The AIDS epidemic among women is expanding.  The number of women living with AIDS increased by more than 75 percent in the five years ending in 1998.  African American and Latina women are the hardest hit; they accounted for over 75 percent of all women living with AIDS in 1998.⁽¹⁾

The women most affected by the AIDS epidemic are current and former injecting drug users and those exposed to AIDS through heterosexual sex.  A large proportion of women infected heterosexually are infected through sex with an injecting drug user.⁽²⁾

The crisis for African American women

• In 1998, more than 14,200 African American women were living with AIDS acquired through injecting drug use.  An additional 18,000 African American women were living with AIDS acquired through heterosexual sex, often through sex with an injecting drug user. Thousands more were infected with HIV.

• AIDS was the third leading cause of death among African American women age 25 to 44 in 1998.  In that year, the AIDS death rate for African American women age 25 to 44 was twenty times higher than the AIDS death rate for white women.⁽³⁾ 

The crisis for Latinas

• In 1998 more than 4,500 Latinas were living with AIDS acquired through injecting drug use.  An additional 6,700 Latinas were living with AIDS acquired through heterosexual sex, often through sex with an injecting drug user. Thousands more were infected with HIV.

• AIDS was the fourth leading cause of death among Latinas age 25 to 44 in 1998.  In 1998, the AIDS death rate for Latinas age 25 to 44 was more than three times higher than the AIDS death rate for white women.

Infants with HIV

The thousands of women infected with HIV/AIDS are mainly in their child-bearing years.  So it is no wonder that some babies are HIV positive.  Of the 233 infants with HIV reported in 34 states in 1999, 66 percent were African American and 14 percent were Latino.⁽⁴⁾  With better medical care, some, but not all, of these babies could have avoided HIV/AIDS infection. 

Infants born with HIV, however, are not the only children we need to be concerned about.  There is another, even larger group of children about whom we need to be concerned: AIDS orphans.

AIDS orphans

As women become infected and die of AIDS, they leave children behind.  In 1998, there were 67,000 American children under the age of 18, mostly children of color, who had lost their mothers to the AIDS epidemic.  More than half of these children were 12 or younger.⁽⁵⁾ 

Most of these orphans were not infected with HIV.  Some were born before their mothers became HIV-positive.  Others were born free of HIV, even though they were born after their mothers were infected.

Throughout the HIV/AIDS epidemic, the majority of babies born to mothers with HIV have not been born infected with HIV.  In the absence of any medical treatment, about 75 out of 100 infants of HIV-infected mothers are born free of HIV.  Given appropriate medical treatment during pregnancy and birth, an infant's chance of being born free of HIV disease now rises to as high as 98 in 100.⁽⁶⁾

About 17 percent of the mothers of the now-orphaned children never injected drugs themselves but were unfortunate in their relationships, infected through heterosexual sex with a man who at one time injected drugs.⁽⁷⁾ 

About 45 percent of the mothers of these now orphaned children became HIV positive because the mothers themselves injected drugs.  We should not assume that, had these mothers lived, they would not have been good parents. Women who inject drugs at one point in their lives are not necessarily drug users for life.  Some experiment for only a short time; others use drugs for longer periods and then stop successfully. 

Children need their parents.  We need to be following policies which ensure that as few children as possible are orphaned by AIDS.

Prevention through safe sex and sterile needles

Because HIV/AIDS spread first among gay men in the United States, some Americans do not realize how pervasive and devastating HIV can become in a heterosexual population.  To see that, we need only look to Africa where the infection rates of the 16 hardest hit countries range from 10 percent to an almost incomprehensible 36 percent.⁽⁸⁾  Nearly all adult Africans with AIDS have been infected through heterosexual sex.

In the United States, HIV acquired through injecting drug use is an important source of the HIV that is spreading to heterosexuals.  African American women and Latinas are the groups hardest hit.⁽⁹⁾  Preventing HIV among injecting drug users is a significant way to prevent HIV among their heterosexual partners.

