Aids, Women, and Poverty

Cultural Constructions of AIDS Transmission

The invisibility of women was soon replaced, however, with cultural constructions that presumed that certain women (i.e., sex workers) were a major source of infection, along with other groups (i.e., gay men, injection drug users, Haitians). These “risk-group” classifications served to stigmatize already marginalized groups rather than orient public health programs for those most at risk of infection. Similarly, fascination with “hidden homosexuality,” “genetic difference,” and the “exotic” sexual or ritual practices of Africans were used to explain differences in transmission rates in this region (Farmer, 1992).

Cultural constructions that stigmatize AIDS victims continue to obscure the role of larger structural forces, both global and local, in engendering risk. These structural forces include poverty, racism, gender inequality, and violence. Poor women and girls have been particularly affected by these forces. By the end of 1999, 95% of the entire world's AIDS cases had occurred in developing countries. The vast majority of infections (an estimated 70%) and the highest prevalence rates (up to 30% of adults in some countries) were recorded in sub-Saharan Africa, the region with the lowest gross national product. In this region, 58% of infections have been recorded among women (UNAIDS/WHO, 2002).

In some areas, prevalence rates among women are extremely high. Among 25- to 29-year-old pregnant women receiving prenatal care in urban clinics in Botswana, for example, 55.6% were living with HIV/AIDS in 2001 (UNAIDS/WHO, 2002). Even younger women (aged 15–24) from this region are [Page 67]vulnerable, with infection rates that are at least double those of young men (6%–11% among young women compared with 3%–6% among young men). While overall rates of new infections have remained steady for the last few years in sub-Saharan Africa, particular countries or regions are still threatened by changing trends, including explosive growth of the epidemic (UNAIDS/WHO, 2002). (In the capital of war-torn Sierra Leone, for example, infection rates among female sex workers rose from 26.7% in 1997 to 70.6% only 2 years later.)

Poverty

Structural factors also shape infection rates in other parts of the world, including the wealthiest nations. In the United States, for example, the majority of women with HIV/AIDS are poor. African American women in the United States accounted for 58% of all women diagnosed with HIV in the United States in 1991, despite the fact that they represent only about 17% of U.S. women. The majority of new infections recorded among 13- to 19-year-olds in 34 areas in the United States were among females (56%). A disproportionate number of these infections were also among young African American women (UNAIDS/WHO, 2002). AIDS is the number one cause of death among African American women aged 25 to 34. Latina women in the United States also experience high rates of infections, and these rates have continued to rise. Latina women represent 19% of cumulative AIDS cases, but 23% of cases reported in the year 2000 (UNAIDS/WHO, 2002). The majority of these cases are among Puerto Ricans, the poorest Latino group in the United States. Similar trends of rising infection rates among poor women can be found in Eastern Europe, Central Asia, the Middle East, North Africa, Latin America, and the Caribbean. Clearly, poor women throughout the world do not share a particular cultural history, “race,” or ethnicity. What poor women do share are poverty and their relative inequality compared with men.

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