Berlin_strategiesHIVwomen

Running Head: STRATEGIES THAT INFLUENCE CHANGE
Strategies that Influence Change for Women and Girls Living
with HIV/AIDS
Kerri-Michaela Berlin
National University

Running Head: STRATEGIES THAT INFLUENCE CHANGE 2
INTRODUCTION
The public health sector has maintained that the legacy of discrimination and disparities
faced by women and girls has contributed to the modern-day, disproportionate burden of
disadvantage, including issues around HIV/AIDS status and risk (Forbes, et. al., 2014). In
discerning the most effective strategies to combat this issue; this paper looks at prevalence,
determinants; such as, gender inequities, harmful norms, resource scarcity, and the socio-
economic injustices of women and girls at risk or living with HIV/AIDS.
There has been cumulative success of female targeted HIV/AIDS strategies, based on the
framework of a woman-centered approach; a human rights-based methodology rooted in a
gender-based theory that acknowledges the disparities women face throughout a life course
(Positive Women’s Network of the United States of America; PWN-USA, 2012). This
synergistic approach amenably and comprehensively weaves its benefits through each level of
change; behavioral, environmental and policy (Cook.; et. al., 2014).
Prevalence
According to the Center for Disease Control & Prevention (CDC), the United States’
female population represent nearly one quarter of those living with HIV/AIDS; constituting a
domestic gender-specific epidemic (CDC, 2015). Despite a general decline in new diagnoses, the
CDC has reported over nine thousand new cases were women, ages 13 and older; predominately
Hispanic and African-American women, residing in U.S. Southern states (CDC, 2013). Contrast
to public perception, recent reports confirm the vast majority of new cases are linked to
heterosexual transmission (World Health Organization, 2013). Although, females are more likely
to get tested (for STIs) and diagnosed earlier in than their male counterparts, they are far less
likely to access, adhere or maintain treatment and routine care; including antiretroviral therapy

(ART), subsequent screenings or support services (Meditz, et. al., 2011). American black women
and adolescents, living in the South, rate among the most at risk for sub-optimal to poor self-care
and comparatively low health outcomes related to their HIV status (Reif, et. al., 2014).
Risk Factors
Historically, research and awareness campaigns have focused on homosexual male and
intravenous drug user communities, however, for the benefit of ending gender based inequities,
all sexual partnerships should be included in the profile of an at risk individual (Gupta;
Parkhurst; Ogden; Ajay & Aggleton, 2008). There are structural, cultural and societal practices
that heighten risk; for example, adolescent/arranged marriage, having multiple partners,
substance misuse and women who engage in sex acts for financial means, all significantly raise
vulnerability for STI/HIV infection (Jewkes & Morrell, 2010).
The relationship between gender inequality and HIV/AIDS is substantiated by a
consensus of literature and responses from advocacy groups, community and governmental
organizations. Namely, the President's Advisory Council (2012) dedicated a workforce to update
the National HIV/AIDS Strategy's Implementation Plan to reflect the unique needs, strategize
and develop an additional set of goals to accommodate the changing landscape of HIV/AIDS
disparities facing women and girls (PACHA, 2012).
DISCUSSION
There are behavioral, biological, economic, and psychosocial factors that mitigate the
vulnerability of girls and women to HIV transmission and poor health outcomes. Most notable
gender differentials include; income, education, gender-based violence (GBV) and access to
comprehensive health services (Cook, et. al., 2014). The sum of these determinants deplete a

