Key Issues
Women are one of the fastest growing populations infected with HIV. The World Health Organization estimates that over 15 million women worldwide will become infected with HIV by the year 2001.

The early and persistent stereotype of AIDS as a "gay male" disease has perpetuated the notion that women are not at risk or HIV. That is no longer the case. In Canada, women are increasingly becoming infected with HIV, especially those who use injection drugs and whose sexual partners are at increased risk for HIV. As of December 1997, the total number of reported AIDS cases among women was 1327. The growing number of HIV infections among women is of particular concern because of the potential for transmission to their infants.

How does mother-to-child (perinatal) transmission occur?
HIV-positive women can transmit HIV to their infant during pregnancy, during birth or by breastfeeding. Of children born to HIV-positive women in the western world, 65 - 75% are not infected; 15 - 20% develop symptoms after 12 months of age and have a chronic illness with median survival of 8.8 years; 10 - 15% develop symptoms in the first 12 months of age and have an acute illness and only 20% survive beyond four years.
Pregnant women should be given the option of HIV testing, since AZT, an anti-viral drug, reduces perinatal transmission by two-thirds, especially if administered at an early stage of pregnancy. Further research into the long-term effects of AZT on infants is still being conducted5.

Why are women vulnerable to HIV infection?

Biological Factors
Women are biologically more vulnerable than men to HIV infection. Studies have found that male to female transmission appears to be two to four times greater than female to male transmission. This is in part because semen contains a far higher concentration of HIV than vaginal fluid and also because there is usually much more semen than vaginal fluid present in sexual encounters.

The presence of sexually transmitted diseases (STDs) which cause genital ulcers, such as chlamydia and herpes, has been shown to increase the risk of acquiring HIV infection in the event of exposure to the virus. Given that women often do not suffer from symptoms of STDs, they may go untreated and undiagnosed. Women between the ages of 15 and 19 report the highest rates of STDs and are therefore a high risk age group.

Social Factors

The economic, social and physical power imbalance between men and women contributes to the lack of safety in sexual relationships and the difficulty for many women in negotiating safer sex. To do so may have repercussions, ranging from stigma to fear of violence or abandonment.

Women in abusive relationships are at a greater risk of HIV infection. Low self-esteem and the fear of instigating violence within an abusive relationship limit an abused woman's ability to insist on condom use with her partner. This risk is an invisible and deadly form of violence against women.

In many relationships (abusive and non-abusive), especially with longer-term partners, there is a tendency to associate non-condom use with loyalty, trust or love. It also appears that fear of pregnancy, not the fear of HIV or STDs motivates condom use. Condom use therefore has shown to decline in women who rely on oral contraceptives as a method of birth control. Other factors associated with not wearing condoms includes an increased number of partners, embarrassment about buying condoms, difficulty discussing condom use with a partner, insufficient knowledge about HIV and STDs, and the belief that condoms interfere with sexual pleasure.

Subordination in education, employment, social and legal status makes women more vulnerable to HIV. Women who have limited access to financial resources are more likely to become economically dependent on men, relegated to the subsistence sector or forced into commercial sex work. Attention to more immediate concerns of food, housing and addiction often takes priority over future concerns of HIV infection.

Women also have a shorter survival rate than men diagnosed with AIDS. This may be due to: (a) a misdiagnosis of early symptoms resulting in later diagnosis and treatment delay; (b) exclusion from drug trials; (c) lack of research in natural history of HIV disease in women; (d) inadequate child care; and (e) the way in which many women tend to care for others before themselves; and f) lack of access to health care and poverty.

How can HIV infection be prevented?

Sex with Men and/or Women
Intercourse (vagina/penis sex, anus/penis sex)

• Use a latex condom or a female condom & a water-based lubricant to reduce tiny rips and tears in the vagina or anus during sex
  

If you can't use a condom, these may help reduce your risks:

• diaphragms or cervical caps cover the cervix from infection, but do not protect the vagina from HIV or STDs

Oral sex

• Oral sex is risky for your partner when you are menstruating because of the presence of menstrual blood
• When giving oral sex to a man, he can wear an unlubricated or flavoured latex condom. When receiving oral sex, your partner can use a latex barrier (dental dam or condom cut open) or non-microwavable plastic wrap between the mouth and the vagina.

