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Issues

Women and AIDS

Women living with HIV/AIDS often place the needs of their families ahead of their own, including health care. Ryan White outreach and primary care programs empower these women to live longer, healthier lives and HRSA works to better educate providers to address the unique needs of this population.

Gay Men

Gay men have been heavily impacted by HIV/AIDS since the beginning of the epidemic. Gay men have helped lead the way towards creating high standards of culturally competent care and integral to the creation and direction of the Ryan White HIV/AIDS Program.

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Cultural Competency

Culturally competent service providers are crucial to recruiting and retaining people living with HIV/AIDS into primary care, particularly when they are members of historically disenfranchised communities and populations such as people of color, gay men, women, and substance users.

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Confidentiality

Ryan White confidentiality guidelines have helped allay the fears that many people living with HIV have around unwanted disclosure and HIV discrimination.

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Treatment Advances

The Ryan White HIV/AIDS Program ensures people living with HIV/AIDS have access to the latest treatments, including life-saving AIDS medications. Advances in vaccine and pharmaceutical research promise new ways to treat, and perhaps halt, HIV infection in the future.

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African-Americans

African-Americans are the racial and ethnic group most disproportionately affected by the HIV/AIDS epidemic. By providing culturally competent, comprehensive care the Ryan White HIV/AIDS Program is committed to turning this tide.

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Aging

Wonderful advances in treatment have brought with them the promise of longer life for people living with HIV. The Ryan White HIV/AIDS Program has been there, growing with the people it serves and ensuring that the program’s aging patients have many years of good health and happiness to look forward to, every step of the way.

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HIV/AIDS Stigma

Stigma represents one of the most complex and pervasive barriers to health care for people living with HIV/AIDS. From the beginning, the Ryan White HIV/AIDS Program has fought against the discrimination and isolation that stigma creates, a commitment that helps more people engage and remain in care.

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Rural Challenges

In rural America, unique challenges add to the complexity of providing care for people living with HIV/AIDS. The Ryan White HIV/AIDS Program is, thus, a critical source of support in remote areas, helping patients overcome barriers to care as well as providing technical assistance for providers.

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Young People

Youth represent the only age group in the United States still experiencing increases in HIV diagnoses. The Ryan White HIV/AIDS Program is working tirelessly to find ways of reaching more of these at-risk young people and providing the kind of comprehensive, responsive care that can change lives.

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Who's at Risk: Public Perception and HIV

Mary Fisher, a White woman from a wealthy Detroit family, did a lot to change the face of the disease for mainstream America when she spoke in 1992 at the National Republican Convention about living with AIDS. Her impassioned speech helped to slowly move the public's perception of the epidemic as affecting only gay men or injection drug users to something that could happen to anyone, including a married mother from one of the wealthiest suburbs in the Nation. And Elizabeth Glaser, a woman who was infected with AIDS through a tainted blood transfusion, helped the world to understand mother-to-child transmission of the virus. She lost 2 of her 3 children to AIDS before losing the battle herself.

Women and the Ryan White HIV/AIDS Program

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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
  • Haitians
  • 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.

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