# Presentation: 363642

## National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Priorities

- Kevin Fenton, M.D., Ph.D., F.F.P.H.
- Director
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
- Centers for Disease Control and Prevention
- June 20, 2007
- HIV/AIDS and African American Women Consultation

## Overview

- Reflections on women and infectious diseases
- Strategies for reducing health disparities
- Opportunities for action:
- CDC and NCHHSTP strategic environments
- Summary

## Introduction

- Social, economic, environmental, and demographic changes during the 20th century have affected the health of women.
- Women are caretakers and brokers of health for their families. These roles can increase their risk for infectious diseases and increase obstacles to adequate and timely treatment.
- Infectious diseases pose an especially formidable threat to women, claiming >15 million lives around the globe each year.
- For many infectious diseases, women are at higher risk and have more severe course of illness than men.

## WHO Gender Framework for understanding Infectious Diseases

*Periago MR, Fescina R, Ramón-Pardo P. Steps for preventing infectious diseases in women. Emerg Infect Dis [serial on the Internet]. 2004 Nov. Available from http://www.cdc.gov/ncidod/EID/vol10no11/94-0555.htm*

## Women and Communicable Diseases:Key policy barriers

- Often difficult to find examples where women's health, has been at the forefront of international development programs or national health planning and policies.
- Often apparent that the focus on women's health is largely motivated by other concerns e.g. family planning and child survival, rather than as the primary beneficiaries of, or the partners in, programs.
- Two key principles should underpin prevention efforts
- Understanding women's health is important in order to address women's specific health needs,
- Women's participation in health promotion and disease prevention is key to the health of families and communities worldwide.

## HIV/AIDS, Viral Hepatitis, STD and TB in Women

- More than half of the estimated 38 million cases of adult HIV infection worldwide are in women.
- The social, economic, and psychologic effects of the disease are more severe for women.
- Prevalent diagnosed HIV infections among women are also on the rise in the United States.

## HIV/AIDS, Viral Hepatitis, STD and TB in Women

- In addition to HIV, women are more susceptible to other sexually transmitted diseases (STDs) and their long-term complications.
- In the United States >50% of preventable infertility is related to STDs .
- Longitudinal studies show that women are also at greater risk for active disease from Mycobacterium tuberculosis infection.
- Case-fatality rates are likewise higher in women. Reasons include decreased immune function.

## HIV/AIDS, Viral Hepatitis, STD and TB in Women

- Pregnancy complicates the impact of many other infectious diseases.  Each year in the United States, ≈20,000 infants are born to women infected with hepatitis B virus (HBV).
- Hepatitis C virus can be transmitted during pregnancy, although the rate of infection appears lower than that of HBV.
- Hepatitis E virus can have severe consequences if acquired during pregnancy, especially during the third trimester.

## Gender-based Violence and STI

- A growing number of studies have documented the high prevalence of intimate partner and sexual violence against women worldwide.
- This violence increases women's vulnerability to HIV and STI both directly, through forced sex, and indirectly, by constraining a woman’s ability to negotiate sexual contact and the use of condoms.
- Sexual abuse during childhood has been associated with high-risk behavior later in life, which also increases the risk for HIV infection.

## Strategies for reducing health disparities in women

## Enhancing CDC’s HIV/AIDS, Viral Hepatitis, STD and TB prevention portfolio

- NCHHSTP will commit to ensuring that:
- Leadership is provided within the National Center to focus on gender and women’s health issues wrt. HIV, viral hepatitis, STD and TB prevention.
- A gender perspective is incorporated into infectious disease analysis and research so that policies and programs can be targeted more effectively.
- Models that address gender inequities in infectious diseases in an integrated manner are developed and implemented.
- Outreach activities are in place which use information, education, and communication strategies and materials for training and capacity building.

## Knowledge Building

- Epidemiologically Disaggregated Data
- Studies demonstrate that gender analysis provides a more comprehensive understanding of the epidemiology of health problems, including that of infectious diseases.
- Analysis of health determinants, impact of disease, and health-seeking behavior should be disaggregated by sex to determine the different factors that affect women.
- Research
- To address the impact of gender in infectious diseases, we need to assess the magnitude of the problem, study gender differences, and then pilot interventions to address the problems identified.

## Training and Capacity Building

- Linking gender to training and performance of health professionals is critical.
- An understanding of gender and its implications for health and health-seeking behavior should be incorporated into training of health professionals.
- Promotion of girls' education and women's empowerment should be addressed through interagency collaboration.

## Other strategies

- Increasing access to reproductive health services;
- Reducing violence against women;
- Protecting women's rights and their property;
- Ensuring women's and girls' access to health services and treatment;
- And supporting educational efforts to combat stigmatization and discrimination.

## Mechanisms for implementation and enhancement within CDC

- CDC Health Protection Goals
- NCHHSTP Strategic Imperatives
- NCHHSTP Program Priorities
- Division-level priorities

## CDC’s Health Protection Goals

- CDC is committed to achieving true improvements in people’s lives by accelerating health impact and reducing health disparities.
- CDC has created a set of four overarching Health Protection Goals, which are supported by a number of strategic goals and objectives.

## Slide 17

## Program Collaboration and Service Integration

**Program Collaboration and Service Integration**

**Reducing Health Disparities**

**Maximizing global synergies**

**Public Health **
**Impact**

**NCHHSTP maximizes public health and safety nationally and internationally through **
**the elimination, prevention, and control of disease, disability, and death caused by **
**HIV/AIDS, Non-HIV Retroviruses, Viral Hepatitis, Other Sexually Transmitted Diseases, **
**Tuberculosis, and Non-Tuberculosis Mycobacteria**

**Accountability**

**Public Health**
**Science**

**Leadership**

**Customer**
**Centricity**

**Global Health **
**Impact**

**Workforce**
**Development**

**Surveillance ****& Strategic ****Information**

## In Summary

- A gender-based approach to communicable diseases may help to uncover the various factors involved in the impact of infectious diseases in the population.
- Partnerships with CBOs are required to decrease gender inequalities in health, including infectious diseases.
- CDC will continue to promote building technical capacity and gender-sensitivity awareness in both developing and industrialized countries.
- Incorporating a gender perspective into health policies and programs is necessary for improving the coverage and effectiveness of health programs.

## Thank you!