Why are women at higher risk of contracting HIV?

Women’s Day Awareness Article

2015

By Alan Brand - Positively Alive - 09 August 2015

In this fact sheet we review specific biological factors in women that make it more or less likely that HIV can be sexually transmitted.

Fast Facts

•          It is estimated that 12.2% of the South African population (6.4 million persons) are HIV positive. This is 1.2 million more People Living with HIV than in 2008 (10.6%, or 5.2 million). The main route of HIV transmission is through heterosexual sex.
•         HIV prevalence in young women 20 - 24 is at 17.4% which is three times higher than in men of the same age, 5.1%. Within the 25 - 29 year age group HIV prevalence amongst women is 28.4% whilst in men of the same age group it is 17.3%.
•         Only 43.5 per cent of male youth (aged 15-24 years) and 40.6 per cent of females of the same age group can correctly identify ways to prevent sexual transmission of HIV and reject major misconceptions about HIV transmission.
•         Women (especially young women and girls) face increased risks of HIV infection, these calls for more effective enabling interventions. Risk-enhancing factors include alcohol abuse, violence against women and socioeconomic insecurity there are many people accessing ARVs which has a huge impact on available domestic resources.

Before we explore why genetically women are more at risk of HIV transmission, lets first look at some important basic information on HIV transmission in general.

How does HIV infection occur?

For infection to occur two things must happen.

·         The virus must find a way to enter your bloodstream.

·         The virus must “take a hold” (find a T/cell with a CD4 and CCR5 receptor which the virus needs to enter the body’s cells) 

Think of it with the word SAD

S = Sufficient quantities of the virus

A = Access into the body

D = Duration

There must be sufficient quantity of the virus to infect you, and it must enter your body in an efficient manner, and their needs to be enough time for this to happen.

There are only three ways in which this can happen:

·         Unprotected sexual acts with an infected person

·         Through infected blood e.g. in sharing needles

·         Prenatally from mother to child during pregnancy or at birth, and through breast milk.

Body fluids!

Body fluids can be divided into those, which contain sufficient quantities of the virus to be infectious. These are:

Blood (100% if HIV Viral load present)

Semen (75% if HIV Viral load present)

Vaginal secretions (50% if HIV Viral load present)

Breast milk (Low but still possible with prolonged breast feeding if HIV Viral load present)

For transmission of HIV to happen, body fluids infected with the virus must pass from the already infected person into the bloodstream of another. HIV can do this through contact with the thin linings of various openings in the body and openings in the skin. These linings contain concentrations of the cells to which HIV attaches to enter the body. The sexual organs of both men and women have such linings.

This is why unprotected sexual acts are the most common route for HIV transmission. The chance of transmission is greatly increased if the lining or skin is inflamed or damaged, for example when another sexually transmitted disease is present.

On the other hand there are other body fluids, which do not contain sufficient quantities of the virus to be infectious.  These are:

Saliva

Sweat

Tears

Urine

How do you get HIV?

• Infection through sexual practices.
• Semen / vaginal fluid coming into contact with the thin linings of various openings in the body and openings in the skin.
• Infection through blood. (Blood products)
• Intravenous drug users.
• Blood transfusions. (Since 1985 all blood is tested for HIV)
• Needles, ear piercing, razor blades, dental tools, (unsterilized)
• Infection from mother to child.
• Across the placenta: - during pregnancy.
• During birth:  damaged lining/skin
• Breast milk:

So why are women at greater risk of HIV?

The risk of transmitting HIV from men to women is much higher than from women to men. This is in part because of the much larger surface area of the vagina and cervix compared to the areas of the penis where transmission can happen (foreskin, urethra and small tears on the head of the penis).

Women are exposed to considerable amounts of seminal fluid during sex, if ejaculation occurs.

The vagina is particularly vulnerable to invasion by bacteria, viruses and other germs. It is an ideal place for bacteria to grow, as it is warm and moist. It also provides an easy entrance into the body.

