission during heterosexual relations, women present a greater vulnerability than men. This vulnerability is explained by several factors:

 Direct factors of a biological and physiological order: a larger surface of mucous (vagina and col of the uterus) and the fragility at the level of the col facilitates the penetration of HIV. This fragility is aggravated on the one hand with the occurrence of MST, which often remains untreated (as it is not visible) and on the other hand in the scope of undesired, violent and traumatizing relations. Finally, the concentration of HIV is higher in sperm than in vaginal secretions.

Indirect factors linked to sexual, cultural and legal norms, but also to social and economic contexts: the inequality of status, insecurity and socio-economic dependence, the taboos that guide feminine sexuality (in particular in certain cultures) account for as many determinants as the risk taking.

Doctor Erica Gollub, Scientific Director of the HIV contamination risk-reduction program carried out in the scope of the EMIPS in the Bouches du Rhône defined the criteria of vulnerability of women to HIV/AIDS like this, in addition to the criteria of biological vulnerability:

Lack of political representation; health politics is often planned without feminine representation or consideration; women's needs for good health is hardly recognized; string gap between family and social responsibilities of women and the political power exercised; discrimination in the workforce; the violence they are subject to …

Unpaid and unrecognized for their work in the home and with their children; paid less than men; women are not welcome in certain professional fields and are the first to be fired during times of crisis, which renders the majority of them dependant; they have less possibility / capacity to end unwholesome, dangerous, violent relations; cases of prostitution to live …

Lack of sexual education, discouragement of women to know their body and seek pleasure, to take care of herself, … Absence of incitation to girls to do sports, to acquire confidence and pride in their body; lack of good resource people for young people (people who aren't themselves embarrassed by these subjects) …

Social sex roles; dependence instilled for decision making; it seems to be the norm that women shouldn't take the initiative, that she should be submissive, should please men, that she doesn't have her own value (unmarried or without children …).

The difficulties and obstacles faced by women faced by HIV/AIDS.

1. In the elaboration of a personal strategy of risk-reduction.

Certain elements are and obstacle to the reinforcement of a woman's capacity to reduce her risks. Indeed, there are situations and factors specific to women that can be classified into 3 major typologies :

 General difficulties.
Women need more time to speak about and to put words on their sexuality (a woman's sexual organs are hidden as is the expression of her sexuality). Also, speaking about herself is often secondary: a woman speaks first as a mother, a wife, an ill women, etc. This mode of access to a voice of course diminishes the possibilities to consider a woman's global life trajectory. Finally, the need for more time is even more important as it is written in an historical process having caused women to be deprived of their voice for a long time. In conjunction with this privation, there exists an unfavorable socio-economic context in relation to men (dependence on a man, language obstacle more important non-integrated foreign women, etc.)

A context of violence.
In general, many women are subject to multiple situations of violence, starting with the violence in the couple. This phenomenon can only accentuate the fragilities of women in their construction of a personal risk-reduction strategy.

The obstacles linked to the selection available of prevention tools.
The prevention tools available for women are too limited: the feminine condom has been available in France since June 1998, but it is far less available than the masculine condom (few pharmacies sell it and its price is high: environ 2  ). Also, there is still no effective virucide available.

NB: the limitation of the selection available of prevention tools isn't specific to women, but it has more serious consequences for women (the masculine condom being most often controlled by the man).

2. In the access to healthcare for women infected with HIV.

There exists a real difficulty of consideration of the specificities of the HIV infection in women. Seropositivity creates an increased risk of occurrence of pathologies and of specific difficulties concerning women (osteoporosis, hormonal irregularities, uterine cancer, metabolic troubles …). Also, real difficulties are noticed with health professionals (including HIV specialists) for gynaecological coverage of seropositive women.


Articles and files that can be consulted on the internet :

 Cathi Albertyn "The law and human rights to reduce women's vulnerability to HIV" (" Le droit et les droits humains pour réduire la vulnérabilité des femmes au VIH ") in: The last will be the first - crucial legal themes and HIV/AIDS (Les derniers seront les premiers - thèmes légaux cruciaux et VIH/sida), Conference in Durban - July 7, 2000

CCathi Albertyn is a Professor and head of Gender Research Project, Center for Applied Legal Studies, University of the Witwatersrand, Johannesburg, South Africa.
In her article entitled "The law and human rights to reduce women's vulnerability to HIV ", she asserts that personal rights and the law can play an important although limited role at the heart of a set of national and international strategies to reduce the vulnerability of women to HIV. She analyses the nature of women's vulnerability to HIV/AIDS, then highlights certain issues and lessons of recourse to these elements to help equality progress between the sexes and to reduce women's vulnerability faced with HIV/AIDS.

This article can be consulted at the following address:

 Geeta Rao Gupta " Gender, sexuality and HIV/AIDS - What ? How? Why?" (" Genre, sexualité et VIH/sida - Quoi ? Comment ? Pourquoi ? ")
Speech given at the international plenary conference on AIDS in Durban, July 12, 2000.

Doctor Rao Gupta discussed vulnerability factors of women to HIV, then the manners by which the imbalance of power in gender relations increase not only women's vulnerability to HIV, but also men's vulnerability, despite- or rather because - of their greater power. She then asked herself how it would be possible to overcome the apparently insurmountable barriers that are the inequality of gender and of sexuality. How to modify the cultural norms which create disparities and harmful, even fatal roles? According to Mme Rao Gupta, an important first step is the acknowledgement, understanding and public discussion of the ways by which the imbalance of power, to the chapter on sexuality and gender relations, worsen the epidemic. She gave some examples of sensible approaches, enabling and favorable to change, then she concluded that in the final analysis, the reduction of the imbalance of power between women and men requires policies conceived to give power to women - policies which target reducing the gulf between genders concerning education, to improve women's access to economic resources, to increase women's political participation and to protect them against violence.

This article can be consulted at the following address:

 The ONUSIDA report on the situation of epidemic diseases in France in 2000 :

The ONUSIDA report on the situation of epidemic diseases in the world in December 2001 :

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