PETRA: Module 1, Chapter 3

Gender

Men and women have different behavioral, biological, and psychological risk factors for HIV/AIDS.

The Risks of Being A Man (1)

Generally, more men than women are HIV+. This is true for all regions of the world except Sub-Saharan Africa.
All over the world, men have more sex partners than women.
Men who have sex with men have the biological risks associated with anal sex.
Men are much more likely than women to abuse alcohol and drugs--two behaviors that increase the likelihood of engaging in risky sexual practices that put them at risk for contracting and transmitting HIV.
Men are more likely to inject drugs, exposing them to the risk of HIV from infected needles and syringes.

The Risks of Being A Woman

The percentage of adults living with HIV/AIDS worldwide who are women has been steadily increasing (2, 3). In Sub-Saharan Africa, women's rates of HIV infection have already surpassed men's.
Although more men than women have been diagnosed with HIV since the beginning of the epidemic, more women than men have died of HIV, reflecting gender differences in access to medical care.
Because of socioeconomic inequities (less education, fewer jobs) and gender norms, (partner age differences, partner communication practices) many women do not have control over when (the timing) and how (whether condoms are used) sex occurs.
Women are far more likely to experience gender-based violence, including physical and sexual abuse, in which they do not have control over the safety of sexual intercourse.
Women are far more likely to become infected through heterosexual intercourse than they are through any other means of transmission (4, 5).
Women are more likely than men to need blood transfusions, because of blood lost during childbirth. Receiving HIV-infected blood in a transfusion is still a risk factor for HIV/AIDS in many countries.
Socioeconomic inequities and social unrest also force some women into exchanging sex for comfort, goods, or money (6).

The Risks of Being Transgender

Although there is limited information about rates of HIV among transgender people, rates are expected to be higher because transgender people have more behavioral risks factors, such as substance abuse and use of shared needles (for injection of hormones as well as for illicit drugs), irregular condom use, and multiple sex partners (8, 9).

Sexual Orientation

In the United States, the group with the highest rates of HIV infection is men who have sex with men. This group has the highest rates of unprotected anal sex, which is a behavioral risk factor for HIV transmission and contraction.
In most other regions of the world, however, the group with the highest rates of HIV is people who have heterosexual intercourse.

Race/Ethnicity

In the U.S., racial and ethnic minorities represent the majority of new AIDS cases, the majority of Americans living with AIDS, and the majority of deaths among persons with AIDS.
Most of the excess risk of HIV/AIDS among African-Americans and Latinos reflect discrimination in employment, housing, earning power, and educational opportunity (10). This discrimination relegates minorities to lower levels of socioeconomic status (SES) and to the risks associated with lower SES.

Socioeconomic Status (SES)

Socioeconomic status indicates people's standing in society, and is usually measured by their income, occupation, or educational attainment. Socioeconomic status is one of the most powerful predictors of sickness and health.
People with lower SES are more likely to contract and transmit HIV/AIDS, perhaps because they have less knowledge about HIV/AIDS, because they are surrounded by people who are more likely to have HIV/AIDS, and because they are more likely to use drugs and practice unsafe sex to escape from stress (11, 12).
HIV+ people with lower SES also die sooner than HIV+ people with higher SES, because of their lack of access to medical care, the high cost of antiretroviral drugs, and their lowered immunity from other illnesses.

Age

About half of all new HIV infections worldwide, or approximately 6,000 per day, occur among young people aged 15-24, the majority of them young women (12).
In US, for men who have sex with men, younger age is strongly correlated with increased high-risk sexual behaviors (unprotected anal sex)(13).
Despite high levels of sexual activity, young people often do not know the basic facts about HIV/AIDS, which puts them at risk. In 17 countries of Africa, more than half of young people demonstrated that they did not know how to protect themselves from HIV (14).

Place of Residence

HIV disease morbidity and mortality vary greatly within and between nations.
In the United States, for example, annual number of deaths by HIV is highest in the South. U.S. regional disparities continue to increase over time (15). Limited access to healthcare, poverty, and discrimination all contribute to these regional disparities.

References:
1. Joint United Nations Programme on AIDS (UNAIDS). Men and AIDS: A Gendered Approach, 2000. Retrieved on December 16, 2003 from http://www.thebody.com/unaids/men/contents.html.)

2. Centers for Disease Control and Prevention (CDC). Advancing HIV Prevention: New Strategies for a Changing Epidemic – United States, 2003. Morbidity and Mortality Weekly Report 52(15):329-352, 2003.

3. Osmond, D.H. Sexual Transmission of HIV. Knowledge Base Chapter. Center for HIV Information, University of California, San Francisco, 1998. Retrieved on January 14, 2004 from http://www.hivinsite.com/InSite?page=kb-07-02-01#S5X.

