Inter Press Service - December 3, 2002
Paul Weinberg

This may be in part because HIV/AIDS emerged in North America and western Europe in the 1980s as a gay male disease, before it subsequently migrated to other high-risk groups, including illicit drug users who "shoot up" with needles and marginalized groups such as indigenous peoples.

Another factor is that "women's health is always low on everyone's agenda to begin with," says Louise Binder, a Toronto lawyer, an HIV-positive woman and chair of the Canadian Treatment Action Council, which advocates on behalf of people living with HIV/AIDS and other vulnerable populations.

"I also cynically believe that the drug companies have never really made any effort to get women in the trials (for new drugs) either or put pressure on the investigators to put women in the trials," she says.

But as the number of women with the disease rises significantly, pharmaceutical companies are starting to notice this new target market.

"Now that there are many more women being infected, now that we are starting to be a serious part of the market, I think they are getting much more interested in making sure that there are statistically significant numbers of women in the research," continues Binder.

About 25 percent of newly infected people in Canada are women, estimates Dale Guenter, a professor of family medicine at McMaster University in Hamilton, an hour's drive from Toronto. Globally, women comprise one-half of HIV/AIDS carriers.

"There is no doubt that more research (on HIV/AIDS treatment and prevention services) has been done in men. There are many more men who have HIV than women, and women have been missed in the research agenda in a number of things. There is a lot of room to fill that gap," says Guenter.

Katherine Morton, director of communications and development for AIDS Calgary in the western province of Alberta, says that women in Canada are two to four times more likely to receive HIV than men during vaginal sexual intercourse.

But John Gill, a doctor at the Calgary-based Southern Alberta HIV Clinic is uncomfortable with such a "blanket" statement, noting that some of the research in what is still a new area of science is "probably shaky".

Gill told IPS that whether women contract HIV through vaginal sexual intercourse depends on a host of factors, including age - younger women with their less mature genital tract are more susceptible - volume of infection and the presence of internal genital ulcers.

He said he prefers to emphasise treatment and prevention for "everyone" and not "argue about a minor difference" between women and men and HIV/AIDS.

Gender does matter, counters Binder. She points to how research and treatment strategies in many areas of health, including HIV/AIDS, have focussed on the male body as the "medical model" and not taken the unique aspects of female physiology into consideration.

A planned Canadian study on the impact of current medication on women with HIV and AIDS may be a first, she adds.

What is indisputable, says medical doctor and HIV/AIDS specialist, Nancy Padian, is that female anatomy makes women's genital areas more likely to become "repositories" of infectious pathogens originating in male semen, as well as the receivers of abrasions and micro-lesions following vaginal sexual intercourse.

Studies on female vulnerability to the infection during vaginal sex among various population groups have come up with different numbers, ranging from two to 10 times that of men.

Guenter tends to trust the two times statistic, as reported in a 1997 review of research on the subject by the prestigious U.S.-based New England Journal of Medicine.

But one "should not get hung up on the numbers. They are incredibly misleading because no one knows exactly what they are," says Padian, director of international programmes at the AIDS Research Institute at the University of California in San Francisco and a professor of obstetrics, gynaecology and reproductive services.

Also, "women are more vulnerable to HIV for many more reasons than purely the biological aspect", says Ralf Jurgens, president of the Montreal-based Canadian HIV/ AIDS Legal Network.

For instance, women caught up in an abusive or financially dependent relationship with a male may have difficulty negotiating the use of condoms for safe sex, he says. (END/IPS/NA/HD/HE/PW/AN/ML/02) .

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