“Is it inevitable that there will be 2 million more HIV infected women and children in 2012 and another 3 million HIV related orphans?”
It doesn’t seem to make any difference where I sit – whether in a clinic in South Africa where there are 6 girls infected to every one boy, or in a hospital in the Democratic Republic of Congo where women are violently raped and deliberately infected with HIV as a weapon of war, or in a public health office in California where the number of women living with HIV has quadrupled in the last 15 years. The conclusion is the same – women need to be protected from unwanted HIV infection.
I have been working with women, children, and HIV since 1981 when the first cases of AIDS were discovered in San Francisco. Incredible discoveries have been made since then that can prevent and treat HIV infections. In spite of these discoveries the HIV epidemic went from less than 5% of HIV infections in women and children in 1981 to over 50% today. I personally saw the impact on vulnerable women and children as I traveled to 11 of the hardest hit countries in the world and spoke with women who were not told that they were being exposed to HIV even though, in most instances, their sexual partners knew that they were infected and many were already on treatment. I had to ask, “Why isn’t more being done to protect women and children from HIV?” And they asked me, “Why aren’t we told that we are being exposed to HIV that may take away my life and that of my child?” Tough questions but one for which the answer is “No one seems to think that contact tracing is an important enough public health measure to implement and certainly not ethically (or legally) required.”
In 1995, I published an article in Journal of the American Medical Women’s Association presenting the argument for universal HIV testing stating that all people should know whether they are infected so they can protect others from becoming infected. Critics shot back, “You shouldn’t test unless you can treat.” Now we have over 30 drugs and combination of drugs to treat HIV infection and the disease has changed from an acute and fatal illness to a chronic and manageable one. In other words, drugs are available to save the lives of mothers and their infants but, you can’t get them unless you know are infected and you need to be told that you have been exposed to HIV to get tested.
Everyone should benefit from these life saving treatments. I believe we should couple universal HIV testing with contact tracing (also called partner notification) so that everyone, but especially women who are disproportionately infected, can be protected or if already infected, can benefit from life saving treatment for themselves and to prevent their babies from being infected. It is estimated that 20% of HIV infected individuals in the US are unaware of their infection; worldwide the percentage in most regions is over 90%. These individuals are capable of transmitting HIV infection to unsuspecting sexual partners and, if they are women, of transmitting a fatal HIV infection to their infants.
One of the potential consequences of contact tracing is that men will blame women for being infected. Critics said, “If women reveal that they are HIV infected they will be subject to physical and sexual violence.” This is a sobering argument against contact tracing but then clinical studies were published showing that women who were HIV infected were more likely to be victims of intimate partner violence suggesting that violence against women precedes HIV infection and that HIV is likely to be yet another and perhaps more lethal manifestation of sexual violence that needs legal protection just as much as any other form of violence. ( “Intimate Partner Violence” Jewkes )
Partner notification and contact tracing have been pillars of the public health control for transmissible infections for decades. They have been used to control SARS, tuberculosis, sexually transmitted infections including syphilis and gonorrhea and many other contagious diseases. HIV is the only sexually transmitted infection that has escaped its routine use because initially the risk of stigma was greater than potential benefit. But things have changed and it is time to provide vulnerable women and children with the means to remain uninfected with HIV. Those who are already infected need to be provided with life saving treatment. Contact tracing has the potential of doing just that – correcting the millions of injustices against women and children that have allowed them to become HIV infected without their knowledge or consent.
Last year’s World AIDS Day theme is “Universal Access and Human Rights.” Over the years, on World AIDS Day and in-between, the oratory has been strong. In 2001 Collin Powell stated, “What we need is a full-scale assault coming from not just the United States but from the rest of the world to deal with this.” That same year Nelson Mandela said, “HIV/AIDS is war against humanity that requires mobilization of entire populations.” In 2006 Stephen Lewis declared, “It’s not just a gender biased disease; it’s the most ferocious assault on one sex, on women, that any disease has ever unleashed.”
If these declarations are indeed true, and if the theme of World AIDS Day is more than just words, then it is time to invoke universal HIV testing and contact tracing to protect women and children from HIV infection while at the same time, establishing local, national and international laws to protect them from discrimination and violence. Only then will we reverse the unacceptable 2 million new HIV infections in women and children that occur each year and the 3 million additional orphans each year because their mothers have died from HIV – numbers that will continue for decades unless we get serious about preventing the spread of HIV.
Intimate partner violence: Causes and Prevention – Rachel Jewkes