ATLANTA, Georgia — On March 14, the Center for Disease Control’s (CDC) Morbidity and Mortality weekly report confirmed a domestic case of woman-to-woman HIV transmission, a rare phenomenon that has broad global health implications for long term care of HIV-positive persons.
The CDC was first alerted to the case in August 2012, when the now 46-year-old patient tested positive for HIV antibodies in a routine screening prior to plasma donation. Curiously, the woman had cleared not one, but two screens in months prior: first, in March 2012, before a plasma donation, and second, at the emergency room a mere 18 days before her positive result (she sought medical intervention due to fever, vomiting, diarrhea and muscle cramps, all classic symptoms of HIV seroconversion illness.)
How Did This Happen?
The CDC spent two years confirming the transmission before its recent announcement. The woman likely acquired the virus from her HIV-positive partner, who was diagnosed in 2008. The 43-year-old had started a treatment regimen in early 2009 before discontinuing use of antiretroviral drugs in January 2011.
Medical authorities used an analytic tool to analyze genetic similarities between HIV strains of the partners, ultimately determining that their infections were from “highly-related” viruses. Neither woman had any other risk factors for HIV, such as injection drug use, blood transfusions or tattoos.
The couple’s personal preferences may have played a role in the transmission. Both reported engaging in unprotected sex, at times during menstruation and of a nature that induced bleeding.
Female-to-female HIV Transmission a Historic Rarity
Transmission between females has “been reported rarely” and is largely considered “difficult to ascertain” due to HIV infection presenting with a variety of additional risk factors. This historic diagnostic difficulty has resulted in a widespread lack of information for WSW (women who have sex with women) at risk of HIV infection.
Unfortunately, the shortage of medical information for this cohort likely contributed to the couple or medical provider’s decision to forego preventative counseling. The CDC cautions that “all persons (regardless of sexual orientation) at risk for HIV…should receive information regarding the prevention of HIV.”
The Information Gap
Domestically, any unfortunate outcome of medical misinformation (in this case, manifested as a lack of information altogether) results in indignation and a widespread call for reconciliation. On an international level, however, information gaps between providers and patients contribute to a large proportion of the 3,600 new HIV infections daily.
Women suffer disproportionately from a misinformation about HIV transmission and infection and account for over half of all AIDS cases worldwide.
Gender Inequalities Contribute to Inequalities in Infection Rates
Archaic gender norms permeate societies in developing nations, empowering males to have numerous sexual partners while exposing women to the wants of older men. This phenomenon, combined with the violent nature of 10 percent to 60 percent of sexual encounters, often results in disproportionately higher HIV infection rates in younger women.
As homemakers (the “natural” role forced upon women,) women are rarely paid and infrequently exposed to education, health care and the opportunity for vocational training. The United Nations Educational, Scientific and Cultural Organization reports that “women and girls continue to lag behind” in the push toward global literacy; females account for over 61 percent of the youth illiterate population.
Because uneducated girls are less “equipped to make safer sexual decisions,” the system creates an inescapable cycle of disenfranchisement and illness.
The Joint U.N. Development Programme on HIV/AIDS reports that only 38 percent of women 15-24 years of age receive “accurate, comprehensive” information regarding HIV/AIDS.
Ineffective Governments Exacerbate Inequality
Though both men and women in developing nations suffer from hurdles in access to health services, women are typically excluded from treatment due to institutional or political barriers rather than social ones.
Despite widespread activism exposing gender-related barriers, only 52 percent of counties “included specific, budgeted support for women-focused HIV/AIDS programs.”
Possible interventions abound, including removing financial barriers to antiretroviral therapies, addressing HIV-related discrimination and offering community based support groups for women to discuss their concerns. Further, campaigns that encourage women to stay in schools and pursue skills training would promote inheritance rights and improve economic mobility.
Takeaways and Role Playing
Recent headlines remind Western nations that “HIV doesn’t discriminate” by gender, economic status or political affiliation. Though largely insulated from the epidemic’s tragedy, the United States was jolted by the latest development in HIV’s infection capability, which opened up a new swath of the population to the possibility of infection.
Action players in the public and private sectors would do well to harness this instinctual anxiety and channel it toward implementing gender-based programs for the women who live in perpetual fear of becoming HIV’s next victim.
Sources: AIDS Map, AMFAR, News Fix Now, CDC, UNESCO, WHO, UNESCO
Photo: Elizabeth Lombino