The global efforts to control the spread of HIV/AIDS are running concurrently with the efforts to fight against stigma attached to the epidemic. The control and management programs of HIV/AIDS across the globe have been derailed by the stigma that has persisted against the epidemic. However, responses to stigmatization are slower in vulnerable groups like women, sex workers, homosexuals, and drug addicts. In the United States, HIV/AIDS flourishes among the marginalized population. As a result, discrimination and marginalization shape up the pattern of the epidemic (National Institute of Allergy and Infectious Disease, 2019). Besides, economic factors, health, gender, and economic status drive disparities of health outcomes among people living with HIV/AIDS. In the United States, women living with face restrictions on their rights that include freedom to movement and expression which in turn have an insidious impact on the integrity of their bodies (Gonzalez et al., 2019). In the United States, women who are poor and of color are the most affected and given that, they already face multiple forms of discrimination and inequality, they are more vulnerable.
Background of Women with HIV
Globally, it is estimated that 33.4 million people are living with HIV/AIDS out of which women account for about 50%. Besides, more than four-fifths of infections among the women population occur in long-term relationships or marriages. Also, young women are 1.6 times more like to be infected compared to their older counterparts (Auerback, et al., 2015). The Caribbean region reflects the global statics where women account for about 50% of PLHA with young women being the most vulnerable population (HIV/STI Surveillance Report 2016, 2017). In Latin America, women comprise a smaller percentage of the population living with HIV/AIDS compared to high-risk groups like men who have sex with their fellow men. However, with the maturity of the epidemic, the heterosexual transmission increases. For instance, 43% of HIV/AIDS infection is associated with the heterosexual transmission (CDC, 2019). About marginalized women in the unites states, most deaths are associated with HIV/AIDS-related diseases with the most affected population being African American women aged between 25 and 34 (Auerback, et al., 2015). Elsewhere, in Canada, indigenous women are three times more likely to contract HIV/AIDS. A female condom is the only trusted, effective, and safe method of controlling HIV/AIDS infections (Gonzalez et al., 2019). However, the female condoms are not accessible to a wide range of populations due to barriers like lack of education or information about the contraceptive technique and high cost of the contraceptive.
The economic status of women is attached to their political, social, cultural, and civil rights and whenever any of the rights are violated, another level of marginalization occurs. Cumulative discrimination and violation of the rights of marginalized women living with HIV/AIDS make it hard for the population to attain economic and social stability. Socioeconomic issues that are associated with a marginalized population living with HIV/AIDS were evident in Shannon’s case in South Carolina (Dehne et al., 2016). The woman was convicted under the South Carolina law that makes it a criminal offense when one fails to disclose their HIV/AIDS states when getting involved in sexual intercourse. Shannon contracted HIV/AIDS while in an abusive relationship and came out publicly during a national conference for advocates in 2010 to say that HIV criminalizing laws were not protecting women but instead harming them (CDC, 2019). Shannon decided to end the abusive relationship and as a result, her husband share hare HIV status with her parents, workmates, and anyone that could listen to him (Mastro et al., 2014). Shannon decided to obtain restraining orders against him and in response; he filed charges against Shannon under South Carolina’s HIV-specific criminalization law. She ended up being sentenced to six years in prison in the essence of being in an abusive relations ship and living with HIV.
After the jail term, Shannon searched for employment but vain despite holding a managerial position before the sentence. Following the intense HIV stigma in South Carolina, when it was listed as an HIV-positive felon, also, AIDS Drug Assistance Program is underfunded in the region which worsens the health conditions of victims (Paudel & Baral, 2015). The stigmatizations culminate in unemployment and underemployment that affect the economic status of the PLHA. Besides, some women end up being homeless and their condition is aggravated when they have children to look after (Geter, et al., 2018). Following the hardship, they face in the streets to support their children; they fail to rake their medication as prescribed by physicians. The issue is evident in the District of Columbia where a woman argues that lack of housing and being unsettled it is hard to take recreational drugs. Women are generally marginalized and discriminated in the society and the conditions worsen when they are living with HIV/AIDS.
Social justice/Health disparities
The link between gender-based violence, discrimination, and social disparities and HIV/AIDS is common globally and culminate in both a consequence and cause of HIV/AIDS infections. Sexual violence like rape increase the chances of women being infected with HIV/AIDS because they cannot negotiate for the use of a condom to protect themselves from infections (Kontomanolis et al., 2017). Also, given the conditions of rape, chances of increased abrasions or lacerations are high, and the virus can easily enter their bloodstream. Moreover, women who are HIV positive have a greater risk of abandonment and domestic violence when they disclose their health status (CDC, 2019). Besides, women living with HIV/AIDS face greater risks of institutional violence. Given the perception of society and women and HIV/AIDS, when the two come together with the situation worsens. Women with HIV/AIDS end up encountering health disparities when seeking healthcare services (Dehne et al., 2016). Due to their low economic status because of underemployment and unemployment, they cannot pay for insurance services and in turn, they are not able to get quality healthcare services. As a result, their health condition worsens.
Ethical issues associated with HIV/AIDS addresses issues like the criminalization of failure to disclose, adherence ART among vulnerable groups, and the push to use ART to treat HIV as a way of “prevention treatment.” Healthcare providers and their patients living with HIV/AIDS manage many ethical issues that include issues of confidentiality and problems with access to ART (Hess et al., 2017). People living with HIV/AIDS are aware of their imminent death because of the dangerous situations of their lives (Breskin et al., 2017). Ethical issues in care for HIV patients occur in the negative social determinants and arises outside the clinic as daily experience with people living with HIV/AIDS (CDC, 2019). Therefore, the clinical interactions between patients and their care providers are included in the daily experiences of social inequality and poverty among marginalized women living with HIV/AIDS.