Women with low levels of the hormone oestrogen may be at increased risk for transmission of HIV because low oestrogen levels directly affect the vaginal wall, making it thinner so HIV can more easily pass through the wall.

How does HIV get into the body through the female genital tract?

The vagina has various defence mechanisms against infection. These help to protect a potential foetus developing in the uterus.

The walls of the vagina are made up of mucous membrane that is thicker than the mucous membrane in other places where HIV transmission often happens, such as the rectum or cervix.  The walls of the vagina have ten to twelve overlapping layers of epithelial cells, which create a strong barrier against germs such as viruses and bacteria.

The vagina is also home to a number of “friendly” bacteria species (for example, Lactobacilli) which are thought to give some protection against less friendly bacteria (for example, Gardnerella vaginalis) as well as viruses that might infect the body.

It used to be thought that HIV can only get through the walls of the vagina through small tears or sores in the mucous membrane. Recent research suggests that HIV can pass between or through healthy cells. This means that HIV can still infect women even if the vaginal mucous membranes are healthy and intact.

Unlike the vagina, the mucous membranes lining the cervix and uterine walls have only a very thin layer of cells (often just one layer thick) and so it is much easier for viruses like HIV to cross into the body through the cervix and possibly the uterus.

Because the cervix acts as a barrier to protect a potential foetus, it is home to a large number of immune cells. Many of those immune cells are CD4+ cells, which are the cells that HIV is most able to infect.

What about sexually transmitted infections?

Women are at more risk for sexually transmitted infections (STIs) than men. In addition, women often have fewer obvious symptoms, and therefore don’t get treatment until the infection has been present for a long time. 

Having an STI increases the risk of HIV transmission in several ways:

•         All STIs cause inflammation of the mucous membrane. Inflammation is the body’s immune response to an infection or irritation. When the mucous membrane is inflamed, a large number of immune cells come to the area to fight the infection.
•         Many of those immune cells will be CD4+ cells or other immune cells that are involved in HIV transmission. In addition, when cells are fighting off an infection, they become activated. Activated CD4+ cells are more easily infected by HIV.
•         Some STIs also cause open lesions or sores, which offer an easy way for the virus to get into the body and cause an infection.

Why are women at higher risk of being affected by HIV?

·         Some women may be unaware of their male partner’s risk factors for HIV (such as injection drug use or having sex with other men) and may not use condoms.

     

      The risk of getting HIV during vaginal sex without a condom or other protection such as PrEP is much higher for women than it is for men, and anal sex without a condom or PrEP is riskier for women than vaginal sex without a condom or PrEP.

·         

      Women may be afraid that their partner will leave them or even physically abuse them if they try to talk about condom use.

·         

      Some sexually transmitted diseases (STDs), such as gonorrhoea and syphilis, greatly increase the likelihood of getting or spreading HIV.

·         

      Women who have been sexually abused may be more likely than women with no abuse history to engage in sexual behaviours like exchanging sex for drugs, having multiple partners, or having sex with a partner who is physically abusive when asked to use a condom.

·         

      Some HIV infections among women are due to injection drug and other substance use—either directly (sharing drug injection equipment contaminated with HIV) or indirectly (engaging in high-risk behaviours while under the influence of drugs or alcohol).

What is “SAFER SEX”?

“Safer Sex” Means: - Sexual practices, which involve the use of condoms for penetrative anal or vaginal sex, and the use of many different forms of experiencing sexual pleasure without placing people at risk of HIV transmission.

Always talk to your regular or potential sexual partner about safe sex.

Alan Brand

Employee Wellness Consultant and Specialist HIV and Employee Wellness Training Provider

www.positivelyalive.co.za

Who can I blame for my HIV status – Dealing with unresolved anger?