Persuading men to use condoms during sex is not a simple task.⁽¹⁰⁾ The Centers for Disease Control and Prevention has spent millions of dollars researching this topic and has yet to find an easy approach.

Because so many heterosexual men are already infected with HIV, women, to protect their own health, will need to continue to persuade their men to use condoms for years to come.  Given the sexual attitudes of substantial numbers of American men, many women are going to fail in these efforts.  

To protect women and men who do not use drugs, we need to do everything we can to keep the number of HIV-positive people as small as possible.  We need sterile needle programs to save the lives of non-drug-injecting women and men, as much as we need sterile needle programs to save the lives of persons who inject drugs themselves.

The inescapable conclusion

With thousands of motherless children and about 60 percent of all AIDS cases among women caused directly or indirectly by HIV-infected needles,⁽¹¹⁾ the case for clean-needle programs to save the lives of women and children and prevent the destruction of families could not be stronger. 

Footnotes

(1) In this section, information on women living with AIDS is from the Centers for Disease Control and Prevention (CDC), HIV/AIDS Surveillance Report, Cases Reported Through December 1999, vol. 11, no. 2, and from a special tabulation from the CDC.

(2) CDC, Fact Sheet: "HIV/AIDS Among U.S. Women: Minority and Young Women at Continuing Risk."  On CDC website.  No date given.

(3) In this section, information on AIDS death rates for both African American women and  Latinas is taken from table 9, CDC, "Deaths: Final Data for 1998," National Vital Statistics Reports, Hyattsville, MD: National Center for Health Statistics, by Sherry L. Murphy, vol. 48, no. 11, July 24, 2000.

(4) CDC, HIV/AIDS Surveillance Report, Cases Reported Through December 1999, vol. 11, no. 2, table 16.

(5) The estimate takes into account the deaths to AIDS-infected children, so the estimate refers only to children alive in 1998.  Personal communication from David Michaels based on his article, "Estimates of the Number of Motherless Youth Orphaned by AIDS in the United States," Journal of the American Medical Association,  December 23/30, 1992, vol. 268, no. 24. UNAIDS reported an estimate of 70,000 orphans for the United States for 1997. UNAIDS, Report on the Global HIV/AIDS Epidemic, New York City: UNAIDS, June 1998, page 66.

(6) Howard Minkoff and Nanette Santoro, "Ethical Considerations in the Treatment of Infertility in Women with Human Immunodeficiency Virus Infection," New England Journal of Medicine, June 8, 2000, vol. 342, no. 23, pages 1748-1750. 

(7) Based on cumulative AIDS cases among women through 1998. CDC, HIV/AIDS Surveillance Report, Cases Reported Through December 1998, vol. 10, no. 2.

(8) The 16 African countries and their infection rates are: Botswana (36 percent), Swaziland (25 percent), Zimbabwe (25 percent), Lesotho (24 percent), Zambia (20 percent), South African (20 percent), Namibia (20 percent) Malawi (16 percent), Kenya (14 percent), Central African Republic (14 percent), Mozambique (13 percent), Djibouti (12 percent), Burundi (11 percent), Rwanda (11 percent), Ivory Coast (11 percent) and Ethiopia (11 percent). Lawrence K. Altman, "U.N. Warning AIDS Imperils Africa's Youth," New York Times, June 28, 2000, page 1.

(9) Special tabulation from the CDC.  

(10) Kathleen J. Sikkema, Jeffrey A. Kelly, Richard A. Winette, Laura J. Solomon, and others, "Outcomes of a Randomized Community-Level HIV Prevention Intervention for Women Living in 18 Low-Income Housing Developments," American Journal of Public Health, January 2000, vol. 90, no. 1, pages 57-63.

(11) Based on cumulative AIDS cases through 1999. CDC, HIV/AIDS Surveillance Report, Cases Reported Through December 1999, vol. 11, no. 2.  

For a list of other materials used on this website, see References.

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