Urgent call for global strategies and resources to confront the rapid "feminization" of the AIDS pandemic

Jun 10 2005

A Johns Hopkins physician and scientist who has spent a quarter-century leading major efforts to combat HIV and AIDS worldwide has issued an urgent call for global strategies and resources to confront the rapid "feminization" of the AIDS pandemic.

In an article appearing in the journal Science online June 10, Thomas C. Quinn, M.D., professor of infectious diseases at Hopkins and a senior investigator at the National Institute of Allergy and Infectious Disease, reports that women have in the last 20 years moved from those least affected by HIV to those in whom the disease is spreading fastest. "There has been a shift in the AIDS pandemic, and the victims are different now," says Quinn, senior author of the Science article.

"Women make up nearly half of the 40 million people worldwide currently infected with HIV, the virus that causes AIDS, and in some developing countries, women represent the vast majority of those living with HIV/AIDS," Quinn writes, whereas, at the start of the pandemic in the early 1980s, men accounted for almost 90 percent of cases in developed countries. In the United States from 1999 to 2003, the yearly increase in AIDS cases rose by 15 percent, but only by 1 percent in men.

"HIV/AIDS first targeted gay men and hemophiliacs in the early 1980s, then subsequently spread most quickly among intravenous drug users and heterosexuals," he adds. "Now, it is having the most profound impact on women."

Internationally, Quinn and his team have led clinical trials of the first effective treatments that prevent HIV from replicating, helped establish laboratory and treatment facilities in the Democratic Republic of the Congo, India and Uganda, and counseled other governments across Africa and Asia about control efforts.

In the new article, he argues that women deserve a separate strategy because of the increasing and disproportionate numbers becoming infected, and the social consequences of so many young mothers dying and leaving behind children who may also be infected as well as orphaned. He also points out that medical research suggests hormonal and developmental factors place young women at greater risk than men for contracting the virus when exposed to it.

In sub-Saharan Africa, 60 percent of people living with HIV are female, Quinn says, and in South Africa, Zambia and Zimbabwe, young women ages 15 to 24 are three to six times more likely to be infected than men. Women make up half the adult population living with the virus in the Caribbean and one-third of those in Latin America.

The reasons for the rise in female cases differ among countries, with 97 percent of female HIV infections in the United States due to heterosexual transmission (81 percent) and intravenous drug use (16 percent). In the developing world, heterosexual transmission is responsible for nearly all of the infections among women, and mother-to-child transmission during childbirth further contributes to the spread of the disease. Women are particularly vulnerable to such cultural factors as their relative lack of power in sexual relationships, widespread poverty, policies that deny women an education and tolerance of violence against women.

Excessive biological vulnerability to HIV among young women, although not fully understood, is believed to be due to an immature genital whose mucosal lining is easier for the virus to penetrate; to hormonal factors, such as the use of birth control pills; and to a high incidence of sexually transmitted diseases, which inflame the female genital area and provide additional target cells for the virus to infect.

According to Quinn, "societal changes will help over the long run, but immediate and faster action requires coordinated efforts to focus on women, develop effective microbicides that women can use themselves and a gender-specific vaccine program that takes into account the different immune responses between women and men."

Also needed, he says, are cultural programs for reshaping gender roles, such as educating more women about safe-sex practices, use of condoms, lessons on negotiating safe sex, and awareness campaigns about where to seek testing and treatment.

"Women are different when it comes to HIV infection," says Quinn. "If medical progress is to continue on how best to prevent and treat the disease, then developing specific strategies that empower women will be key to its success."