HIV, Women & the Big Picture

Starry, Starry Night
by David Waggoner

Museums can become crowded and very often you are only able to steal one glimpse or a few partial views of a work of art before you have to move on. This happens when I visit my favorite painting, The Starry Night, by Vincent van Gogh at the Museum of Modern Art. It’s popular, I know! But on the rare occasion when the galleries are emptied of visitors, I can spend some time looking at the work of art from many angles. I can see the entire sky in all of its energetic glory.

The Starry Night, by Vincent Van Gogh

When it comes to HIV, we still often do not look at the entire sky, so to speak, and it’s not only because we are rushed. In the U.S., for example, men still dominate the mainstream consciousness when it comes to thinking about HIV/AIDS. The focus on men started from the beginning. Historically, the CDC delayed expanding AIDS definitions to include women-specific diseases, researchers blocked women from trials and the NIH dismissed women-centered grants. One could argue it has been because of the numbers, then and now. Accordng to HIV.gov: ”Of the 37,968 new HIV diagnoses in the U.S. and dependent areas in 2018, 69% were among gay and bisexual [cisgender] men.” And overall, 81% of new HIV diagnoses were (cisgender) men. The research assigns 19% of new HIV diagnoses to (cisgender) women. (I’m adding “cisgender” because the website does not make it clear that’s what they mean.) Looking at global statistics, however, UNAIDS reports that 48% of all new infections in 2019 were among cisgender women and girls. The percentage jumps to 59% in sub-Saharan Africa.

As COVID-19 reminds us, we cannot simply address the coronavirus pandemic at home and not be concerned about Italy or Brazil. We need the big picture to tackle prevention, treatment and care. And so it is for the AIDS pandemic. We need the global view, the differences among us, and how we interconnect. Without it, in our American tunnel vision, we may inadvertently deprioritize the needs of women and girls.

And we may deprioritize the needs of women of trans experience. Take another look at the U.S. statistics quoted above: 81% (cisgender) men, 19% (cisgender) women—the numbers add up to 100%. In this part of the website, they seem to make invisible women and men of trans experience. HIV.gov does include statistics about individuals who are transgender: “From 2009 to 2014, 2,351 transgender people received an HIV diagnosis in the United States. Eighty-four percent (1,974) were transgender women, 15% (361) were transgender men, and less than 1% (16) had another gender identity.…A 2019 systematic review and meta-analysis found that an estimated 14% of transgender women have HIV. By race/ethnicity, an estimated 44% of black/African American transgender women, 26% of Hispanic/Latina transgender women, and 7% of white transgender women have HIV.”

As you can see, the HIV-related needs of women of trans experience should be a high priority. Our March cover story subject, Hailie Sahar, tells A&U Senior Editor Dann Dulin that more attention is needed across the board: “There’s a lack of protection within our government for the trans community and discrimination still exists. In terms of employment, many people of trans experience are not able to secure jobs, therefore forcing them into sex work. I also believe there’s a lack of guidance within the trans community. We must do better as a nation to end discrimination.

“On top of that, the research that’s being done is not inclusive of the trans experience. Many companies that are conducting research around HIV oftentimes clump data of women of trans experience with gay men. These are two completely separate subjects who have two different lifestyles and different disparities, so a lot of the research that has been done is off and incorrect.” As one of the stars of Pose, Hailie is using her platform to be an advocate and ally. Stunningly photographed by Francis Hills, she helms an issue that spotlights women. In our My Turn column, Claire Gasamagera weighs in on how women become disproportionately burdened working inside and outside of the home during pandemics like COVID-19. In his column, Art & Understanding, Managing Editor Chael Needle revisits women like our March 2001 cover story subject Beth Broderick, who have made a difference in improving access to HIV services during the early days.

Speaking of the early days, check out Drama Editor Bruce Ward’s review of the British miniseries about HIV/AIDS, It’s a Sin, in The Culture of AIDS feature. The show is a good reminder that women have been allies, if not represented as people living with HIV, from the beginning.

March 10 is National Women and Girls HIV/AIDS Awareness Day. Let’s keep the entire sky in our frame. Every star. Every swirl.


David Waggoner is Editor in Chief and Publisher of A&U, the first national HIV/AIDS magazine in the U.S.