“Feeling guilty is a learned response. You’ve been told to feel guilty about yourself for things you did before you could even do anything.” – Neale Donald Walsch [1]

I have often been asked what my initial response was to being diagnosed with HIV. I have tried to reflect back and recall my emotional response on that afternoon in January 1997. All I can remember was having an overwhelming sense of numbness and a feeling of guilt and shame.  Who do I blame for this? All I could think at the time was what an idiot I was; did I really think this would not happen to me?

I guess it would be easy to accept that an HIV+ diagnosis would initially result in feelings of shock and disbelief.  When this initial emotion subsides one is left with a feeling of complete numbness. Especially back in 1997, for me at that time, I had nobody to fall back on, no institution or counsellor to talk to. I could not tell my loved ones as I was totally overwhelmed with a sense of guilt and shame.

The doctor had not even told me she was doing an HIV test when she took my blood for as part of a routine health check. Let’s do a full blood count she had said, not mentioning that she was including an HIV test. When I got the call to make an appointment to receive the result of the “full blood count” I had not given any thought to what the test would be for and hence bounced into the doctor’s rooms as cheerful as always. Without any counselling or warning she pronounced the verdict “your HIV results came back positive” she said, and then proceeded to hand me a slip of paper on which she had written the details of an HIV specialist whom she recommended I make an appointment with. And that was that, nothing more and nothing less. No counselling, information from the medical doctor I had come to trust and called my home doctor.

Many years have past since that day and now I find myself in the fortunate position of being able to provide counselling and support to newly diagnosed individuals. One of the biggest stumbling blocks that continues to limits or hinders the person from breaking through to acceptance and forgiveness is the issue of unresolved anger and a desire to seek out who to blame.

FORGIVE; you might say… what for? Why forgive the person that infected me! If I see him/her on the street I will …..! I can see the feeling of anger well up like a volcano about to erupt! One needs to embrace the reality that these feeling of anger, resentment and loss are all normal and they must be expressed. However, to remain in anger would be to deny oneself the freedom of forgiveness. It was only when I could honestly say that my HIV status was my fault, that I had loaded the pistol and pulled the trigger, that I was able to start a process of forgiveness.

By forgiving you do not condone the actions of others nor do you validate the right that the HI virus has to be in your body. Forgiveness is only fully achieved when one understands that to forgive in itself is a selfish act. I do not forgive the person who infected me for their sake, I do so to release myself and set myself free. I do not accept the virus and forgive it for entering my body, for I did not invite it in, I do so because through forgiveness I take back the power to control my future.

Forgiveness does nothing to the person that it is delivered towards, but it does bring about the miracle of healing in the heart of the forgiver.  So feel your anger and express your loss but do not tally there too long as the long you remain in the dark pit of anger, the longer you will sink into despair and the only person who will suffer will be you.

Rather be selfish and start the journey of forgiveness, forgive yourself, forgive the virus, forgive the person that infected you and on and on the path of forgiveness will lead you. Without forgiveness you are bound to the dark and unresolved feelings of anger and hatred that will consume you. Anger will do nothing but harm you.

“Forgiveness is the path to self-love, and self-love is the key to inner healing. We all make the wrong choices in life at times and we can go through the rest of our lives criticising ourselves for these choices. If we continue to blame ourselves we are bound to that mistake for the rest of our lives. Just as we had the choice then, we have the choice today to release ourselves from that bondage through forgiving ourselves. Forgiving yourself for contracting HIV, for example, or for having unprotected sex, will enable you to move forward, to face others and yourself, and to open the way to loving yourself.[2] 

Through forgiveness release the past and all past experiences.

Continue into the light with love.

Alan Brand

Employee Wellness Consultant

Positively Alive

www.positivelyalive.co.za

albrand@iafrica.com

Alan is also the site administrator of the support network for HIV+ gay, bisexual and transgender men (MSM) in South Africa -Positively Alive  for more details visit www.Positively-Alive.com  

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[1] From Conversations with God, Book 1 on feelings of guilt.