Fingering/fisting

• When inserting fingers into the vagina or anus, HIV can enter the bloodstream through open cuts or sores on the hand.
• A latex glove can be worn during fisting or fingering. Water-based lubricants can help reduce scratches in the vagina or anus.

Sex toys

• HIV can be passed by sharing sex toys.
• Use a new latex condom on the toy and clean with one part bleach to ten parts soapy water between uses.

Vagina to vagina rubbing (tribadism)

• Sometimes rubbing vaginas can cause tiny rips in the vagina.
• Use a latex barrier (dental dam or condom cut open) or non-microwavable plastic between vaginas.

Drug Use

Sharing needles

• Needles, syringes and other paraphernalia can become contaminated by the infected blood of another user.
• Try not to share needles. If you do share, always clean the needle and other equipment with bleach between users.

In addition, alcohol and other drug use are factors that can contribute to the risk of HIV transmission because they impair judgement needed to practice safer sex. Furthermore, alcohol and other drug use has shown to suppress the immune system, weakening the body's ability to fight disease. Substance use among women in university is especially high¹⁶.

Social Activism

Action needs to be taken to address the social factors that make women vulnerable to contracting HIV. Programs need to be developed that promote women's self-empowerment, women's self-esteem, and tackle the issue of women negotiating safer sex for themselves and their partners.

Men need to educate themselves and each other on the impact of gender inequality and power imbalance in relationships and work for change.

Women can also form and join women's groups to challenge unhealthy sexual traditions and expectations. Women can talk about sex in groups and bring issues into the open. They can teach one another about successful ways of achieving safer sex. Group meetings can also empower women to voice their opinions on HIV/AIDS to each other.

The Female Condom

Women can use the female condom as a way of preventing HIV infection. It can be most beneficial for women whose sex partners do not use latex condoms. The female condom is made of polyurethane sheath, is unlikely to rip or tear, comes prelubricated and is meant to be used for only one sex act.

1. Health Canada. Laboratory Centre for Disease Control. HIV and AIDS among women in Canada. Ottawa : Health Canada, 1996.
2. Health Canada. AIDS Education and Prevention Unit. Facts about AIDS and HIV infection in women and children. Ottawa : Health Canada, 1994.
3. American Association for World Health. Women and AIDS
4. Interagency Coalition on AIDS & Development. Women & HIV/AIDS. Ottawa : Interagency Coalition on AIDS & Development, 1995.
5. Health Canada. Laboratory Centre for Disease Control. HIV and AIDS among women in Canada. Ottawa : Health Canada, 1996.
6. Health Canada. AIDS Education and Prevention Unit. Facts about AIDS and HIV infection in women and children. Ottawa : Health Canada, 1994.
7. Interagency Coalition on AIDS and Development. Women & HIV/AIDS. Ottawa : Interagency Coalition on AIDS & Development, 1995.
8. Health Canada. AIDS Education and Prevention Unit. Facts about AIDS and HIV infection in women and children. Ottawa : Health Canada, 1994.
9. Health Canada. AIDS Education and Prevention Unit. Facts about AIDS and HIV infection in women and children. Ottawa : Health Canada, 1994.
10. Interagency Coalition on AIDS & Development. Women & HIV/AIDS. Ottawa: Interagency Coalition on AIDS & Development, 1995.
11. DeCarlo, Pamela, Gómez, Cynthia. What are women who have sex with women's HIV prevention needs? San Francisco, CA : Center for AIDS Prevention Studies,m 1997.
12. Health Canada. AIDS education and Prevention Unit. Facts about AIDS and HIV in women and children. Ottawa : Health Canada, 1994.
13. Stanborough, Maria. Women who have sex with men. Vancouver : AIDS Vancouver, 1996 and
14. Stanborough, Maria. Women who have sex with women. Vancouver : AIDS Vancouver, 1996.
15. Health Canada. AIDS Education and Prevention Unit. Facts about AIDS and HIV in women and children. Ottawa : Health Canada, 1994.
16. American Association for World Health. Women and AIDS.