Washington, DC — Women's and girls' exposure is theme of World AIDS Day

A global census of people living with HIV/AIDS finds that more than 37 million carry the virus. About half are female, but in some regions women and girls surpass men in the ranks of the infected. In sub-Saharan Africa, close to 60 percent of adults living with HIV are women.

The younger the women, the worse it gets. Among people aged 15-24 who are living with HIV in sub-Saharan Africa, 76 percent are female. In the United States, AIDS now ranks among the top causes of death for African-American women aged 35-44, according to AIDS Epidemic Update 2004, compiled by the Joint U. N. Programme on HIV/AIDS (UNAIDS) and released November 23.

Statistics like these help explain why recognition of World AIDS Day in 2004 on December 1 is devoted to the theme of women, girls, HIV and AIDS.

"Women are so victimized because they are so economically dependent on men that their ability to say no sexually, or even to seek protection for themselves sexually, often does not exist," observes Jessie Milan, an AIDS program administrator with a Washington-based company. He has also traveled widely, participating in HIV/AIDS education and awareness programs sponsored by the U.S. State Department's International Information Programs (IIP).

Jessie Milan is HIV-positive and has been for 22 years. That life experience allows him to see the many social and political threads interwoven into the story of the AIDS epidemic.

"HIV is exposing the world to the economic, social and political weakness of women of today," Milan said in a Washington File interview. "And we have to help build strategies to make women far more empowered so that this disease does not continue to kill them."

The lower social status of women is a factor that drives their increasing infection rates in all world regions, he said. Myths and misinformation are another factor.

"The most striking thing is that there are men who still continue to assume that if you have sex with a virgin or a post-menopausal woman you're going to be cured of HIV," said Inge Corless, a specialist in HIV/AIDS care and a professor at MGH Institute of Health Professions, affiliated with Massachusetts General Hospital in Boston. She has also traveled in Africa, participating in IIP education programs and engaged in other international medical and educational exchanges.

"There have been cases of 9-month-old baby girls being raped," said Corless. "It's mind-boggling to think of that."

More effective and pervasive education programs may help dispel such myths, but Corless calls for more. She calls on African leaders to publicly denounce male sexual behavior that fuels the rapid spread of the epidemic.

"It's only when our leaders speak out, then it really sets the tone for what's going to happen. That's true in any other country as well," Corless told the Washington File. "I think it has to be a matter of patriotism not to spread HIV/AIDS."

Changing attitudes and behaviors will be one step toward decreasing women's vulnerability to HIV exposure. Changing women's economic status will be another way to protect their health, according to Professor Muhiuddin Haider. He is an expert in public health education and is on the faculty in the Department of Global Health at George Washington University.

Poverty is a major factor in women's vulnerability to disease, Haider said. That is what drives them into sexual relationships with men who may expose them to disease. That is what drives them into commercial sex work, a significant route of transmission in Tajikistan, where he recently participated in another IIP program on HIV/AIDS.

Haider said that helping women develop greater economic independence might also help protect them from HIV. "NGOs [nongovernmental organizations] and private communities can look into socioeconomic activities at the local level and involve women in order to divert them from the vulnerability of commercial sex work."

In Tajikistan, grassroots groups are discussing how to launch microenterprise programs to help alleviate poverty and create greater economic independence among women, Haider said.

The Global Coalition on Women and AIDS, a UNAIDS initiative focused on this aspect of the epidemic, is pushing for several related actions to better protect women: prevent HIV infection among girls and women, including access to reproductive health care; reduce violence against women; protect the property ownership and inheritance rights of women and girls; and ensure equal access by women and girls to care and treatment.

Evidence of the increasing vulnerability of women and girls to HIV draws a clear line between gender inequality and death, according to Dr. Peter Piot, the executive director of UNAIDS. "It's time now for the women's movement and the AIDS movement to find each other, and that hasn't happened yet," Piot said in an Associated Press interview. "Ultimately, without putting women at the heart of the response to AIDS, I don't think we will be able to control this epidemic."

History demonstrates that the struggle against AIDS can result in broader social consequences. Jessie Milan looks back on the early years of the disease's emergence in the United States, a time when it was wrongly thought that the epidemic was largely restricted to the homosexual population. The misery of the disease caused demands from the homosexual community for greater action, an outcry that had far broader social effects.

"The civil rights movement of gay and lesbian people has been driven by their desire to no longer suffer from not only the shackles of discrimination but the shackles of AIDS," Milan said.

Failure to address the trend of growing exposure among women and girls is likely to have broader negative impacts across many societies, according to UNAIDS. In many nations, women carry the greatest responsibilities for caring for the sick, cultivating crops and tending to orphans. As more fall ill and are unable to perform these tasks, the devastation of the AIDS epidemic expands.

(The Washington File is a product of the Bureau of International Information Programs, U.S. Department of State. Web site: http://usinfo.state.gov)