Rona Taylor

Outmoded CDC Surveillance System Inadequately Counts HIV+ Women

The National Women and AIDS Collective, (NWAC), a coalition born out of the Women and AIDS Fund at the Ms. Foundation, in collaboration with the National Association of People Living with AIDS (NAPWA) recently convened a congressional briefing sponsored by Senator Hilary Clinton that brought attention to the flawed HIV-surveillance system as it is currently designed and how that impacts women who are accessing HIV testing and counseling.

The current system is based on an outmoded understanding of the epidemic from the early 1980s. Therefore, it does not accurately report or reflect why women are increasingly becoming infected with HIV. The result: policies, programs and funding levels that are tragically inadequate to address the true magnitude of the HIV/AIDS epidemic among American women. This has profound implications for women at risk of, or living with, HIV/AIDS in the United States.

“For years, it has been widely understood among health practitioners and advocates nationwide that women— particularly women of color and low-income women—are at high risk of HIV infection. But as long as the data doesn’t reflect this reality, women will continue to be denied life-saving prevention and testing services now reserved for other high-risk populations such as men who have sex with men and injection drug users, “says Vanessa Johnson, a member of NWAC and Deputy Director for NAPWA.

In reality, many women are contracting HIV because they believe they are in a monogamous relationship with their male partner and/or they are unaware of their male partner’s sexual history, risk behavior or HIV status. Unable to identify their partner’s HIV status or risk behavior, they do not fit into any of the exposure/risk categories specified by the Center for Disease Control. This focus primarily on risk behaviors does not take into consideration contributing environmental and socioeconomic factors that go beyond basic gender, race and ethnicity classifications.

Consequently, the CDC surveillance system automatically places them in the category labeled "no identified risk”, which is eight out of eight in the hierarchy of risk. Once placed in this category, information about their case has no real chance of informing funding prescriptions for prevention and testing efforts nationwide or influencing public perceptions of the epidemic. This percentage ranges anywhere from 47-60% of women currently being tested.

In order to address this disparity, the National Women and AIDS Collective has written a position paper that is proposing the following policy recommendations.

1. Revise the CDC HIV/AIDS surveillance system's transmission categories in order to accurately capture HIV incidence and prevalence data on women.

2. Create an acquisition category that would capture information on comprehensive socioeconomic and environmental factors known to elevate women’s—particularly women of color and low-income women—risk of HIV infection irrespective of presumed or identified behavioral risks.

3. Increase surveillance funding.

4. Convene a workgroup to discuss items number 1 through 3 with representation from the National Women and AIDS Collective.

These recommendations will help to ensure a more accurate picture of the epidemic in women and enable this country to adequately address it.

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Posted at 6:00 AM, Nov 08, 2007 in Health Care
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