woman’s coping abilities and enhance psychological stressors that degrade the immune system;
potentially suppressing the intended effects of ART and quality of life (PWN-USA, 2012).
The core concepts of a woman centered approach to HIV/AIDS gender issues show
evidentiary potential to influence each of necessary level of change; behavioral, environment and
policy. These approaches, withstanding rigorous evaluation, deliver multidimensional, culturally-
relevant messages of education, empowerment and resilience (Auerbach, 2009). Successful
approaches aim to transform atmospheres that fail to offer adequate resources of basic livelihood
by addressing the comprehensive needs of women living with HIV/AIDS (Kates, 2013). This
includes training facilitators to identify and meet the community’s most urgent needs. Training
professionals about delivering health information with such concepts as Trauma Informed Care,
is an example of a salient approach to improving outcomes for women and girls affected by
HIV/AIDS who carry the compounding burden of traumatic life experiences (Machtinger, 2012).
Lastly, interventions that incorporate of the experience of an HIV positive woman
recognize and utilize the direct expertise and insightful feedback of the target group as valuable
mentors, advocates and leaders in the implementation and execution of community strategies
(Kates, 2013). Program success is then reciprocal and the value of community-based
participatory methods lie in its collaborative nature and afford more precise prioritization and
robust participation (Forbes, et. al., 2014).
Strategies
Strategies that influence change should be structured with sustainability in mind,
recognizing the fact that the community’s needs are dynamic, requiring modification to fit the
appropriate stage of a woman’s life (Jewkes, 2010). The deleterious effects of HIV/AIDS will
vary in severity over time; therefore, strategies must be designed with forethought to overcome

the health and circumstantial challenges women face across their life course (Martin & Curtis,
2004).
Behavioral
Health educators, trained in theoretical behavioral models, teach women and girls what a
healthy relationship looks like and how it should empower their sense of self-efficacy and
capability to be an equal partner in sexual negotiations (Martin & Curtis, 2004). Culturally
sensitive education tactics promote a woman’s value and instill messages that offset the
masculine power dynamic so that she is better able to recognize abusive patterns and understand
rigid gender roles that may act as potential barriers to safe sex practices (Pulerwitz; et al., 2002).
Prevention endeavors, drawn from the latest scientific findings, equip women with
knowledge about contraceptive mechanisms that can be safely accessed, with the benefit of
personal choice and privacy (USAIDS, 2016). The female condom and the emerging availability
of microbicides (viral suppressing solutions that can be discreetly applied vaginally or rectally)
give women control over their choices that reduce the risk of gender-based violence and lessen
the challenges of sexual negotiation (Forbes, et. al, 2014).
Environmental
HIV/AIDS programs influence environmental change when they have interdisciplinary
partnerships, and collaborative assistance from within the community (Talman, Bolton, &
Walson, 2013). The WCA conduct direct observation of highly impacted communities; where
poverty, violence and crime affect a woman’s ability to achieve quality health outcomes (WHO,
2009). Environmental strategies that identify the link between local resource scarcity, HIV/AIDS
and health outcomes, often use harm reduction methods to develop trust and behavior change
adherence (Martin & Curtis, 2004). Microfinance and wraparound interventions for the

marginalized population of sex workers and drug dependent, are examples of income/resource
generating and prevention strategies aimed at reducing male dominated economic dependence
and establishing a sustainable environment of support (Thomas, J.; et. al, 2006).
The JEWEL (Jewelry Education for Women Empowering Their Lives) is an example of
wraparound/microfinance program, targeting high risk communities in Baltimore, Maryland.
This inner-city pilot study, indented to reach drug dependent women involved in sex work, teach
HIV prevention in addition to the skills of designing, marketing and selling of jewelry (Sherman,
German, Cheng; Marks & Bailey-Kloche, 2006). Subsequent three-month intervention
participant post-tests, reported overall reductions in drug use, sexual transactions, and increased
protective knowledge and self-reliant behaviors (Sherman, German, Cheng; Marks & Bailey-
Kloche, 2006). Baltimore’s JEWEL project is noted for its innovative approach to reducing harm
and enhancing economic empowerment.
Policy
A prominent example of a policy directed strategy is the development and promotion of
accessible, cost-effective and quality women’s integrated health services. Given the statistics
regarding the high percentage of girls and women diagnosed, yet failing to follow-up with
HIV/AIDS related treatment and care; WCA initiatives have emphasized the need for integrated
reproductive health services (Kaufman; Cornish; Zimmerman & Johnson, 2014). This means a
single structure, centrally located, where an interdisciplinary team of providers and health
education professionals address all of the medical and support services necessary for women
living with or at risk of contracting HIV/AIDS (Kaufman; Cornish; Zimmerman, Johnson &
Blair, 2014). While this is a daunting initiative, WCA organizations have already begun