4. Türmen, T. Gender and HIV/AIDS. International Journal of Gynecology and Obstetrics, 82: 411-418, 2003.

5. Joint United Nations Programme on AIDS (UNAIDS). Gender and HIV/AIDS: Taking stock of research and programmes. UNAIDS Best Practice Collection. Geneva, Switzerland: Joint United Nations Programme on HIV/AIDS, 1999.

6. Clements-Nolle, K., Marx, R., Guzman, R., & Katz, M. HIV prevalence, risk behaviors, health care use, and mental health status of transgender persons: Implications for public health interventions.

7. Denny, D. Transgendered youth at risk for exploitation, HIV, and hate crimes. American Educational Gender Information Services, Inc., 1995. Retrieved on January 20, 2004 from http://www.aidsinfonyc.org/Q-zone/youth.html.

8. Department of Health and Human Services. Fact Sheet on AIDS and Transgender Persons. Retrieved on October 5, 2004 from http://www.surgeongeneral.gov/aids/factsheets/transgender.html.

9. Quinn, S.C. AIDS and the African American woman: The triple burden of race, class, and gender. Health Education Quarterly, 20:305-320, 1993.

10. Joint United Nations Programme on AIDS (UNAIDS). AIDS Epidemic Update, December 2002. Geneva, Switzerland: Joint United Nations Programme on HIV/AIDS, 2002. Available online at: http://www.who.int/hiv/pub/epidemiology/epi2002/en/

11. Feldman, D.A. (Ed). Culture and AIDS. New York, NY: Praeger, 1990.

12. United Nations Population Fund (UNFPA). State of World Population 2003 Making 1 Billion Count: Investing in Adolescents’ Health and Rights. New York, NY: United Nations Population Fund, 2003.

13. Kalichman, S.C. Preventing AIDS. A Sourcebook for Behavioral Intervention. Mahwah, NJ: Lawrence Erlbaum Associates, 1998.

14. Feinstein, N. and Prentice, B. The UNAIDS Gender and AIDS Almanac. Los Altos, CA: Sociometrics Corporation, 2001.

15. Centers for Disease Control and Prevention (CDC). Trends in the Percentage Distribution of Deaths due to HIV infection by Geographic Region, USA, 1987-1999. Slide 21 of 36, Mortality slide series L285. Retrieved on February 18, 2004 from http://www.cdc.gov/hiv/graphics/images/l285/l285-21.htm.





