Women and HIV: Prevention

Key Issues:

• HIV/AIDS prevention education must focus on the needs and life-circumstances of women. Society must be made aware of the increased risks women have to infection.
• The economic, social and physical power imbalances between men and women must be leveled so women can negotiate safer sex practices.
• Women must have access to female-controlled products and substances so they can protect themselves against disease, without the knowledge or consent of their partners.
• Research and development of microbicides must become a priority for governments and pharmaceutical companies; women need these products urgently.
• Female condoms must be more reasonably priced and easily accessible.
• Women are one of the fastest growing segment of the population to contract HIV: as of 1999,women accounted for 24% of all new HIV infections in Canada,¹ and 46% of all new infections globally.² The rate of infection has increased each year since the early 1990’s. Because women are becoming infected at an increased rate, prevention education must focus on women, their needs and life-circumstances.

The routes of HIV transmission are well established: unprotected vaginal or anal intercourse with a person who is infected with HIV, or through sharing needles with an infected person. Low risk sexual activity may include unprotected oral sex.

The main methods of protection against HIV are, using latex condoms during vaginal, anal or oral sex, and when sharing sex toys; using dental dams, or condom cut open, for vaginal or anal oral sex. For injection drug users the best protection is to use a clean needle with every injection, or failing this it is recommended that needles be cleaned with bleach before sharing them.³

Physiological and biological differences between women and men place women at greater risk of contracting HIV. Women are physiologically more vulnerable to infection because they have a larger surface area of mucosa (wet surface) exposed to their partner’s semen, and semen remains in a women several hours after sex, increasing the length of exposure to HIV. Biologically women are at greater risk for HIV infection if they have unprotected sex during menstruation, or if they experience bleeding during intercourse. Women are also more vulnerable to HIV infection because of other infections, such as: vaginosis, genital ulcers, genital warts (HPV), and pelvic inflammatory disease (PID), the most common effect of sexually transmitted diseases (STDs). Frequently women do not experience symptoms of STDs and, if left untreated they increase vulnerability to HIV.

Negotiating Safer Sex

The economic, social and physical power imbalance between men and women contributes to the lack of safety in heterosexual relationships. Insisting on safer sex practices may have repercussions ranging from stigma to fear of violence or abandonment. These issues severely limit women’s ability to insist on condom use with their partners. Violence is a reality for many women who are raised in environments where sexual and alcohol use is prevalent. Society frowns on women who are sexually assertive, and often women are labeled or made to feel ashamed; this can results in the inability of women to negotiate safer sex practices. In some relationships, especially with longer-term partners, there is a tendency to associate non-condom use with loyalty, trust or love.⁴

Injection Drug Use and Sharing Needles

Sharing needles for injection drug use is always a risk. The most effective method of preventing HIV infection is to always use a clean needle. Failing this, cleaning a needle before sharing it can reduce risk. Injection drug use among women poses a particular risk for contracting HIV. A recent study has shown that men tend to share needles with strangers more often than women. Women tend to share needles with those they are most intimate with (close friends and primary sex partners). Therefore women who have unprotected sex, or share needles with men who shares needles with strangers, are at greater risk for contracting HIV.⁵

Female-Controlled Methods of Prevention

Both female and male condoms require the consent and negotiation of women’s partners since women do not wear male condoms. Female condoms are not widely used and are expensive. These factors place women at greater risk of contracting HIV. Because of this, women urgently need female-controlled methods of prevention. Women must have access to prevention products that do not require the consent of their partners. Access and affordability to all such products are of primary importance.

Female Condom

The female condom is a preventative product that has only recently been made available. However, female condoms still require negotiation and the cooperation of the male partner. It is an effective method of preventing HIV infection. It is beneficial for women whose sex partners do not, or will not, use latex condoms. The female condom is made of a polyurethane sheath, is unlikely to rip or tear, comes pre-lubricated and is designed for only one sex act. Since the female condom, unlike the male condom, is not made of latex it can be used with oil based lubricants like massage oil, baby oil, and Vaseline. Men report that female condoms feel more 'natural' because body heat can be felt while using them. Because they are larger than male condoms and are unfamiliar, some women are uncomfortable using them. However reports indicate that with increased use, women become more comfortable using them. Since the female condom is visible outside the body it is impossible for a woman to use one without the knowledge of her partner. More studies are needed to determine the risk of infection if the condom falls out, is pulled out with the removal of the penis, or if the penis is not inserted directly in the condom.

Female condoms are expensive and not as easily obtainable as male condoms. Most AIDS service organizations provide male condoms free, but do not provide female condoms. Some, but not all, Public Health Units provide female condoms at no charge.

Microbicides

Research is being carried out to develop a substance that allows women to actively take control in reducing their risk of HIV infection. It is important to note that no such substance has yet been approved: it is not available yet. These substances are known as microbicides, chemicals that kill or neutralize HIV and other STDs. They can be formulated in a number of ways: gels, creams, suppositories, sponges or films, similar to products used with diaphragms. They are applied directly into the vagina or rectum before sexual intercourse.

Ideally microbicides would: be colourless and odourless; effective in preventing HIV as well as other STDs; allow a woman to become pregnant if she chooses; inexpensive and widely available.⁶

1. Health Canada. HIV and AIDS in Canada: Surveillance Report to June 1999. Division of HIV/AIDS Surveillance, Bureau of HIV/AIDS, STD, and TB, LCDC, Ottawa, 1999.
2. Joint United Nations Programme on HIV/AIDS (UNAIDS): AIDS epidemic update: December 1999.
3. Canadian AIDS Society; 1998-1999 National AIDS Awareness Campaign Resource Guide: Module 2-20
4. Health Canada, AIDS Education and Prevention. Facts about AIDS and HIV infection in women and children. Ottawa, 1994.
5. L. Leonard, Epidemiological Update and HIV and Women Who Use Injection Drugs, University of Ottawa, Department of Epidemiology and Community Medicine, 1999.
6. Joint United Nations Programme UNAIDS: Update on Female-Controlled Methods for HIV and STD Prevention, Geneva, 22 June 1999.