Of the approximately 1.1 million people living with HIV/AIDS in the United States today, more than 280,000 are women.1 Although men who have sex with men represent the largest number of people living with HIV/AIDS, rates of HIV infection among women, particularly racial and ethnic minority women, continue to climb.
Health disparities among racial and ethnic minorities are a major issue in the fight against HIV/AIDS. Women accounted for 26 percent of estimated AIDS cases in 2008,* of which 84 percent were among women of color.2 Even with the availability of life-saving antiretroviral drugs, AIDS is still the fourth leading cause of death for Black women ages 25 to 54.3 This is, in part, due to late diagnosis; in 2010 an estimated 30 percent of women in States with HIV name reporting developed AIDS within a year of their diagnosis.4 Women of color living in urban areas such as Atlanta, Chicago, Los Angeles, Miami, New York, Philadelphia, San Francisco, and Washington, DC, have historically been hit especially hard by the epidemic. Today, AIDS among women of color is on the rise in the South.5
In the Beginning
In the earliest days of the AIDS epidemic, scientists and researchers focused their energies on understanding this disease that was mysteriously killing gay men. Soon, however, it became apparent that the new condition (called “the gay cancer” and “gay-related immune deficiency” [GRID]) was about much more than men who have sex with men.
In the July 9, 1982, edition of Morbidity and Mortality Weekly Report, the U.S. Centers for Disease Control and Prevention (CDC) reported on 34 cases of Kaposi’s sarcoma and opportunistic infections in Haitians, 4 of whom were women. These cases had the hallmarks of the immunodeficiency disorder previously diagnosed only in gay men.6 The report led to a dramatic advancement in understanding of the new disease, its associated risk factors, and potential modes for transmission. It also foreshadowed a torrent of infections among women—especially minority women—over the coming decades.
Living With a Scarlet Letter
Shortly after HIV cases were found among Haitians, the first case related to a blood transfusion was documented. The CDC quickly began to construct a profile of people at risk, which included the following groups:
- gay and bisexual men
- sex workers
- intravenous drug users
- female sexual partners of men who have AIDS, and
- people who had received a transfusion of infected blood.
It had become clear that the new killer was not isolated to the gay community. By the end of July 1982, the CDC changed the name GRID to acquired immune deficiency syndrome (AIDS).7
While the medical research community was slowly getting a better handle on what behaviors made women vulnerable to HIV/AIDS, the CDC’s definitions and risk categories made it easy for mainstream America to remain in denial. It was somebody else’s problem. Women all over the country breathed a collective sigh of relief when media spread the word that the only way they could get this disease was through prostitution, sex with a gay man who had AIDS, injection drug use, or transfusion with tainted blood products. The definitions were so narrow that most women never saw themselves at risk—nor did their health care providers.
As the epidemic evolved, a lack of accurate information about what behaviors put women of all ages at risk coincided with growing HIV incidence among this population. By 1986, women represented 7 percent of all documented AIDS cases in the United States.8 Yet, an article in the January 1988 issue of Cosmopolitan, a publication that many young women looked to for information on sex and relationships, declared that a woman could indeed safely have unprotected intercourse, even if her partner was HIV positive.9
*The most recent year for which data are available.