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Taking a Deep Look At Why Women Are Vulnerable to HIV/AIDS

A new book draws upon research from a number of disciplines to offer a look at why poor black women are overrepresented globally in the HIV/AIDS epidemic.

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April 14, 2009 | by Pat Vaughan Tremmel
CHICAGO --- Think again about the face of HIV/AIDS today. So much has changed about the virus since the media reported in the early 1980s on an outbreak of a rare form of cancer among gay men in New York and California.

A new book edited by a Northwestern University School of Law professor draws upon research from a number of disciplines to offer a provocative look at why today poor black women are overrepresented globally in the HIV/AIDS epidemic.

"Sex Power & Taboo: Gender and HIV in the Caribbean and Beyond" pulls back the veil to show how gender and economic power imbalances play out in the bedroom and make black women particularly vulnerable to the infection.

Responding to the AIDS crisis in the Caribbean, the book explores the relationship between gender and sexuality in that region and elsewhere to illuminate the impact of gender on HIV risk and prevention.

Many of the book's authors -- from the fields of anthropology, communications, law, literary theory, psychology, and public health, sociology and gender studies -- initially came together at a conference designed to offer a deeper understanding of the global epidemic.

"We're not focusing on especially stigmatized groups like sex workers," said Dorothy Roberts, a co-editor of the book and a professor at Northwestern University School of Law. "We're looking much more broadly at the political, social and economic conditions that make black women and men, especially those who are poor, vulnerable to HIV risk."

Much of the HIV research aims at stopping risky behaviors, and studies dealing with gender tend to focus on how HIV/AIDS is different for men and women, without exploring the underlying power imbalances and gender norms that perpetuate the epidemic, said Roberts, who also is a faculty fellow at Northwestern's Institute for Policy Research (IPR).

"Gender inequities affect women in a number of ways, from engaging in sex for money to putting up with unfaithful husbands because they cannot afford to leave them," she said.

Celeste Watkins-Hayes, an assistant professor of sociology and African American Studies and IPR faculty fellow at Northwestern, wrote a chapter titled "The Social and Economic Context of Black Women Living with HIV/AIDS in the United States." She points out that 15 years ago the study participants she has been following for a number of years would not be alive.

Compared to HIV's probable death sentence 25 years ago, people today are more likely to live many years with the virus if they have access to medical treatment because of the powerful class of anti-HIV drugs that were introduced in the 1990s.

Watkins-Hayes thinks that it is imperative that researchers and policymakers address the daunting social dynamics that women at the bottom of the economic pyramid face while living with AIDS. "The critical question for those already infected is 'How do women who are HIV-positive go from believing they have a death sentence to believing they can live with AIDS?'"

From the early days of AIDS, when news accounts and obit after obit put the nation in a panic with chronicles of gay men's deaths, the stigma of the disease has been the greatest for those perceived to be operating outside of mainstream sexual norms.

"Many continue to believe HIV is a kind of punishment, complete with sympathetic and unsympathetic victims," said Watkins-Hayes. "Research shows that the sexuality of black women who are HIV-positive tends to be highly scrutinized, feared and viewed in light of stereotypical notions about supposed irresponsible sexual behavior of black women."

The same women who are most likely to be HIV-positive are most likely to be subject to a vast number of social conditions that are bad for their welfare. They are more likely to be homeless, to be incarcerated or to have family members in prison. They tend to have little education and, after they get HIV, they often don't have the necessary stamina to continue to work at jobs that often require physical strength. They, like most of us, depend on social networks, which, for them, tend to be highly fragile.

The problems of poor black women, like those of many women, often are compounded by the consequences of male dominance inside and outside the bedroom "Even powerful women who wield a lot of influence in their professional lives report they sometimes have difficulty asking men to use a condom," said Roberts.

And women's experience of violence is a strong predictor of HIV infection. Research shows that fear of violence prevents women from refusing unwanted sex or discussing condom use with their partners, according to the book.

In the United States, nearly half of over one million Americans living with HIV are black. African-American males continue to bear the greatest burden of HIV infection, according to the Centers for Disease Control and Prevention (CDC). One in 16 black men will be infected with HIV in his lifetime, compared to one in 30 black women, according to the CDC. African- American women are 15 times more likely to be infected than white women.

Roberts began her work on the book when she was on a Fulbright fellowship in the Caribbean region, ranked second in HIV infection statistics. The book grew out of a conference that was part of the Research Initiative on Gender, Sexuality and the Implications for HIV and AIDS at the University of the West Indies (UWI) in Trinidad and Tobago. Roberts helped launch the project, and the UWI research initiative is ongoing. Besides Roberts, the co-editors of "Sex Power 7 Taboo: Gender and HIV in the Caribbean and Beyond" are Rhoda Reddock, Dianne Douglas and Sandra Reid.