 from Leela McCullough <leela@healthnet.org> -----

The rapid "feminization" of the AIDS pandemic must be confronted
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Johns Hopkins Medical Institutions
http://www.hopkinsmedicine.org

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 Hop-
kins and a senior investigator at the National Institute of Al-
lergy 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 haemophiliacs 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 replicat-
ing, helped establish laboratory and treatment facilities in the
Democratic Republic of the Congo, India and Uganda, and coun-
seled other governments across Africa and Asia about control ef-
forts.

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 in-
fected as well as orphaned. He also points out that medical re-
search 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 par-
ticularly vulnerable to such cultural factors as their relative
lack of power in sexual relationships, widespread poverty, poli-
cies that deny women an education and tolerance of violence
against women.

Excessive biological vulnerability to HIV among young women, al-
though not fully understood, is believed to be due to an imma-
ture 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 ef-
forts 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 pre-
vent and treat the disease, then developing specific strategies
that empower women will be key to its success."

For more information or to schedule an interview with Quinn,
please contact David March dmarch1@jhmi.edu.



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