implementing integrative reproductive care efforts at the national level in the form of updates to
the Presidents HIV/AIDS workforce and expansion of the affordable care act (PEPFAR, 2012).
Building upon the synergistic nature of the WCA, direct involvement of the target group
is helping advance existing policies and propose new legislation for HIV/AIDS advocacy (PWN-
USA, 2012). Women, once victims of their HIV status, have been validated as an integral part of
the solution; leading community planning processes, facilitating campaigns to raise funds and
lobbying for state and local legislative policy (USAIDS, 2016).
CONCLUSION
Efforts to provide comprehensive, multidimensional, gender specific strategies are
needed across every level, throughout the entire life cycle. HIV-positive minorities are
encumbered with the greatest physical, social, environmental burdens. Society has perpetuated
harmful norms and the government has neglected the unique needs of women and girls affected
by HIV/AIDS. The most effective strategic interventions address underlying factors that impede
the achievement of gender equity; such as, economic dependence, gender-based violence,
resource accessibility and social stigma. Women centered approaches continue to employ theory,
methodology and culturally sensitive avenues to alleviate the disparity and promote positive,
sustainable change through behavior, environment and policy.

REFERENCES
Auerbach J. (2009). Transforming social structures and environments to help in HIV prevention.
Health Affairs; 28(6):1655-65. doi: 10.1377/hlthaff.28.6.1655.
Beekera, C., Guenther-Greyb, C. & Rajc, A. (1998). Community empowerment paradigm drift
and the primary prevention of HIV/AIDS. Social Science & Medicine, Volume 46, Issue
7, Pages 831–842
Centers for Disease Control and Prevention (CDC). (2015). HIV Among Women. Retrieved
from http://www.cdc.gov/hiv/group/gender/women/
Centers for Disease Control and Prevention. (2014). HIV Surveillance Report; vol. 26. Retrieved
from http://www.cdc.gov/hiv/library/ reports/surveillance
Choi K-H, Hoff C, Gregorich SE, et al. (2008) The efficacy of female condom skills training in
HIV risk reduction among women: a randomized controlled trial. American Journal of
Public Health 98 (10):1841-1848
Cook J.E, Purdie-Vaughns V., Meyer I.H.; et. al. (2014). Intervening within and across levels: a
multilevel approach to stigma and public health. Social Science Med.103;101–109.
Dunkle, K. and R. Jewkes. (2007). Effective HIV prevention requires gender-transformative
work with men. Sexually Transmitted Infections 83: 173-174.
Fisher, JD & Fisher W.A. (1992). Changing AIDS-risk behavior. Psychology Bulletin: 111; 455–
474.
Forbes, A.; et. al. (2014). Understanding the Promise: Considering the experiences of women
living with HIV to maximize effectiveness of HIV prevention technologies. Women’s
Health Issues Volume 24, number 2, pages e165-e170.

