Surgeon General Dr. David
Satcher
March 2001
AIDS is
commonly viewed by many people as a disease affecting gay
men. However, a profound shift has occurred over the last
couple of decades. Women now comprise nearly one-quarter (24
percent) of new AIDS cases—up from just 6.7 percent
in 1982. Through effort and education, including that of my
own initiative—The Leadership Campaign on AIDS (TLCA)—Americans
are increasingly recognizing the epidemic's broader impact
on communities of color, and what U.S. Rep. Connie Morrella
of Maryland has called a "silent genocide" among
women and their children.
African
Americans and other individuals of color should take particular
notice of this development, and of the increased need for
HIV/AIDS prevention. Black and Hispanic women accounted for
81 percent of AIDS cases among women from July 1999 to June
2000. Since 1995, heterosexual contact has been the major
means of women's exposure to HIV infection, with injection
drug use being the second most common means. And in the southern
region of the U.S., we find 41 percent of all female reported
AIDS cases.
On the
surface, these data tell us little about why HIV/AIDS is increasing
so dramatically among women. We need to look deeper into women's
place in society and their interactions with men—both
social and economic.
We must
address issues such as the lack of open conversation around
sexual health that pervades sexual relationships in the U.S.
Women and men often do not know anything about their partner's
sexual history, and if they learn it, they do not know if
their partner is being truthful. The issue of bisexuality
must also be addressed. Some public health officials believe
that the significant number of men who hide their bisexuality
from their female partners are behind some of the increased
risk being faced by women, especially in communities of color
where the barriers to open communication (e.g., homophobia,
denial, and fear) are sizable.
There
is a Native American proverb that holds that "[If] the
physical, mental, emotional, and spiritual well-being of the
woman is intact, so too is that of the family, community,
and society." By the same reasoning, the multiple concerns
faced by women of all ages and cultures are also concerns
that the community must address. Individuals do not usually
become economically and emotionally self-sufficient by declaration
alone. As a community, we must establish systems that promote
women's health and ease the competing economic and social
burdens women often face (i.e., affordable childcare and transportation)
that can compromise it. As partners, sexual or otherwise,
we must take on greater responsibility for the welfare of
ourselves and others. For men, this means honesty and respect
for women.
At the
same time, there are steps women can take to help themselves.
Women are often thought of as family and community caretakers,
and they frequently put health and welfare concerns of others
before their own. Women must reach that point where their
own health is also at the top of the priority list.
In relation
to HIV, effective prevention will occur if women believe that
HIV is a threat to them personally, if they have the tools
to prevent HIV infection, and if they feel they are capable
of using them. Our goal must be to decrease the numbers of
women becoming infected with HIV and to get those already
infected into care.
Women
are our mothers, daughters, sisters, and friends. Control
over one's destiny emerges from one's identity as both an
individual and a member of a community. Congresswoman Donna
Christian-Christensen, Chair of the Congressional Black Caucus
Health Braintrust, makes this point about supporting women
living with HIV: "It is our responsibility to do all
we can to...ensure that all women_who are HIV-positive are
provided the necessary treatments to prolong their lives."
It is my hope that women of color, supported by others in
national and local arenas, will embrace and care for one another
to create a community that provides care for those at-risk
and/or living with HIV.
The first
group singled out by AIDS—gay men—adopted this
caring approach as part of a strategy that has dramatically
reduced new infections in their community. By helping one
another, women can monitor their spiritual, mental, and physical
health - including their reproductive health - and that of
their partners. We must educate, motivate, and mobilize against
HIV/AIDS. In the long run, this will translate into community
survival.
To learn
about TLCA and/or HIV/AIDS, please visit http://www.surgeongeneral.gov/aids/tlcapage1.html
or the Centers for Disease Control and Prevention at http://www.cdcnpin.org,
or call (800) 458-5231.
