AIDS expert says global strategy needed to combat feminization of HIV/AIDS

Thomas C. Quinn, M.D., a Johns Hopkins physician and scientist, who has spent the best part of the last 25 years leading major efforts to combat HIV and AIDS throughout the world, is calling for global strategies and resources to confront the rapid "feminization" of the AIDS pandemic.

Quinn, a 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 being those least affected by HIV to those in whom the disease is spreading fastest.

According to Quinn women now 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.

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.

He says that now AIDS is having the most profound impact on women.

Internationally, Quinn and his team are renowned for leading clinical trials of the first effective treatments that prevent HIV from replicating, and helping to establish laboratory and treatment facilities in the Democratic Republic of the Congo, India and Uganda, and counselling other governments across Africa and Asia about control efforts.

Now he argues that 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, women deserve a separate strategy.

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.

60 percent of people living with HIV in sub-Saharan Africa, 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.

The excessive biological vulnerability to HIV among young women, 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.

Quinn says that eventually societal changes will help, 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.

Cultural programs are also needed 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.

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

The article appears in the journal Science online June 10.