Miami Herald - July 14, 2004
Fred Tasker

BANGKOK, Thailand - A generation ago, one in 10 of new AIDS patients in the United States was a woman. It's now one in four.

Worldwide, women made up nearly half of the adults living with HIV/AIDS in 2003, up from 41 percent in 1997.

In sub-Saharan Africa -- which has the world's highest rates of HIV/AIDS with an estimated 25 million cases -- there are, on average, 13 HIV-positive women for every 10 HIV-positive men -- up from 12 infected women for every 10 men in 2002.

In session after session at the 15th International AIDS Conference, delegates are coming to this conclusion: The biggest single cause of the gender epidemic is women being infected by men who are injecting drugs or having sex with multiple other women or other men.

"In many African and Asian societies, women's legal and social status is subordinate to men's, and they may have little or no control over the sexual behavior of male partners and often cannot negotiate the use of condoms," says U.S. AIDS researcher Dr. Zeda Rosenberg.

America needn't look down its nose.

'I've seen poor girls crying hysterically, saying, 'We've been together for two years, and he's still having sex with other women,' " says Sheri Kaplan, founder of the Center for Positive Connections, an HIV clinic in North Miami, who is attending the convention.

"A lot of women don't have the power to say no even if they believe their man is having sex with six other people."

U.S. MINORITIES

Across the United States, the problem is more acute among minorities. Black women made up 12 percent of the U.S. female population, but 64 percent of new female HIV infections in 2003, according to the Centers for Disease Control and Prevention. Hispanics made up 14 percent of the U.S. female population and 18 percent of new female HIV cases during the same period.

"The greatest risk factor for African American women lies in unprotected sexual intercourse with their male partners," says a new report by AMFAR, or American Foundation for AIDS Research. "Many are unaware that a partner engages in high-risk behavior such as male-to-male sex or injection drug use."

In Florida, Hispanic women are less at risk. They made up 17 percent of the female population and 11 percent of new HIV cases in 2003, according to the Florida Department of Health.

Across the world, the problem is worst in Africa. In a UNAIDS study of six African countries, girls and women ages 15-24 were 2.5 times more likely to be HIV-infected than their male counterparts.

Perhaps most tragically, the age of infection is getting younger. More than 11 million young people, ages 15-24, were living with HIV/AIDS in 2003, according to UNICEF and UNAIDS. Of those, 7.3 million were girls and women, 4.5 million, boys and men.

VIRGIN MYTH

"There is a widespread myth in Africa and parts of Asia that having sex with a virgin will cure AIDS, which has resulted in an increased number of child rapes," says a report by the American Foundation for AIDS Research.

And a session in Bangkok on violence, sex and AIDS revealed a litany of bad male behavior that spanned the globe:

* In the village of Cange, in rural Haiti, at a women's health clinic run by Partners in Health and Harvard University, a survey indicated that 54 percent of its patients had been forced into having sex at some point in their lives -- usually by their husbands or long-term boyfriends. Haiti, the Caribbean's worst-affected country, has 5.6 percent of its population infected with HIV.

'NO CHOICE'

'People talk about the 'ABCs' of HIV prevention -- abstinence, be faithful to your partner, always use a condom," said Partners in Health medical director Joia Mukherjee.

"But all too often the women have no choice."

* Young women 16-23 in rural South Africa who had been sexually abused as children were much more likely to later engage in such sexually risky behaviors as having multiple sex partners, having sex with men more than five years older than they and having sex for money.

* At a brothel in Bangladesh, 110 of 176 commercial sex workers interviewed said they had been punched, kicked, cut or burned with a cigarette in the past year, and a third of the time it was because they demanded that a client use a condom.

Few researchers believe male attitudes will change any time soon.

Still, countries are developing programs to make the attempt.

In South Africa, the government runs a "loveLife" youth information program promoting respect in relationships. In 171 countries including the U.S., MTV Network's International's 2003 version of the Staying Alive campaign does the same.

UGANDA CAMPAIGN

Uganda launched a national AIDS education campaign that strongly urged condom use.

The result: Uganda's national HIV rates dropped from 12 percent in the early 1990s to 4.1 percent in 2003, according to UNAIDS.

And if men won't change their ways, a new study presented in Bangkok indicates that young women can be taught how to deal with them more effectively.

In Atlanta, 522 sexually experienced African-American girls 14 to 18 were divided into two equal groups. One group received four four-hour group sessions on exercise and nutrition. The other got information about gender pride, HIV knowledge, healthy relationship skills and condom use.

The study was done under lead author Ralph J. DiClemente of Emory University's Center for AIDS Research.

In six- and 12-month follow-ups, the group given the HIV information was half again more likely to report more condom use, less pregnancy and fewer new sexual partners.

Later this week, a major presentation is scheduled for new methods for women to protect themselves, including a new class of drugs aimed at prevention during sex and an improved female condom.

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