The HIV/AIDS epidemic is rapidly growing among minority women, and Yale researchers are doing their part to raise awareness of this emerging trend.
Karina Danvers, Coordinator of the Connecticut AIDS Education and Training Center at the Yale School of Nursing, who is living with AIDS, testified regarding the rising infection rates among minority women at a congressional briefing in Washington, D.C. last month. Danvers said that while she, with health insurance and access to treatment, is still capable of living a relatively normal life, she is atypical of the AIDS-infected population.
“Poverty and lack of education have been the cause of so many things, and the spread of AIDS is one of them,” she said. “It has been true for a long time, though we’re just paying attention to it now. AIDS has always targeted a vulnerable population — vulnerable because society doesn’t like them or because of poverty.”
Other Yale experts also said such populations must be targeted if the disease is to be effectively controlled.
Robert Heimer, associate professor in the School of Epidemiology and Public Health and director of the Interdisciplinary Research Methods Core at Yale’s Center for Interdisciplinary Research on AIDS, said that on a domestic level, he is seeing clear shifts in the concentration of people infected with the disease.
“The epidemic is increasingly becoming a poor, Southern minority disease, especially female, with the exception of some gay male populations, mostly in the West,” he said.
But Dietra Hawkins, an associate research scientist in psychology, said this new trend could be influenced more by changing perceptions than by figures.
“In some regard, it’s not really a changing face,” she said. “It’s who the media is covering. The recognition of the fact that African Americans and Latina women are greatly infected has increased.”
Hawkins said recognition of a shift in the groups at risk for AIDS is new to African Americans and Latinos as well, since in the past, she said, AIDS was often written off as a disease exclusive to gay white males.
Luz Gonzalez, the executive director of Hispanos Unidos, a New Haven-based agency that specializes in providing support to Hispanic people affected by HIV and AIDS, said the state of Connecticut is a microcosm that serves as an example of global changes. In New Haven alone, approximately 5,000 people are infected with the disease, which is concentrated in minority groups — 38 percent of those infected are black and 25 percent are Hispanic. About a third of these people are women — 36.8 percent of the blacks and 30.3 percent of the Hispanics — a figure that has risen by several percent for both groups in the past year.
Gonzalez said these groups are susceptible to the disease because they lack the resources and knowledge to combat its spread.
“It all comes down to the need to survive in poverty,” she said. “Eating and finding housing is the priority, not protection from AIDS, so there are issues like drugs and sex for money. Poverty has a lot to do with the spread of AIDS. You cannot educate people when they are homeless and on drugs.”
Heimer said he agreed that poor socioeconomic conditions contribute greatly to the spread of the epidemic in the United States.
“The disease will continue to be concentrated in the poor, who have the least access to information,” Heimer said. “America is becoming an ignorant society, and the greatest number of people at risk who see the effect of the downslide toward ignorance is the poor.”
Trace Kershaw, a professor at the School of Epidemiology and Public Health who specializes in chronic disease epidemiology, said that while education and poverty play substantial roles, there are deep societal and cultural reasons for the rising numbers of women afflicted with the disease. Kershaw’s research examines how gender disparity might affect sexual health risks, both in the United States and abroad, in countries including Haiti and South Africa.
“In many settings, there is an unequal power level between men and women,” he said. “Women have a lack of power in sexual decisions, so they are more likely to make decisions that put them at risk health-wise.”
Kershaw said the most effective programs in curbing the spread of HIV will both educate women and empower them to make decisions dealing with sex and contraception, in addition to addressing cultural norms for men.
For blacks in particular, Hawkins said social concerns also limit effective management of the disease.
“African Americans not only don’t have access to proper treatment, but many don’t want to deal with the stigma attached toward treatment,” she said, “African American women in particular are not always comfortable sharing that they’re HIV-positive, so they don’t properly acquire the knowledge to stay on their medication and take it effectively.”
Heimer said the reason for the shift in targeted populations may be the effectiveness of past and current programs targeting the previous high-risk populations in the United States. He cited the diversion of money from research and sexual education programs to abstinence-only prevention programs as one possible reason for growing ignorance.
“Sadly, there is very little possibility that effective treatment methods for prevention will be developed soon,” he said.
But Danvers said the decrease in AIDS activism could be related to the drop in the number of AIDS-related deaths since the introduction of antiretroviral medications in the mid-1990s. Still, she said, those who have been infected or affected by the disease must continue to talk about it.
“I have been doing this since 1989,” she said. “What preventative methods are lacking is conveyance of the struggle, pain and emotional sacrifice that goes into dealing with AIDS. We do have therapy for HIV and people are living longer, and I’m afraid that people think the problem is solved and we can move on … what no one talks about is the hell of living with them.”