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When the test result came back positive, Carmen thought it was her death sentence. “The first thing I asked the nurse was how long I had left to live. My biggest fear was that I would have passed it on to my girls,” this 23-year-old Mexican recalls the day she found out she had HIV. “I never imagined that it could happen to me. She thought that this was more a matter of some gentlemen ”.
In the world there are more women with HIV than men, as collects the latest UNAIDS report. But that reality is concentrated in sub-Saharan African countries, where adolescent girls and young women between the ages of 15 and 24 are three times more likely to acquire HIV than their male counterparts.
“With the exception of the Caribbean region, in Latin America, the prevalence of the infection is much higher in the focus groups: men who have sex with men, sex workers, injection drug users and transgender women,” says Brenda Crabtree, infectologist and HIV researcher at the Salvador Zubirán National Institute of Medical Sciences and Nutrition in Mexico City. “However, women make up the group that has been most affected by the increase in infections,” she adds.
Latin America is one of the regions that in the last decades has experienced an increase. Of the estimated 340,000 people living with the pathology in Mexico in 2019, almost 20% of the total reported cases corresponded to women and girls, according to data from the National Center for the Prevention and Control of HIV/AIDS (Censida).
Much of the female population living with the virus does not know it “because women are not part of public detection and control policies,” says Crabtree. This reality has been documented by the psychologist specialized in Gender, Sexual Rights and Reproductive Rights of the Universidad Autónoma Metropolitana-Xochimilco, Ana Amuchastegui.
According to the expert, “women are not part of the key sectors in prevention and treatment campaigns, but when analyzing those living with HIV, elements such as gender violence and the scant information on sexual and reproductive health that exist stand out.” available”.
Like Carmen, who never thought that HIV could happen to her. “One day I started with very strong flu symptoms. I went to the hospital with my partner, then we found out that we had HIV, he had transmitted it to me and we were both already in the AIDS phase”. The final and most serious stage of the infection. When the virus has destroyed the immune system and the body can no longer fight opportunistic infections.
Victims of gender violence are up to 1.5 times more likely to acquire HIV
The lack of access to education, gender inequality and sexual violence are three conditions that have increased the number of women with HIV in Latin America. “Girls not going to high school or being abused at home are key risk factors for contracting the infection,” says Crabtree.
According to Censida, in Mexico, victims of sexist violence tare up to 1.5 times more likely to acquire HIV. The largest number of cases of infection in the country is concentrated in those entities with the highest rates of violence linked to poverty, such as Guerrero, Veracruz, Oaxaca and Chiapas. “In this State, the incidence by population of HIV is similar to that of African countries”, the researcher qualifies.
The epidemiological situation in Chiapas reflects the relationship between the social conditions of women and vulnerability to contracting the virus, as pointed out by research carried out at the end of 2020 with the objective of describing the dynamics of the inequalities of the affected women. Of the more than 200 Chiapanecas between the ages of 18 and 44 surveyed with HIV, 4 out of 10 had suffered some type of violence, also that associated with the diagnosis of HIV in some services and in the communities.
“Women are not usually diagnosed when they go to medical care for symptoms that suggest an infection of this type,” says Amuchástegui, author of several studies that indicate this. “The health system itself excludes them: if an indigenous woman comes to a clinic with the same symptoms as a gay man, only the second will be tested for HIV,” Crabtree qualifies.
“More than half of Mexican women realize that they are positive once pregnant,” explains Angélica Pedraza, a pediatrician and infectologist at the National Institute of Perinatology, specializing in HIV. The official standard for the prevention and control of virus infection establishes mandatory testing during pregnancy. “But in our country there is not good coverage of prenatal screening,” says the specialist, who is used to receiving consultations with future mothers who are victims of sexual violence who test positive for the virus. “Among them, many adolescents who suffer attacks within their close family, from their father, from an uncle,” she explains. “Other derivatives also arrive from centers where they did the rapid test when they were about to give birth and they came out positive for the infection.”
But, Crabtree warns, the ones that most escape controls are those who are no longer of childbearing age. For this reason, he says that “a lot of awareness is lacking.”
The importance of gender parity in HIV research teams
The invisibility suffered by women around HIV is extrapolated to the scientific field. “Although the majority of the population living with the infection worldwide is made up of women, their inclusion in clinical trials is still a minority,” denounces the infectologist. “For this, gender equality in scientific teams is very important: the integration of women when designing trials has an impact on more and better study of health problems that affect women,” she says.
As the statistics show, women continue to be underrepresented in fields related to research and innovation, representing less than 30% of the authorships worldwide.
“In Latin America, this percentage is highly disproportionate, despite the fact that including researchers in clinical trials has been shown to improve studies,” the infectologist highlights. Various studies have shown how a proportionate composition between them and them in the research teams it gives better results, not only increasing the impact and citations of the work, but also taking into account differential factors, such as gender, in the essays. “That is why we need more affirmative initiatives with a gender perspective. The reality is that the issues that affect women only concern us, as the fight against HIV perfectly exposes ”, she concludes.
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