Gupta, G.R.; O Parkhurst, J.; Ogden, J.A.; Ajay, M. & Aggleton, P. (2008). Structural
approaches to HIV prevention. International Center for Research on Women,
Washington, DC, USA. The Lancet 6736(08)60887-9. doi:10.1016/S0140
Hardee, K., Gay, J., Croce-Galis, M., & Peltz, A. (2014). Strengthening the enabling
environment for women and girls: what is the evidence in social and structural
approaches in the HIV response? Journal of the International AIDS Society, 17(1),
18619. http://doi.org/10.7448/IAS.17.1.18619
Jewkes, R. (2010). HIV/AIDS. Gender inequities must be addressed in HIV prevention. Science
329 (5988): 145-147.
Kates, J. (2013). Implications of the Affordable Care Act for People with HIV Infection and the
Ryan White HIV/AIDS Program: What Does the Future Hold? Retrieved from:
http://kff.org/hivaids/issue-brief/implications- of-the-affordable-care-act-for-people-with-
hiv-infection-and-the-ryan-white- hivaids-program-what-does-the-future-hold/
Kaufman, M.R; Cornish, F.; Zimmerman, R.S. & Johnson, Blair, T.P. (2014). Health behavior
change models for HIV prevention and AIDS care: practical recommendations for a
multi-level approach. JAIDS Journal of Acquired Immune Deficiency Syndromes, 66
(p)S250–S258.
Machtinger, E.L., Haberer, J.E., Wilson, T.C., et al. (2012). Recent trauma is associated with
antiretroviral failure and HIV transmission risk behavior among HIV-positive women and
female-identified transgenders. AIDS Behavior; 16: 2160. doi:10.1007/s10461-012-0158-
Machtinger, E. L.; Wilson, T. C.; Haberer, J. E.; Weiss, D. S. (2012). Substantive Review:
Psychological trauma and PTSD in HIV-positive women: a meta-analysis. AIDS and
Behavior, Volume 16, Issue 8, pp 2091-2100.

Martin, S. L., & Curtis, S. (2004). Gender-based violence and HIV/AIDS: Recognising links and
acting on evidence. The Lancet, 363(9419), 1410-1.
Meditz, A. L., MaWhinney, S., Allshouse, A., Feser, W., Markowitz, M., Little, S.& Kilby, J. M.
(2011). Sex, race, and geographic region influence clinical outcomes following primary
HIV-1 infection. Journal of Infectious Diseases, 203(4), 442-451.Chicago
Positive Women’s Network of the United States of America (PWN-USA). (2012). Bringing
Gender Justice to HIV Prevention: A Blueprint for Women’s Action. Oakland, CA.
Available: http://www.pwn- usa.org/wpcontent/uploads/2012/08/PWN_policy_brief
President’s Advisory Council on HIV/AIDS(PACHA). (2012). Resolution on the Needs of
Women at Risk for and Living with HIV. Washington DC. Available:
http://aids.gov/federal resources/pacha/meetings/2012/may-2012-resolution-on-
women.pdf
Pulerwitz J., Amaro H., De Jong W., et al. (2002). Relationship power, condom use and HIV risk
among women in the USA. AIDS Care, 14:789–800.
Reif, S., Pence, B.W., Hall, I., Hu, X., Whetten, K., & Wilson, E. (2014). HIV diagnoses,
prevalence and outcomes in nine southern states. J Community Health, 40(4), 642-651.
Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4490182/pdf/10900
Sherman, S; German, D; Cheng, Y; Marks, M & Bailey-Kloche M. (2006). The evaluation of the
JEWEL project: an innovative economic enhancement and HIV prevention intervention
study targeting drug using women involved in prostitution. AIDS Care;18(1):1–11.
Talman, A., Bolton, S., & Walson, J. L. (2013). Interactions between HIV/AIDS and the
environment: toward a syndemic framework. American Journal of Public Health, 103(2),
253–261. http://doi.org/10.2105/AJPH.2012.300924

USAIDS. (2016). Promoting Gender Equality and Women's Empowerment in HIV and AIDS
Responses. Retrieved; from https://www.usaid.gov/what-we-do/global-health/hiv-and-
aids/promoting-gender-equality-and-womens-empowerment-hiv-and-aids
Wingood, G. M., DiClemente, R. J., Villamizar, K., Er, D., DeVarona, M., Taveras, J., Jean, R.
(2011). Efficacy of a health educator delivered HIV prevention intervention for Latina
women: A randomized controlled trial. American Journal of Public Health, 101, 2245-
2252.
World Health Organization. (2009). Women & Health. Today’s Evidence for Tomorrow’s
Agenda. WHO, 76. Available at http://www.who.int/gender/documents/9789241563857.

Berlin_strategiesHIVwomen

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Viewers also liked

Viewers also liked (20)

Similar to Berlin_strategiesHIVwomen

Similar to Berlin_strategiesHIVwomen (20)

Berlin_strategiesHIVwomen