By Shirley L. Smith
Despite a significant decrease in the number of black women in the United States getting HIV (the virus that causes AIDS) between 2008 and 2010, heterosexual black women are still disproportionately affected by the AIDS epidemic — they represent the majority of new HIV infections among women, and are the second highest risk group in America for HIV after gay and bisexual men.
In 2010, there were 9,500 new HIV infections among women, which reflect a 21 percent decrease from the 12,000 women infected in 2008, according to a recent report from the Centers for Disease Control and Prevention (CDC). The decline is due to a drop in new HIV infections among black women, from 7,700 in 2008 to 6,100 in 2010. There was no significant change in new HIV infections among white and Hispanic women.
"While the decline is encouraging, African-American women remain far more affected by HIV than women of other races," said Janet Cleveland, deputy director of CDC's Division of HIV/AIDS Prevention. "In 2010, CDC's incidence analysis also showed that African-American women accounted for the vast majority — 64 percent — of all new infections among women, and 13 percent of all new infections in the U.S." In contrast, white women comprised 18 percent of new HIV infections among women in 2010, and Hispanic women accounted for 15 percent.
Since AIDS took root in the United States in the early 1980s, gay and bisexual men have borne the brunt of this insidious disease, which attacks the body's immune system, leaving people susceptible to life-threatening infections. However, CDC data show that the percentage of adult and adolescent women with an AIDS diagnosis rose from 7 percent in 1985 to 25 percent in 2010, and HIV/AIDS has claimed the lives of thousands of women, most of whom are black. Between 1987 and 2010, the National Center for Health Statistics mortality reports indicate that more than 86,600 women died of HIV/AIDS, and more than 55,800 of them were black women.
"The rate of new HIV infections among black women in 2010 was 20 times that of white women and nearly five times that of Hispanic women," said Salina Cranor, a spokesperson for the CDC's National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention. Additionally, the latest data reveal that in 2010, HIV was among the top 10 leading causes of death for black women ages 15 to 64.
Cleveland attributes the high rate of HIV/AIDS among black women to a host of socioeconomic factors, including limited access to affordable and quality health care (which results in less access to testing and treatment) and the high prevalence of HIV and other sexually transmitted diseases in the black community, which can mean a greater risk of HIV exposure with each sexual encounter.
Research shows that most women contract HIV through unprotected sex with an HIV-positive man. The virus can be transmitted through blood, vaginal fluid, pre-seminal fluid and semen. Unprotected vaginal, anal and oral sex is riskier for women than for heterosexual men because, as the receptive partner, women receive all of the fluids and are potentially exposed to the virus longer, said Carolyn Williams, Ph.D., the chief of the Epidemiology Branch at the National Institute of Allergy and Infectious Diseases (NIAID) Division of AIDS. Women who use contaminated needles or paraphernalia to inject drugs are also at high risk of contracting the virus.
Needle exchange programs, which provide clean needles to drug users, have substantially reduced HIV transmissions among female injection drug users, Dr. Williams said. While this decline is heartening, Dr. Williams stressed that declines in heterosexual transmission to women, especially black women, have been modest. "The epidemic among African-American women remains exceptionally high," she said.
In the 1980s and 1990s, HIV was often seen as a death sentence. But today, Dr. Williams said, most people can live long, productive lives with HIV if the virus is caught and treated early. "Prior to antiretroviral therapy, the average length of time that someone lived with HIV was around 12 years," she said. "Today, if someone gets infected with HIV and gets therapy, that person can expect to live a nearly normal life span."
As a result of well-designed prevention programs, "more Americans are being tested for HIV than ever before," Cleveland said, but many people are still unaware of their HIV status, which puts them and their partner's life at risk. Currently, an estimated 1.1 million people in America are living with HIV, and more than 279,000 are women, Cranor said. She added that nearly one in five of those individuals who are HIV-positive are unaware of their infections.
Women need to make HIV testing a priority, Dr. Williams said. "Women are coming into care far too late, and when they come into care late, the virus has damaged their immune system, and it is difficult for them to recover even with today's medicine," she said. A NIAID sponsored study found that people who receive treatment early when their immune systems are relatively healthy can reduce the risk of sexually transmitting HIV to their uninfected partner by 96 percent.
For women who are pregnant or plan to become pregnant, it is even more important to get tested and treated, because appropriate treatment will not only help them achieve a better health outcome for themselves, but it significantly reduces the risk of a pregnant woman transmitting the virus to her child, said Dr. Sarah Read, director of the Therapeutics Research Program at the NIAID's Division of AIDS.
"Without antiretroviral therapy, the chance of a HIV-infected woman passing the virus to her child is about 25 percent during pregnancy, labor and delivery," said Read, who specializes in HIV/AIDS treatment. "The risk can be reduced to less than one percent with antiretroviral therapy during pregnancy, labor and delivery, if the baby is delivered by cesarean section and if the mother does not breastfeed, as the virus can also be transmitted through breast milk."
The CDC recommends that all adults and adolescents get an HIV test at least once in their lifetime, and people who practice risky behavior should be tested more frequently, Cleveland said. Most HIV tests look for HIV antibodies, which most people develop within three months after infection, but some individuals may take longer to develop detectable antibodies, so the CDC advices people who test negative soon after engaging in risky behavior to get re-tested after three months. And all sexually active individuals are advised to use latex condoms, even during oral sex (oral sex is not as risky as vaginal or anal sex, but can still transmit the virus).
For more information on HIV and testing, visit the CDC's National HIV and STD Testing Resources.
Published September 4, 2013
Shirley L. Smith is a freelance journalist.