A Johns Hopkins physician and scientist who has spent
a quarter-century leading major efforts to combat HIV and
AIDS worldwide has issued an urgent call for global
strategies and resources to confront the rapid
"feminization" of the AIDS pandemic.
In an article appearing in the journal Science
online June 10, Thomas C. Quinn, professor of
infectious diseases
at Johns Hopkins and a senior investigator at the National
Institute of Allergy and Infectious Diseases, reports that
women have in the last 20 years moved from those least
affected by HIV to those in whom the disease is spreading
fastest. "There has been a shift in the AIDS pandemic, and
the victims are different now," says Quinn, senior author
of the Science article.
"Women make up nearly half of the 40 million people
worldwide currently infected with HIV, the virus that
causes AIDS, and in some developing countries, women
represent the vast majority of those living with HIV/AIDS,"
Quinn writes, whereas, at the start of the pandemic in the
early 1980s, men accounted for almost 90 percent of cases
in developed countries. In the United States from 1999 to
2003, the yearly increase in AIDS cases rose by 15 percent,
but only by 1 percent in men.
"HIV/AIDS first targeted gay men and hemophiliacs in
the early 1980s, then subsequently spread most quickly
among intravenous drug users and heterosexuals," he says.
"Now, it is having the most profound impact on women."
Internationally, Quinn and his team have led clinical
trials of the first effective treatments that prevent HIV
from replicating; helped establish laboratory and treatment
facilities in the Democratic Republic of the Congo, India
and Uganda; and counseled governments across Africa and
Asia about control efforts.
In the new article, he argues that women deserve a
separate strategy because of the increasing and
disproportionate numbers becoming infected, and the social
consequences of so many young mothers dying and leaving
behind children who may be infected as well as orphaned. He
also points out that medical research suggests hormonal and
developmental factors place young women at greater risk
than men for contracting the virus when exposed to it.
In sub-Saharan Africa, 60 percent of people living
with HIV are female, Quinn says, and in South Africa,
Zambia and Zimbabwe, young women ages 15 to 24 are three to
six times more likely to be infected than men. Women make
up half the adult population living with the virus in the
Caribbean and one-third of those in Latin America.
The reasons for the rise in female cases differ among
countries, with 97 percent of female HIV infections in the
United States due to heterosexual transmission (81 percent)
and intravenous drug use (16 percent). In the developing
world, heterosexual transmission is responsible for nearly
all the infections among women, and mother-to-child
transmission during childbirth further contributes to the
spread of the disease. Women are particularly vulnerable to
such cultural factors as their relative lack of power in
sexual relationships, widespread poverty, policies that
deny women an education and tolerance of violence against
women.
Excessive biological vulnerability to HIV among young
women, although not fully understood, is believed to be due
to an immature genital whose mucosal lining is easier for
the virus to penetrate; to hormonal factors, such as the
use of birth control pills; and to a high incidence of
sexually transmitted diseases, which inflame the female
genital area and provide additional target cells for the
virus to infect.
According to Quinn, "societal changes will help over
the long run, but immediate and faster action requires
coordinated efforts to focus on women, develop effective
microbicides that women can use themselves and a
gender-specific vaccine program that takes into account the
different immune responses between women and men."
Also needed, he says, are cultural programs for
reshaping gender roles, such as educating more women about
safe sex practices, use of condoms, lessons on negotiating
safe sex and awareness campaigns about where to seek
testing and treatment.
"Women are different when it comes to HIV infection,"
Quinn says. "If medical progress is to continue on how best
to prevent and treat the disease, then developing specific
strategies that empower women will be key to its
success."
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