Until death do us part

Acquired Immune Deficiency Syndrome (AIDS) was first reporting in the United States in June of 1981.

Charles John Palenik, MS, PhD, MBA

Acquired Immune Deficiency Syndrome (AIDS) was first reporting in the United States in June of 1981. Identification of the causative agent of AIDS, the human immunodeficiency virus (HIV), occurred in 1984. World AIDS Day took place Dec. 1, 2004. The theme was “Women, Girls, HIV. and AIDS.”

HIV/AIDS is a global crisis. Each day, over 8,000 people die of the disease. In 2004, an estimated 39.4 million people were infected, almost half of which are women. This represents an increase of more than 9 percent in the last two years. There are now almost 19 million women living with HIV/AIDS. Over two million infected women give birth each year and pass the virus to more than 700,000 newborns. A 2004 WHO report indicated that the number of women living with AIDS continues to increase in every region of the world. Almost 50 percent of all new cases today occur among women. AIDS is affecting women most severely in places where heterosexual contact is a dominant mode of HIV transmission, as is the case in sub-Saharan Africa and the Caribbean. Women are more physically susceptible to HIV infection than are men. Male-to-female HIV transfer during sex is almost twice as likely to occur as female-to-male transmission.

The most affected region is sub-Saharan Africa, which has only 10 percent of the world’s population, but is home to more than 60 percent of all HIV-infected persons. More than 75 percent of all 15-24-year-olds infected with HIV are women. The second most affected region is the Caribbean, where there were 53,000 cases and 36,000 deaths in 2004. The Caribbean has the highest prevalence of HIV (2.3 percent of the adult population) in the world. Eastern Europe and Central Asia also are heavily affected. In those areas, 80 percent of cases involve IV drug abuse.

In many areas of the world, young women are becoming an endangered species. Why are these women so at risk? The reasons are cultural, ignorance, and economic. In many areas, women have little or no access to education and employment. Women become economically dependent on men. They have no power, culturally or financially, to resist sex or request that partners wear condoms. The balance of power in many relationships tilts in favor of men, and this can have life and death implications. One large study in Africa indicated that women were more likely to be HIV positive in relationships where men wield considerably more power and control than the women.

Focusing programs on persuading girls and young women to abstain from sex until marriage is of little help to many young women. Often, the main HIV risk factor for a woman is the fact that she is faithful to a husband who has previous or current sex partners. There are studies from Africa which show HIV rates are 10 percent higher among married women than sexually-active, unmarried girls. In many areas, the vast majority (greater than 90 percent) of girls and young women 15 to 19 years old are married. Usually, the husbands are considerably older and are more likely to have other partners and greater chances for being HIV positive.

Social norms impose a dangerous ignorance on girls and young women. The expectation is that these women know little about sex and sexuality prior to marriage. There are strong cultural and economic reasons for these women to marry. A lack of knowledge magnifies the risk for HIV infection. In many countries, women do not know how to protect themselves against infection. Methods for family planning are equally absent.

For many women in developing countries, the typical “ABC Prevention Approach” of abstinence, being faithful, and reducing the number of sex partners and condom use does not work well. Urgently needed are strategies which address social and economic inequalities if there is to be a near-future stemming of the AIDS epidemic.

Required is special attention to prevent HIV infections among women, especially within marriage. Two elements must be present - women the world over need greater power and skills to decide the terms and nature of their sexual relationships and, at the same time, reductions in the chances HIV infection in their male partners must occur.

OSAP, the Organization for Safety & Asepsis Procedures, is dentistry’s prime source for evidence-based information on infection control and prevention and on human safety and health. Further information concerning HIV transmission is available on the OSAP Web site at www.osap.org.

Dr. Charles John Palenik is an assistant director of Infection Control Research and Services at the Indiana University School of Dentistry. Dr. Palenik has authored numerous articles, book chapters, and monographs, and is the co-author of the popular “Infection Control and Management of Hazardous Materials for the Dental Team.” He serves on the Executive Board of OSAP, dentistry’s resource for infection control and safety. Questions about this article or any infection-control issue may be directed to office@osap.org.

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