Women, Minorities, and Infectious Disease
Women, Minorities, and Infectious Disease
History and Scientific Foundations
Introduction
Infectious disease research and programs for women examine a host of factors, including social class, income, religious factors, geographic location, access to medical care and transportation, and other demographic and environmental issues. While women in developed countries often have life spans that are longer than those of men, in developing countries the average woman who reaches age sixty-five lives only three-fourths as long as her female counterparts in developed countries. Poverty, infectious disease, and lack of access to health care all feed into this disparity.
Research into infectious disease issues and gender often focuses on mother-child transmission of certain diseases, such as HIV/AIDS; prevention includes behavioral and pharmaceutical interventions. Malaria, schistosomiasis, group B streptococcus (GBS), hepatitis B (HBV), human papillomavirus (HPV), and all forms of sexually transmitted diseases disproportionately affect women. Repeated pregnancies and breastfeeding can leave women in lower economic conditions chronically malnourished, with weakened immune systems.
Minority populations also experience higher rates of infectious disease and higher morbidity and mortality rates overall. Minority women, in particular, have lower rates of health care service use, increased rates of infectious disease, increased disability rates, and shorter life spans on average than non-minority women. In the United States, persons in minority populations, such as Hispanic men, tend to seek services for infectious disease such as HIV/AIDS at much later stages in the disease course than their non-minority counterparts.
Cultural expectations, socioeconomic status, age, and education level all affect disease transmission rates (maternal-child transmission, transmission to and from sexual partners, or transmission within the family and community) and the progression of disease in women. Because women often act as the gatekeepers for health care in their families, reaching women to promote public health initiatives and reduce infectious disease transmission has become a major component of public health programs.
History and Scientific Foundations
Medical research studies historically focused on male participants and applied results to women. The assumption that the male body and the female body were similar with the exception of the reproductive system led to lower rates of female research study participants, and a “one-size-fits-all” approach when applying the results from studies that examined men only. Assumptions about infectious disease transmission and progression in women based on such research proved to be incorrect in many instances.
Research on TB rates in developed countries noted that in the 1930s through the 1950s, infection rates for women 15–34 were higher than those of men in the same age range. For women of childbearing years, the time from infection to disease itself is swifter than for similarly aged males, but as prevention and treatment options became more prevalent, infection among women decreased.
In 2004 a study of tuberculosis rates among men and women in Bangladesh showed that the female to male ratio of TB infections there stood at 0.33 to 1, even when women's lower rate of access to health care is factored out. Previous research had questioned whether TB is underreported among women in developing countries. The 2004 findings confirmed a previous study from 2000, but many women's public health researchers questioned the prevailing concept that women consistently underreport or are underrepresented in research studies. In such cases, studying women's rates of tuberculosis along with those of men demonstrated that studying only men could lead to erroneous assumptions that impacted women's health.
In the developing world, women often face discrimination or cultural shame for contracting sexually transmitted disease, but also for contracting other infections such as malaria and TB. A mother diagnosed with TB is less likely to complete a drug protocol for many reasons, including lack of time to complete appointments with health-care workers, devotion of financial resources to children rather than self, or lack of access to appropriate health-care providers (i.e., female physicians for female patients, as required by some religions). By not following treatment protocols, the mother puts her children, partners, and other families at greater transmission risk. In addition, pregnancy and childbirth can make women especially vulnerable to infectious diseases, such as malaria, because pregnant women experience decreased immunity and increased susceptibility. Pregnancy can also lead to malnutrition and chronic anemia in women of childbearing years. In areas where birth control is unavailable or a violation of cultural practices, closelyspaced pregnancies weaken women and compromise overall health, leaving women vulnerable to infectious disease.
Over the past two decades HIV/AIDS prevention and treatment has dominated public health issues related to minority populations and women. More than 50% of all new identified HIV cases in the United States are African American, although only 12–13% of the population is African American. In addition, black women account for more than 70% of all female cases, Hispanic women 8–9%, Caucasian women 18–19%, and the rest a mixture of various racial and ethnic groups. Minority women have become the focus of HIV/AIDS public health efforts in the United States in terms of behavioral and drug-based approaches to prevention and treatment.
Applications and Research
HIV/AIDS and tuberculosis have converged in many developing countries. Immunocompromised (persons with a weakened immune system) patients are vulnerable to TB, and the two infectious diseases have posed a challenge to public health workers. Pregnant women face even greater obstacles, since their lowered immunity makes them more susceptible to infectious disease, and treatment can be limited by concerns about fetal exposure to certain drugs.
In addition, women often seek treatment when the disease is more advanced. Human papillomavirus (HPV), for example, is highly treatable in early stages, but in later stages some strains of the virus can lead to cervical cancer. Routine pap smears can detect pre-cancerous changes in cervical tissue, but women in developing nations and minority women in the United States receive such preventive care at lower rates. Advanced cervical cancer can be difficult to treat. In the United States, more than one-third of women diagnosed with invasive cervical cancer will die from the disease. In the developing world, fewer than 5% of all women undergo a pap smear every five years. Condom use, which aids in reducing HPV and other STD transmission, is lower for minority women and women in developing nations engaged in sexual intercourse. A new vaccine that protects against most of the HPV strains that lead to cervical cancer is expensive, and rarely available for women in the developing world.
WORDS TO KNOW
IMMUNOCOMPROMISED: A reduction of the ability of the immune system to recognize and respond to the presence of foreign material.
MICROBICIDE: A microbicide is a compound that kills microorganisms such as bacteria, fungi, and protozoa.