[2] Positively Alive, by Alan Brand, Published by Jacana Media (Pty) Ltd. 2005

Positively Alive - Employee Wellness Consultant and Specialist HIV/AIDS Training Facilitator

AIDS, HIV, TB, absenteeism management, Peer educator, Counselling Skills, Champions of wellness and much much more,

Employee Wellness training provider and facilitator. 

Specialising in; HIV/AIDS Peer Educator/Wellness Champions Training Modules, HIV/AIDS Awareness Training Module and Managing Wellness in the Workplace – Policy and Law Training Modules.

Should you require on site employee wellness training, contact Alan Brand for a formal quotation or for further details regarding the courses provided, accreditation or much more.  Available to conduct training througout South Africa.

POSITIVELY ALIVE ^cc

Employee Wellness Consultant and Specialist Trainer

CK2010/00285/23

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Mobile: +27 (82) 453-0560

Direct Line: +27 (11) 482-5605

Fax to mail: 086 245 6833

E-mail: albrand@iafrica.com
Website: www.positivelyalive.wozaonline.co.za/home

Brief Historical outline of HIV and AIDS – South Africa.

Introduction:


An estimated 5.6 million people were living with HIV and AIDS in South Africa in 2009, more than in any other country. It is believed that in 2009, an estimated 310,000 South Africans died of AIDS. Prevalence is 17.8 percent among those aged 15-49, with some age groups being particularly affected. Almost one-in-three women aged 25-29, and over a quarter of men aged 30-34, are living with HIV. HIV prevalence among those aged two and older also varies by province with the Western Cape (3.8%) and Northern Cape (5.9%) being least affected, and Mpumulanga (15.4%) and KwaZulu-Natal (15.8%) at the upper end of the scale.

Marking a welcome change from South Africa's history of HIV the South African Government launched a major HIV counselling and testing campaign (HCT) in 2010.

By raising awareness of HIV the campaign aims to reduce the HIV incidence rate by 50 percent by June 2011.

History:

1982 – The first HIV infections were diagnosed in South Africa in two white, homosexual flight attendants who had travelled to the United States. This lead to the belief that HIV was largely a white, homosexual disease in SA, as was the case in the US and Europe. As a result, the homophobic apartheid government, which was in power at the time, disregarded the health risk and ignored the issue.

1987 – The first black South African was diagnosed with AIDS-related illness.

1990, Chris Hani, chief of the ANC guerilla force (known as ‘Spear of the Nation‘) said, ‘Those of us in exile are in the unfortunate situation of being in the areas where the prevalence is high. We cannot afford to allow the AIDS epidemic to ruin the realization of our dreams. Existing statistics indicate that we are still at the beginning of the AIDS epidemic in our country. Unattended, however, this will result in untold damage and suffering by the end of the century.' Chris Hani was tragically assassinated shortly before democracy was achieved.

1991 – Heterosexual HIV infection rates equalled homosexual ones. (Heterosexual infections has since become the main mode of transmission of the virus in SA)

Coinciding with the turbulent political period, HIV and AIDS started to gain national public interest though it is not difficult to understand why all energy was focused on deciding South Africa’s political fate seeing the need to address a complex and tough negotiation process needed to end apartheid.

1992 – ( a decade after the 1st reported case), a group of political parties, trade unions, academics, business organisations and civil society groups formed the National AIDS Coordinating Committee of South Africa (NACOSA).

1994 – South Africa’s first democratic elections, and the ANC Government adopted a National AIDS Plan – but the scheme hardly translated into action.

Scandals: - made situation worse!

Sarafina II – A musical screenplay which was supposed to raise awareness of HIV and AIDS was judged widely to be beside the point and confusing. The government funded play used large amounts of unapproved European Union money.

Virodene - South African Government caused worldwide embarrassment when it committed millions to medical trails of an antiviral drug Virodene. Virodene was found to contain a toxic industrial solvent.

1998 – Aids Activists and researches called for the scientifically approved drug AZT to be administered to prevent transmission of HIV from mother to child. ANC turned down this call arguing it would rather focus on education and prevention campaigns then treatment.

