Women-specific HIV/AIDS services: identifying and defining the components of holistic service delivery for women living with HIV/AIDS.
The increasing proportion of women living with HIV has evoked calls for tailored services that respond to women’s specific needs. The objective of this investigation was to explore the concept of women-specific HIV/AIDS services to identify and define what key elements underlie this approach to care.
The profile of the global HIV/AIDS epidemic has changed dramatically over the past three decades, from a disease that predominantly affected men to one that is affecting a growing number of women. Women now represent over 50% of the 33.3 million people living with HIV globally. In regions of sub-Saharan Africa, women constitute a disproportionate 60% of HIV cases. In Latin America and the Caribbean, the percentage is over 35 and 50%, respectively. In Asia, the proportion of women living with HIV (WLWH) has grown even more rapidly. In China, for example, the male-to-female sex ratio among HIV-positive people has narrowed from 9:1 in the 1990s to 3:1 in 2007. In North America, men who have sex with men continue to account for the majority of people living with HIV, but the proportion of WLWH has steadily increased over the past decade. In Canada, 26% of newly diagnosed HIV infections in 2009 were among females aged 15 years and above, more than double the proportion observed in 1999 (12%). Figure 1 shows the increasing proportion of WLWH globally over time.
Differences in the biological and social realities of men and women are key drivers of the feminization of the HIV epidemic. In the context of heterosexual vaginal intercourse, the efficiency of male-to-female HIV transmission is two times greater than female-to-male transmission, owing to a more receptive contact surface of the vagina, a higher concentration of HIV in semen compared to vaginal fluid and cervical ectopy. Social factors can exacerbate this increased risk. For instance, women who are economically disadvantaged or who have experienced gender-based violence are more likely to engage in unprotected sex, have multiple partners and resort to trading sex for money, drugs, food or housing. These women are also less likely to have the capacity to affirm one’s self and to negotiate condom use, discuss fidelity with partners and leave risky relationships.