Issues in the perception of AIDS risk and risk reduction activities by black and Hispanic/Latina women.

Until recently, most Americans thought of Acquired Immunodeficiency Syndrome (AIDS) as essentially a man’s disease afflicting homosexual, bisexual, and intravenous drug abusing males (“Women and AIDS,” 1986). However, women have been counted among AIDS cases ever since the deadly disease first emerged six years ago. Of the 66,464 individuals diagnosed with AIDS, reported as of July 4, 1988 to the Centers for Disease Control, 5,757 are women, representing nearly 9% of all cases (AIDS Weekly Surveillance Report. July 4, 1988). Although this number may seem of relatively small concern when compared with the number of men affected by AIDS, there are important reasons to focus special study on these women. First, the fact that most cases at present have been diagnosed in men reflects an early epidemiologic pattern of infection by a virus with a long, and still unknown, average latency before disease expression (National Academy of Sciences, Institute of Medicine, 1986). In actuality, the number of cases among women today is approximately equivalent to the number of cases among men only two to three years ago and is expected to reach between 22,000 and 30,000 cases by the year 1991 (Morgan & Curran, 1986). As can be seen in Table 1, most women with AIDS are of ethnic minority background (Cochran, Mays, & Roberts, 1988). Table 1 Total Number of AIDS Cases by Risk Group for Each Ethnic/Race Group by Gender, United States, July 4, 1988 Among Latinas, risk is differentially present across the diverse populations that comprise this ethnic group, but the Centers for Disease Control AIDS Public Access Data Tape does not permit making such important distinctions. For example, in 1985, more than 40% of AIDS deaths on the Lower East Side of New York City occurred among Puerto Ricans (Worth & Rodriguez, 1987). Second, the pattern of infection transmission for women is changing. Whereas in 1982 only 12% of the women diagnosed with AIDS were presumably infected by their male sexual partners, by 1986 26% of women with AIDS were contracting it through heterosexual contact (Guinan & Hardy, 1987). Of these women infected through sexual activity, 77% are Black or Latina. Estimates (reported in “Bleak Lives,” 1987) are that up to 50,000 women in New York City are human immunodeficiency virus (HIV) seropositive. For women in New York City, the prevalence of infection is thought to be 50% among intravenous (IV) drug users and 20% among those whose sexual partners are IV drug users. Of these women, 80%, or 40,000, are most likely Black or Latina. Since 1980, AIDS has become the sixth leading cause of years of potential life lost before age 65 for women in New York City, and for those between the ages of 25 and 29, AIDS is the most frequent cause of death (Kristal, 1986). Experts estimate that heterosexual transmission will increase sevenfold in the next five years (Villarosa & Roberts, 1987). Nationwide, it is thought that approximately 100,000 women are HIV-infected (“Bleak Lives,” 1987). A third reason to be concerned about AIDS in women is that most pediatric cases of AIDS in the past have and virtually all in the future will result from infection acquired from an HIV-positive mother (Brooks-Gunn, Boyer & Hein, this issue, pp. 958–964). Further reductions in the incidence of pediatric AIDS are dependent upon the choices and behavior of infected women, many of whom are unaware of their infection status. Finally, AIDS, as a behaviorally transmitted disease, often through sexual contact, involves the behavior of both men and women. Risk reduction relies on altering the intimate behaviors of individuals during sexual activity. In this context, it seems relevant to explore women’s sexual and contraceptive behavior. Because AIDS risk reduction activities are sometimes identical to contraception efforts (e.g., using condoms), it is reasonable to extrapolate what is known about women and contraceptive behaviors in anticipating potential issues with encouraging “safer” sexual practices aimed at reducing AIDS transmission. In focusing on AIDS and women, our primary concern is with poor, urban, ethnic women because, at present, this is one of the populations most at risk for acquiring an HIV infection. This look at issues surrounding perceptions of risk and risk reduction activities by Black and Latina women may prove valuable in attempts to stop the spread and transmission of the disease. In doing so, it will also become quickly apparent that the AIDS epidemic has highlighted both the good and bad aspects of our society, particularly as it relates to ethnic minorities.