	Gender Men and women have different behavioral, biological, and psychological risk factors for HIV/AIDS. The Risks of Being A Man (1) Generally, more men than women are HIV+. This is true for all regions of the world except Sub-Saharan Africa. All over the world, men have more sex partners than women. Men who have sex with men have the biological risks associated with anal sex. Men are much more likely than women to abuse alcohol and drugs--two behaviors that increase the likelihood of engaging in risky sexual practices that put them at risk for contracting and transmitting HIV. Men are more likely to inject drugs, exposing them to the risk of HIV from infected needles and syringes. The Risks of Being A Woman The percentage of adults living with HIV/AIDS worldwide who are women has been steadily increasing (2, 3). In Sub-Saharan Africa, women's rates of HIV infection have already surpassed men's. Although more men than women have been diagnosed with HIV since the beginning of the epidemic, more women than men have died of HIV, reflecting gender differences in access to medical care. Because of socioeconomic inequities (less education, fewer jobs) and gender norms, (partner age differences, partner communication practices) many women do not have control over when (the timing) and how (whether condoms are used) sex occurs. Women are far more likely to experience gender-based violence, including physical and sexual abuse, in which they do not have control over the safety of sexual intercourse. Women are far more likely to become infected through heterosexual intercourse than they are through any other means of transmission (4, 5). Women are more likely than men to need blood transfusions, because of blood lost during childbirth. Receiving HIV-infected blood in a transfusion is still a risk factor for HIV/AIDS in many countries. Socioeconomic inequities and social unrest also force some women into exchanging sex for comfort, goods, or money (6). The Risks of Being Transgender Although there is limited information about rates of HIV among transgender people, rates are expected to be higher because transgender people have more behavioral risks factors, such as substance abuse and use of shared needles (for injection of hormones as well as for illicit drugs), irregular condom use, and multiple sex partners (8, 9). Sexual Orientation In the United States, the group with the highest rates of HIV infection is men who have sex with men. This group has the highest rates of unprotected anal sex, which is a behavioral risk factor for HIV transmission and contraction. In most other regions of the world, however, the group with the highest rates of HIV is people who have heterosexual intercourse. Race/Ethnicity In the U.S., racial and ethnic minorities represent the majority of new AIDS cases, the majority of Americans living with AIDS, and the majority of deaths among persons with AIDS. Most of the excess risk of HIV/AIDS among African-Americans and Latinos reflect discrimination in employment, housing, earning power, and educational opportunity (10). This discrimination relegates minorities to lower levels of socioeconomic status (SES) and to the risks associated with lower SES. Socioeconomic Status (SES) Socioeconomic status indicates people's standing in society, and is usually measured by their income, occupation, or educational attainment. Socioeconomic status is one of the most powerful predictors of sickness and health. People with lower SES are more likely to contract and transmit HIV/AIDS, perhaps because they have less knowledge about HIV/AIDS, because they are surrounded by people who are more likely to have HIV/AIDS, and because they are more likely to use drugs and practice unsafe sex to escape from stress (11, 12). HIV+ people with lower SES also die sooner than HIV+ people with higher SES, because of their lack of access to medical care, the high cost of antiretroviral drugs, and their lowered immunity from other illnesses. Age About half of all new HIV infections worldwide, or approximately 6,000 per day, occur among young people aged 15-24, the majority of them young women (12). In US, for men who have sex with men, younger age is strongly correlated with increased high-risk sexual behaviors (unprotected anal sex)(13). Despite high levels of sexual activity, young people often do not know the basic facts about HIV/AIDS, which puts them at risk. In 17 countries of Africa, more than half of young people demonstrated that they did not know how to protect themselves from HIV (14). Place of Residence HIV disease morbidity and mortality vary greatly within and between nations. In the United States, for example, annual number of deaths by HIV is highest in the South. U.S. regional disparities continue to increase over time (15). Limited access to healthcare, poverty, and discrimination all contribute to these regional disparities. References: 1. Joint United Nations Programme on AIDS (UNAIDS). Men and AIDS: A Gendered Approach, 2000. Retrieved on December 16, 2003 from http://www.thebody.com/unaids/men/contents.html.) 2. Centers for Disease Control and Prevention (CDC). Advancing HIV Prevention: New Strategies for a Changing Epidemic – United States, 2003. Morbidity and Mortality Weekly Report 52(15):329-352, 2003. 3. Osmond, D.H. Sexual Transmission of HIV. Knowledge Base Chapter. Center for HIV Information, University of California, San Francisco, 1998. Retrieved on January 14, 2004 from http://www.hivinsite.com/InSite?page=kb-07-02-01#S5X. 4. Türmen, T. Gender and HIV/AIDS. International Journal of Gynecology and Obstetrics, 82: 411-418, 2003. 5. Joint United Nations Programme on AIDS (UNAIDS). Gender and HIV/AIDS: Taking stock of research and programmes. UNAIDS Best Practice Collection. Geneva, Switzerland: Joint United Nations Programme on HIV/AIDS, 1999. 6. Clements-Nolle, K., Marx, R., Guzman, R., & Katz, M. HIV prevalence, risk behaviors, health care use, and mental health status of transgender persons: Implications for public health interventions. 7. Denny, D. Transgendered youth at risk for exploitation, HIV, and hate crimes. American Educational Gender Information Services, Inc., 1995. Retrieved on January 20, 2004 from http://www.aidsinfonyc.org/Q-zone/youth.html. 8. Department of Health and Human Services. Fact Sheet on AIDS and Transgender Persons. Retrieved on October 5, 2004 from http://www.surgeongeneral.gov/aids/factsheets/transgender.html. 9. Quinn, S.C. AIDS and the African American woman: The triple burden of race, class, and gender. Health Education Quarterly, 20:305-320, 1993. 10. Joint United Nations Programme on AIDS (UNAIDS). AIDS Epidemic Update, December 2002. Geneva, Switzerland: Joint United Nations Programme on HIV/AIDS, 2002. Available online at: http://www.who.int/hiv/pub/epidemiology/epi2002/en/ 11. Feldman, D.A. (Ed). Culture and AIDS. New York, NY: Praeger, 1990. 12. United Nations Population Fund (UNFPA). State of World Population 2003 Making 1 Billion Count: Investing in Adolescents’ Health and Rights. New York, NY: United Nations Population Fund, 2003. 13. Kalichman, S.C. Preventing AIDS. A Sourcebook for Behavioral Intervention. Mahwah, NJ: Lawrence Erlbaum Associates, 1998. 14. Feinstein, N. and Prentice, B. The UNAIDS Gender and AIDS Almanac. Los Altos, CA: Sociometrics Corporation, 2001. 15. Centers for Disease Control and Prevention (CDC). Trends in the Percentage Distribution of Deaths due to HIV infection by Geographic Region, USA, 1987-1999. Slide 21 of 36, Mortality slide series L285. Retrieved on February 18, 2004 from http://www.cdc.gov/hiv/graphics/images/l285/l285-21.htm. © Sociometrics Corporation, 2004