HIV/AIDS on rise for Canadian women

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Prevention, treatment, care and support programs and policies do not address needs of girls and women

by BARBARA CLOW
From the Atlantic Centre of Excellence for Women’s Health

As the International AIDS Conference draws closer -- to be held in Toronto 2006 with more than 20,000 participants and media from around the world -- it is time for Canada to look at its own HIV/AIDS epidemic with fresh eyes. HIV/AIDS in Canada is not what it was a decade ago.

Although the majority of those living with HIV and AIDS-related illnesses in Canada are men who have sex with men and intravenous drug users, growing numbers of women — especially young women — are becoming infected through heterosexual contact. Many programs and policies in Canada do not adequately address the needs of diverse groups of women at risk of HIV infection. Without immediate and appropriate action, the HIV epidemic in Canada may well follow the same devastating path as it has elsewhere in the world, spreading through the general population with heterosexual contact as the primary route of transmission.

Since the early 1990s, the rate of new HIV infections has declined among men who have sex with men and among injection drug users. This is good news. But in contrast, infections arising from heterosexual contact have risen steadily, from 13% in 1993 to 43.8% in 2003. And the greatest increase in new infections has been among young women, aged 15 to 29. At present, heterosexual transmission accounts for nearly 75% of all new infections in women.

Physiological differences between females and males — sex — place women at greater risk of infection. Delicate tissues in the female reproductive tract and concentrations of the virus in semen make it easier for infected males to transmit the disease to their female sexual partners than vice versa.

But social roles and cultural expectations — gender — are critical factors in women's heightened vulnerability to HIV infection. Because women often have less power — social, economic, political — than men in our society, it can be difficult or even impossible for many to refuse sex or negotiate safer sex.

Gender roles and stereotypes also hinder women's ability to manage HIV and AIDS-related infections. Women diagnosed with HIV tend to, according to Health Canada have a lower survival rate than men in part due to "late diagnosis and delay of treatment because of misdiagnosis of early symptoms; exclusion from drug trials and lack of access to antiviral treatment; lack of research into the natural history of HIV in women; higher rates of poverty among women and lack of access to adequate health care; and the tendency of many women to make self-care a lower priority than the care of children and family."

While women as a group are more vulnerable than men to HIV infection and AIDS-related illnesses, some populations of women face significantly greater risks. For example, HIV affects more than twice as many Aboriginal as non-Aboriginal women in Canada. As elsewhere in the world, women in Canada who are most disadvantaged and marginalized are also most vulnerable to HIV.

On the whole, policies and programs aimed at HIV prevention, treatment, care, support and impact mitigation have not focussed on, nor — in some cases — even taken account of the differential needs of women and the gender dimensions of the epidemic.

Governments and policy makers can help to stem the tide of the epidemic in Canada and abroad by advancing the work of the National Ministerial Council on HIV and AIDS, by promoting further gender-based analysis of the Canadian Strategy on HIV/AIDS and of provincial and territorial strategies, where they exist, and by encouraging the development of gender-appropriate HIV/AIDS strategies in all regions of the country.

In particular, we should be promoting the understanding of the ways in which females and males are differentially affected by HIV and AIDS-related illnesses, specifically through support for research as well as public and professional education. All levels of government also need to make certain that gender is mainstreamed into all policies and programs pertaining to HIV/AIDS prevention, care, treatment and support.

In general, we need to foster a broader and more inclusive approach to HIV/AIDS in order to recognize and respond to the needs of all Canadians, regardless of sexual orientation, gender, ethnicity and life circumstances. This may mean protecting existing resources and securing new resources to help support agencies and programs that foster positive-living for those infected and affected by HIV/AIDS.

The Canadian government also needs to honour international commitments and agreements aimed at poverty reduction, elimination of discrimination and violence against women, child development, human rights, and HIV/AIDS prevention, treatment, care and support around the world. And we need to hold our government to these promises.

If Canada does not respond swiftly and appropriately to these changing patterns of infection, the HIV epidemic threatens to become endemic — with appalling consequences for all Canadians.

For more information, visit the Atlantic Centre of Excellence for Women's Health: www.acewh.dal.ca

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* All statistics taken from HIV and AIDS in Canada, Surveillance Report to December 31, 2003, Health Canada; HIV/AIDS Epi Update, 2003, Health Canada; Women and HIV/AIDS Factsheet, Bureau of Women's Health and Gender Analysis, Health Canada, 2004.

Useful Websites on Women and HIV/AIDS

Voices of Positive Women

Voices of Positive Women aims to empower women living with HIV/AIDS through confidential support, outreach, information and education. The organization advocates to improve the health and quality of life of HIV-positive women. VOPW promotes accurate, affirming images of HIV-positive women and offers peer support programs in Toronto and throughout Ontario.

HIV, Women & Youth

This site, a project of Planned Parenthood Federation of Canada, provides resources including: information sheets on HIV testing, pregnancy, prevention, and healthy HIV positive living; resources for service providers, including statistics and advocacy guidelines; a quiz, story archive and a glossary.

HIV/AIDS: Know Your Risks – Know Your Choices

This website, created by the Canadian AIDS Society, is part of a national awareness campaign on HIV/AIDS targeting young women. The site includes a quiz, a look at the different campaign materials, a glossary and a listing of other good sites.

Positive Women's Network

Positive Women's Network provides information, resources, and services as well as leadership in advocacy, training and community inclusion of health issues affecting women with HIV. Their website offers newsletters, trends and research reports, and contact information for some AIDS service organizations in British Columbia.

Head and Heart

This magazine, published by the Centre of Resources, Interventions and Services in Sexual Health (CRISS), offers information for women who are infected or affected by HIV/AIDS. Articles deal with issues such as family life, HIV in the workplace, HIV treatment and HIV and women's health.

Canadian HIV/AIDS Information Centre

The Canadian HIV/AIDS Information Centre provides information and communication services on HIV prevention, care, treatment and support. The Centre maintains Canada's largest library of HIV/AIDS resources and distributes thousands of posters, pamphlets and manuals every year.

Canadian AIDS Treatment Information Exchange (CATIE)

CATIE provides information to help people living with HIV/AIDS, and their caregivers, make informed health care decisions, and assists physicians and other health care professionals to access the latest information on AIDS treatment advances. The group advocates for improved research, better treatments and easier access to treatments.

Canadian AIDS Society

The Canadian AIDS Society (CAS) is a coalition of community-based AIDS organizations that advocates for people and communities affected by HIV/AIDS. CAS facilitates the development of programs, services and resources for member groups, and provides a national framework for community-based participation in Canada's response to AIDS.

Compiled by Barbara Bourrier-LaCroix