July 13, 2012 marked the two-year release of President Obama’s National HIV/AIDS Strategy, and the 19th International AIDS Conference (“AIDS 2012”) started less than ten days later. The first such conference to take place on U.S. soil in over 22 years, AIDS 2012 already demonstrates a shift in a new direction. The prevailing message so far has been that “we have the tools to care for all people with HIV and to end the epidemic, now we need to muster the political will and resources to do so.” But it’s not totally clear that we truly possess the tools necessary to address the global HIV epidemic for women. And we certainly seem to lack the political will to do so. 30 years into the epidemic, women continue to comprise over half of people living with HIV globally and one in four people living with HIV nationally.
In the U.S., an estimated 300,000 women are living with HIV. Yet we still do not have an effective HIV prevention tool that is women-controlled. Not “women-initiated” – that is, not something that women ask their partners to consent to using. Not something women even have to inform their partners they are using – thereby risking negotiation, in a best-case scenario, and manipulation or violence, in a worst-case scenario. Tools whose use is truly controlled by women, that require neither partner consent nor even a partner’s knowledge. And of course that are effective and accessible.
HIV care continues to fail women as well. It is well established that recent trauma and intimate partner violence are disproportionately experienced by HIV-positive women in the U.S. – one study showed that 78% of women living with HIV have experienced trauma in their lifetimes. In addition, in a press conference this morning, researchers and providers demonstrated that recent trauma and intimate partner violence lead to poor health outcomes, including death, for women living with HIV. However, most HIV clinical care systems do not integrate trauma and violence screening on a regular basis, let alone trauma recovery. This is a major missed opportunity.
The U.S.’ first National HIV/AIDS Strategy failed women by not articulating a single concrete HIV prevention or care goal for women. It failed further by completely failing to articulate the role of violence in women’s lives as a risk factor for HIV acquisition and for vulnerability to poor health outcomes upon HIV diagnosis. The Department of Health and Human Services 2-year progress report on the Strategy’s implementation, released this week, does allude to the role of violence screening as a potential prevention intervention. However, it still misses the boat on the devastating role that violence and trauma play in women’s health outcomes. Fortunately, President Obama’s recently formed Federal Interagency Working Group on HIV/AIDS, Violence against Women and Girls, and Gender-related Health Disparities has an opportunity to rectify this – by creating gender-specific metrics and goals for the Strategy, promoting demonstration and pilot projects that integrate trauma recovery into HIV care, and supporting integrated services for women.