Plan of Action
During the UN General Assembly High-Level Meeting Political Declaration on HIV/AIDS in 2011, it was pledged that gender-based violence and gender-based inequalities would be eliminated and that the capacity of women and adolescent girls would be increased to ensure that they protect themselves against risks of being infected with HIV/AIDS. However, the objectives and interventions have not been achieved at a faster pace than expected. The inclusion of gender equality in HIV responses is an important strategy to achieve success in alleviating discrimination among marginalized women living with HIV/AIDS. As the fact that the underlying factors that aggravate women’s physiological vulnerability to HIV/AIDS have made the efforts take place at a slow pace.
I propose three action plans that can make a difference in this group and promote well-being. My projects include (women agency, implement strategies to alleviate HIV vulnerability and partner violence and, increasing cash transfers and social protection to reduce poverty and HIV/AIDS vulnerability among girls and women.)
Women agency: through women’s collective agency, institutions are shaped, and the social norms are marketed (Rice et al., 2018). When women are empowered socially and politically, policies in an institution can change to be more representative of their voices.
Implement strategies to alleviate HIV vulnerability and partner violence: women are vulnerable to partner violence and HIV because of rape (CDC, 2019). Thus, putting in place strategies and stringent measures to curb rape and violence will enhance the lives of marginalized women living with HIV/AIDS.
Transfer and social protection to reduce poverty and HIV/AIDS vulnerability among girls and women: Increasing cash transfers and social protection to reduce poverty and HIV/AIDS vulnerability among girls and women (Amin, 2015; Breskin et al., 2017). When women marginalized women living with HIV/AIDS are empowered economically, they can be able to cater to their medical insurance and basic need and above all adhere to the prescription of their recreational drugs.
Stigmatization relating to HIV/AIDS are likened to overestimation of risks associated with the risk of infection as a result of casual contact with the victims, ultimate blame of the victims for their condition, higher intentions of neglecting and ignoring the victims socially, and denial of human rights and support of programs that restrict the freedom of action of people living with HIV/AIDS. Marginalized women living with the epidemic are associated with poor socioeconomic status, social injustice, health disparities, and ethical issues regarding their disclosure, and preventive treatment with ART. To overcome the challenges that marginalized women with HIV/AIDS encounter, women collective agencies should provide leadership, strategies to prevent rape and violence would be implemented, and the population should be supported economically. Consequently, their wellbeing will be enhanced.
Amin, A. (2015). Addressing gender inequalities to improve the sexual and reproductive health and wellbeing of women living with HIV. Journal of the International AIDS Society, 18(6S5), 1-6. doi:10.7448/IAS.18.6.20302
Auerback, J. D., Kinsky, S., & Charles, V. (2015). Knowledge, attitudes, and likelihood of pre-exposure prophylaxis use among US women at risk of acquiring HIV. AIDS Patient Care and STDs, 29(2), 102-110. doi:10.1089/apc.2014.0142
Breskin, A., Adimora, A. A., & Westreich, D. (2017). Women and HIV in the United States. PLOS ONE, 12(1), 1-6. doi:10.1371/journal.pone.0172367
Centers for Disease Control and Prevention. (2019). Retrieved from About HIV/AIDS: https://www.cdc.gov/hiv/basics/whatishiv.html
Centers for Disease Control and Prevention. (2019). Retrieved from HIV among women: https://www-cdc-gov.proxy.cc.uic.edu/hiv/group/gender/women/index.html
Centers for Disease Control and Prevention. (2019). Retrieved from HIV and Pregnant Women, Infants, and Children: https://www.cdc.gov/hiv/group/gender/pregnantwomen/index.html
Dehne, K. L., Dallabetta, G., Wilson, D., Garnett, G., Laga, M., Benomar, E., . . . Benedikt, C. (2016). HIV prevention 2020: A framework for delivery and a call for action. The Lancet, 3(7), e323-e332. doi:10.1016/S2352-3018(16)30035-2
Geter, A., Sutton, M. Y., Armon, C., Durham, M. D., Palella, F. J., Tedaldi, E., . . . Buchacz, K. (2018). Trends of racial and ethnic disparities in virologic suppression among women in the HIV outpatient study, USA 2010-2015. PLOS ONE, 13(1), 1-13. doi:10.1371/journal.pone.0189973 J
Gonzalez, S. M., Aguilar-Jimenez, W., Su, R. C., & Rugeles, M. T. (2019). Mucosa: Key interactions determining the sexual transmission of HIV infection. Frontiers in Immunology, 10(144), 1-11. doi:10.3389/fimmu.2019.00144
Hess, K. L., Hu, X., Lansky, A., Mermin, J., & Hall, H. I. (2017). like the risk of a diagnosis of HIV infection in the United States. Annals of Epidemiology, 27(4), 238-243. doi:10.1016/j.annepidem.2017.02.003
HIV/STI Surveillance Report 2016. (2017). Retrieved from Chicago.org: https://www.chicago.gov/content/dam/city/depts/cdph/HIV_STI/HIV_STISurveillanceReport2016_12012017.pdf
Kontomanolis, E. N., Michalopoulos, S., Gkasdaris, G., & Fasoulakis, Z. (2017). The social stigma of HIV-AIDS: Society’s role. HIV AIDS-Research and Palliative Care, 9, 111-118. doi:10.2147/HIV.S129992
Mastro, T. D., Sista, N., & Abdoll-Karim, Q. (2014). ARV-based HIV prevention for women-where we are in 2014. Journals of the International AIDS Society, 17(3S2), 1-8. doi:10.7448/IAS.17.3.19154National Institute of Allergy and Infectious Disease. (2019). Retrieved from HIV/AIDS: https://www.niaid.nih.gov/diseases-conditions/hivaids
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