HIV-positive AIDS activist Zackie Achmat formed the TAC in December 1998.

1999 – Newly elected president Thabo Mbeki appointed Manto Tshabalala-Msimang as health minister, heralded an even stronger stance against antiretroviral drugs. Mbeki’s questioning if HIV causes AIDS adding to the conflict between organisations like the TAC.

2001 – Death of presidential spokesperson Parks Mankahlana, Official ANC statement reported that his death was due to heart failure after a long illness. When the SA media speculated that his illness was AIDS related, it sparked heated national debate on the ethics of HIV reporting, including objectivity, privacy.

Court Cases

2002 – The TAC and Children’s Rights Centre filed a court motion and later a constitutional claim against the health minister and provincial MEC’s to compel them to make Nevirapine available to women giving birth in state hospitals. The court ruled in favour of the TAC in 2001 and again in July 2002.

2003 – TAC focuses shift to pushing government to roil out ARV treatment through the public Health system. When health minister refused to sign a draft national treatment plan, the TAC launched a civil disobedience campaign. More than 10,000 people protest in front of parliament during Mbeki’s State of the Nation address.

19 November 2003, Cabinet finally announces the health department would make available ARVs to all who need them.

2004 – 2005 Rollout of ARVs slow with treatment guidelines only being issues in September 2004 and supplies of ARVs only being selected in March 2005.

2006 - Tshabalala-Msimang insists that a healthy diet and nutritional supplements, including garlic, beetroot and the African potato, could offer an alternative to ARV treatment. Stephen Lewis, publicly slated Tshabalala Msimang’s statements at the 2006 International AIDS Conference in Toronto Canada. At the same conference, AIDS law Project leader Mark Haywood demanded that the health minister be fired.

Tshabalala-Msimang was hospitalised in late 2006 and her deputy Nozizwe Mandlala-Routledge with Deputy President Phumzilie Mlambo-Ngcuka made major steps to bring back the reputation of the South African National AIDS Council (SANAC), attempting to repair the damaged relationship with civil society organisations, particularly the TAC.

2007 – Government launched its progressive HIV and AIDS and STI Strategic Plan for SA 2007 – 2011, indicating a shift in its health policy. Its main objective being to provide ARV treatment to 80% of people who need it and to half new HIV infections by 2011.

Later that year Mbeki sacked Madlala-Routledge, allegedly because she was too critical of her predecessor and himself. Tshabalala-Msimang was reinstated resulting in the newly built bridges between the department of health and civil society groups quickly crumbling yet again.

2008 – Tshabalala-Msimang finally lost her post to Barbara Hogan in September 2008. Hogan’s term was short lived despite her popularity and commitment to cooperate with civil society.

2009 – Newly elected president Jacob Zuma appointed a previously little-known politician Aaron Motsoaledi to the position of health minister. Aaron Motsoaledi has so far made a number of positive statements, showing intention to tackle the epidemic and improve health services provision.

2010 - For the first time in the history of the South African epidemic, a real properly resourced HIV testing campaign was launched. Minister of Health Dr. Aaaron Motsoaledi is leading the largest every HIV testing drive on the continent with a target to test 15 million people by June 2011

References:


Kirsten Palitza, Natalie Ridegard, Helen Struters and Anton Harber “What is Left Unsaid” Published by Fanele an imprint of Jacana Media (PTY) Ltd on behalf of the Anova Health Instutute, in 2010


Fidel Hadebe, Vukani Mnyandu; Department of Health, 22 Feb 2011


Center for Law and Social Justice, Minister Aaron Motsoaledi delivers — 15 million people to be tested. Get tested. Prevent HIV. Get treated. Always use a condom!


Professor S Karim, University of Natal, King George V Avenue, Durban 4041, South Africa, International Epidemiological Association 2002


Sher R. Acquired immune deficiency syndrome (AIDS) in the RSA. S Afr Med J 1986


http://www.avert.org/history-aids-south-africa.htm