Gender & HIV

Siane Daley, 3 November 2004

Lesley Doyal, a professor in health and social care from Bristol University, recently held a seminar at the Terrence Higgins Trust in West London to discuss her recent study ‘Sex, Gender and Health: the need for a new approach’, which was published in the British Medical Journal in November 2001.

In the study, Lesley, who has also worked with the World Health Organisation (WHO) and the United Nations (UN), examines how socially-constructed gender characteristics determine how men and women contract HIV and AIDS, the differing ways that the illness impacts on the male and female body. Also how men and women are defined by their gender, influences the differing ways in which they access healthcare services.

‘Sex, Gender and Health: the need for a new approach’ makes the distinction between ‘biological’ differences and ‘gender’ differences between men and women. Biological differences are ‘fixed‘, and refer to women’s physical capacity for reproduction and childbirth, which men do not have. Gender differences refers to the way in which culture and society view and treat men and women in different ways, which can be changed.

This is significant in healthcare terms as it is also a determining factor in the different ways that men and women contract the virus, which is of significance to HIV/AIDS education, health and prevention agencies, who can’ target’ their literature and healthcare according to gender differences, both biological and cultural.

In relation to children with AIDS, this study also impacts on their health and wellbeing, as children with the disease primarily contract it from their mother. Women are also more biologically vulnerable than men, and are 2.5 times more likely to contract HIV/AIDS: this is because semen during intercourse stays in the vaginal tract for longer.

In 1994, the International Population and Development Conference in Cairo devised a ‘Platform of Action’ that addressed the impact of gender on health, and many countries have since developed new health services as a result.

Throughout the world, men and women are treated unequally to varying degrees between different societies and cultures. For example, the United Kingdom, where there is marginal gender inequality compared to a country like Bangladesh.

In terms of how gender differences impact on the transmission of HIV/AIDS, a fitting country to examine would be the Sub-Saharan Africa. In this region, 60-65% of all HIV/AIDS cases affect women. It is also significant that this region also has the highest rates of gender violence in the world. This can be taken to mean the cultural expectations of men and women, where men’s sex needs are taken to be paramount, and where girls aged between 16-24 years are six times more likely to be the victims of violence, rape and unwanted sex, thus increasing their risk of infection.

Sub-Saharan African men, like many men, are biologically pre-disposed to engage in risky behaviour in order to ‘prove’ their masculinity. In terms of contracting HIV/AIDS, they are likely to engage in unsafe sex, which is also more common amongst men in the poorest communities.

Once the disease has been transmitted, the biological differences between men and women come into play. This means that men and women’s bodies cope with the disease in markedly different ways, and the drugs used to treat them also act differently.

AIDSMAP, a comprehensive HIV information site, has recently highlighted recent studies that show that women have higher blood levels or greater total exposure to certain drugs, which explains higher rates of certain toxicities in women. This theory was tested, using the anti HIV drug Lopinavir, which works by blocking a part of HIV called 'protease', a chemical/ enzyme that HIV needs to make new viruses to attack the body.

Lopinavir was tested on a sample of 130 patients by Burger DM et al. It was discovered that women had significantly higher Lopinavir levels left in their bodies after treatment than the men tested. The concluding statistics were: females had 11.7mg/L compared to 7.0mg/L in men. This study took into account the differing body weights of those sampled, which suggests that a 'biological' difference exists between the male and female bodies and how they process anti-HIV drugs.

In conclusion, both studies are not conclusive, and there are other factors that need to be taken into account. For example, in Lesley's study: 'Sex, Gender and Health: the need for a new approach', she acknowledges that biological sex and social gender are major determinants of how HIV is contracted and treated. However, Lesley acknowledges that these factors cannot be understood in isolation, as they are constantly interacting with age, social class, ethnicity and geo-political status.

Regarding the biological effects of HIV and drug-treatment on men and women, there is still more data to be found and the need to work out how this data affects the advice and drug-treatment that men and women are given by healthcare professionals.

Further Information:

1. Lesley Doyal, Professor in Health and Social Care (Bristol University): L.doyal@bristol.ac.uk

2. British Medical Journal: http://www.bmj.com

3. Burger DM et al. "Lopinavir plasma levels are significantly higher in female than in male HIV-1 infected patients" (Third International Workshop on Clinical Pharmacology of HIV Therapy, abstract 6.5, 2002).

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