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Women's Infections on Rise
Social Inequalities Add Fuel To AIDS Fire, Scholar Says

By Rich McManus

Declaring that "poverty is the least studied risk factor for AIDS," scholar Janie Simmons painted a depressing portrait of a worldwide AIDS pandemic that seems, almost diabolically, to be targeting the most vulnerable element of society -- young women and girls in developing nations.

Speaking on the topic of "Women, Poverty and AIDS," at an AIDSEpidemiology and Clinical Research Interest Group seminar in Lipsett Amphitheater recently, she warned that despite headlines announcing declining rates of overall deaths due to AIDS, "there is a contrary trend among African American and Latino women" in this country and in poor women worldwide. "There is a continuing and steady rise in HIV infections in women internationally," said Simmons. Women, she charged, are diagnosed later in their disease than men, die sooner than men following diagnosis and are treated less equitably.

"This has never been an equal opportunity disease," she said. "It is now largely a disease of poverty," particularly in Subsaharan Africa and Southeast Asia. "Where you find the most poverty, you also find the most AIDS."

The pandemic is composed of multiple subepidemics, she explained, and in women and girls, the infection rate is exploding. In the age group 10-29, women are being infected at a much higher rate than men, she said. "Ninety-one percent of those infected who are under age 13 in the U.S. are girls."

How did AIDS become a leading cause of death in women, she asked? Besides a biologic vulnerability -- virologists have reported that virtually the entire reproductive tract in women is vulnerable to HIV entry -- strong factors include poverty, gender and inequality. "Social status magnifies a woman's biological predisposition to HIV," she said.

Simmons recited a harrowing litany of social arenas in which women, particularly in the developing world, face inequalities: housing, health care, land ownership, schooling, jobs, legal protection, etc. "Gender inequality is a significant factor in infection and survival," she said. "Women are powerless in many economies."

One scholar has characterized the world's deprived social milieus, into which AIDS is simply one more unwelcome enemy, as "a synergy of plagues," Simmons noted. Social disintegration and "toxic social environments" can therefore be regarded as a "cause" of AIDS, she suggested.

Simmons read two alarming biographies from a text she coedited with Drs. Paul Farmer and Margaret Connors, Women, Poverty and AIDS -- Sex, Drugs and Structural Violence. One involved an Indian girl sold into sexual slavery by desperately poor parents, and the other was about a Harlem woman whose family collapsed under the weight of drug addiction, poverty and AIDS. Only by examining the social and economic forces shaping the AIDS pandemic can successful interventions be imagined, she argued.

"I have heard stories of Thai women who are washing out their condoms after use," she related. "That's just ridiculous. And there are lots of poor places that don't even have condoms."

She urged much more interdisciplinary -- and highly critical -- analyses of how and why AIDS is progressing almost unchecked in many populations. "The anthropologists, the physicians, the epidemiologists -- they can't just go off and do their thing independently," she said. "Only by combining our insights will we be able to get a better grip on the epidemic. We have to enlarge our theoretical framework, and maybe redefine who we are allied with."

Simmons works for the Hispanic Health Council, Inc., in Hartford. She is also affiliated with the Institute for Health and Social Justice, part of a nonprofit group called Partners in Health, which works with community-based organizations in poor communities in Haiti, Peru, Mexico and Boston.

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