MORBIDITY: The term “morbidity” comes from the Latin word “morbus,” which means sick. In medicine it refers not just to the state of being ill, but also to the severity of the illness. A serious disease is said to have a high morbidity.
MORTALITY: Mortality is the condition of being susceptible to death. The term “mortality” comes from the Latin word mors, which means “death.” Mortality can also refer to the rate of deaths caused by an illness or injury, i.e., “Rabies has a high mortality.”
HIV/AIDS research and programs for prevention and treatment in developing nations focus a significant amount of resources on sub-Saharan Africa. Seventy-seven percent of all women living with HIV/AIDS worldwide live in this region. Fifty-seven percent of all HIV/AIDs cases in sub-Saharan Africa are women, according to United Nations Population Fund data, and in those African countries with the highest HIV/AIDS rates, women of childbearing years (ages 15–49) account for 75% of all HIV/AIDS patients.
Women and minorities in higher-income countries are affected by HIV/AIDS trends as well. Data from the Centers for Disease Control and Prevention (CDC), released in 2004, show that HIV/AIDS is the leading cause of death for African American women between the ages of 25 and 34, and the fourth leading cause of death for Hispanic women of the same ages. The data also show that North America experienced one of the largest increases in HIV/AIDS female patients in the world.
The CDC initiated a new campaign in 2003, targeted at female minorities, called Advancing HIV Prevention. According to the CDC: “This initiative comprises four strategies: making HIV testing a routine part of medical care, implementing new models for diagnosing HIV infections outside medical settings, preventing new infections by working with HIV-infected persons and their partners, and further decreasing perinatal HIV transmission.”
The same four points are applied to women in the developing world, although women in North America have easier access to regular, stable medical care and to antiretroviral medications that help control HIV/AIDS and reduce transmission rates during pregnancy and childbirth. The 1994 introduction of zidovudine (AZT) during pregnancy and in the antenatal period led to a dramatic drop in maternal-child transmission rates. The use of AZT in the developing world has been controversial, since cost, access to medical facilities, and cultural myths about the transmission path of HIV/AIDS present obstacles to public health efforts.
Impacts and Issues
Female reproductive health and roles continue to dominate research and public health programming in the area of infectious diseases, such as HIV/AIDS, HPV, HBV, and other STDs. Creating safe and consistent medical care facilities for women in developing nations is as significant as creating such health-care settings for women and minorities in lower socioeconomic levels in developed countries such as the United States.
Women experience higher infection rates of various STDs, including HIV/AIDS, from vaginal intercourse than do men. In addition, sexual violence leaves women worldwide vulnerable to disease transmission. Microbicidal gels, inserted into the vagina prior to sexual intercourse, are a promising area of research. As of late 2006, trials were underway to test gels that had shown some effectiveness in preventing the spread of HIV in animal tests.
A vaginal microbicide that does not need to be refrigerated, is highly portable, and affords women control over the use of the product could be a powerful tool in public health efforts according to researchers. Many men in areas of the world where HIV/AIDS is prevalent refuse to use condoms as a cultural matter. A microbicidal gel could be undetected and used by women as a form of protection against infection via sexual violence. Public health officials note that prostitutes, who are key transmission points and can often infect hundreds of men, could use the gel to help protect themselves and their clients. While worldwide and U.S. campaigns to promote condom use have had limited success due to cultural bias against condoms, the gels or creams represent a workaround that takes into account issues unique to women and sexuality.
See AlsoHIV; Sexually Transmitted Diseases; United Nations Millennium Goals and Infectious Disease; World Health Organization (WHO).
BIBLIOGRAPHY
Books
Faro, Sebastian, and David Soper. Infectious Diseases in Women. Saunders, 2001.
Periodicals
Holmes, C.B., H. Hausler, and P. Nunn. “A Review of Sex Differences in the Epidemiology of Tuberculosis.” The International Journal of Tuberculosis and Lung Disease 2 (1998): 96–104.
Katz, Ingrid T., and Alexi A. Wright. “Preventing Cervical Cancer in the Developing World.” New England Journal of Medicine 354 (March 16, 2006): 1110.
Kelley, C.F., et al. “Clinical, Epidemiologic Characteristics of Foreign-born Latinos with HIV/AIDS at an Urban HIV Clinic.” The AIDS Reader 17 (February 2007): 73–74, 78–80, 85–88.
Perrino, T., et al. “Main Partner's Resistance to Condoms and HIV Protection Among Disadvantaged, Minority Women.” Women & Health 42, no. 3 (2005): 37–56.
Salim, M.A., et al. “Gender Differences in Tuberculosis: A Prevalence Survey Done in Bangladesh.” The International Journal of Tuberculosis and Lung Disease 8 (August 2004): 952–957.
Thorne, C., and M.L. Newell. “Safety of Agents Used to Prevent Mother-to-Child Transmission of HIV: Is There Any Cause for Concern?” Drug Safety 30, no. 3 (2007): 203–213.
Weber, J., et al. “The Development of Vaginal Microbicides for the Prevention of HIV Transmission.” Public Library of Science Medicine 2 (May 2005): e142.
Web Sites
National Center for Infectious Diseases. Centers for Disease Control and Prevention. “Office of Minority and Women's Health.” February 5, 2004. <http://www.cdc.gov/ncidod/omwh/infectious.htm> (accessed March 13, 2007).
Women's Health.gov. “Minority Women's Health.” November 2006. <http://www.4woman.gov/minority/> (accessed March 13, 2007).
World Health Organization. “Women, Ageing, and Health.” June 2000. <http://www.who.int/mediacentre/factsheets/fs252/en/> (accessed March 13, 2007).
Melanie Barton Zoltán