When I started learning and teaching about HIV and AIDS, I expected to learn a lot about biology, medicine, drug addiction, and homosexuality. And of course, I did. I did not realize that I would also constantly be confronting key women's issues. The poverty of women, gender inequality, sexual exploitation, lack of control of sex in intimate relationships, discrimination of all kinds, inequality of access to education. These issues are devastating. I have granddaughters who are living sheltered and protected lives. As I have studied AIDS, I have learned again and again about girls and young women who are vulnerable and at great risk. Girls and women who dot, do not have the advantages that some of us enjoy. With each passing year, the AIDS epidemic becomes increasingly feminized. The majority of new HIV infections are in women. AIDS related diseases are the largest cause of death among of women of reproductive age. How can we explain such a vast, overwhelming global fact? Women have less money and less power than men. They are discriminated against and have less control over their bodies and their sex lives than men. Gender inequality is common throughout the world. Women and girls are valued as sex objects. And when they are poor and lack access to resources, they are exploited. In many settings and in many cultures, they simply can not protect themselves against dangerous sex. All of this adds up to more and more women becoming infected with HIV, and coming down with AIDS. The world is full of sugar, dag, daddies, pimps, traffickers, men who buy sex for money, and men who comfortably settle into relationships in which they dominate. All of this adds up to diminished female autonomy, and often to disease. For the rest of today's video lecture, we will turn to more positive topics, to people who are helping women in my home country, the United States, deal with living with their HIV infections. The first person is Dr. Patricia Brown at Wayne State University and the Detroit Receiving Hospital. As the only infectious diseases specialist in her department who is female, the women patients tend to gravitate to her. You will see a part of a conversation I had with Dr. Brown and her associate patient advocate Margareth Corkery and a much larger section of that conversation will come later in the course. I'll also show you a segment from a conversation with Sheeyana Watson, a minister, AIDS community worker and social work student. She has been running a support group for women living with HIV. And she discusses how the women use these opportunities to get together. Patty, when you've come to my on campus class you've told us that in the Infectious Disease Practice here, you're the only woman. Is that still true? >> That is still true. >> It's still true? >> I'm the only faculty provider in the practice who is female. But that will change in, two months? >> Mm. >> We've hired a new just out of fellowship physician who's another woman so- >> I'm glad to hear that she's coming. >> We're going to double our ranks as soon as she arrives. >> But, you've also told me that in a sense, you've sort of specialized on the the HIV positive women in your practice who want to see you? >> It's sort of by default, yeah. We've, and again, this isn't unique to HIV care. Many, this is true for internal medicine, true for obstetrics and gynecology, many women express a preference to have a female provider. So sort of by default I, I have the largest female patient population of any of the other providers. >> And can you tell us a little bit about that? >> Yeah. Well you know, I do think that there are some special issues around caring for women with HIV. one, and again, this is my own personal experience as well as supported by, by the literature that we know. Is that, because women are often caregivers for others, they tend to neglect their own health. So, you know, there are special challenges around, you know, caring for children, caring for a partner who might be ill or have other issues. So, that, you know, retention in care is a really, important challenge for us as we care for women. The issues around reproductive health are extremely important. It is absolutely possible for women who are HIV positive to safely achieve pregnancy, and to prevent transmission to their infant through anti-retroviral therapy, deliver. And so it's not a reason not to have a baby but it requires some strategizing and so we have to make sure that we're working with women, letting them know, you know, still, most pregnancies that occur in my practice are, are surprises, at least to me. >> [LAUGH] >> I don't know if they were surprises to the patient. Although we know nationally in the United States 49% of pregnancies are unintended. But we try as much as we can to work with patients to let us know about their plans in terms of their reproductive health so we can help them safely navigate achieving, you know conception safely, protecting their partner if their partner's uninfected, and then protecting their baby. And we work very closely with a physician, Dr. Theodore Jones, who, again, is the preeminent expert in the state in perinatal HIV care. And so as soon as pregnancy is diagnosed, we will, you know, refer them to Dr. Jones who will then oversee the provision of anti-retroviral therapy throughout the pregnancy and then get the patient back to us, after delivery. >> Hm. And that's highly successful in, in, in having HIV negative babies? >> Oh, yeah. >> Oh, absolutely. In fact, there was a period of time in the state of Michigan where we went for, what five, six, seven years without a single HIV positive patient, infant, born in the state. And then there was one and then I mean it was like a sentinel event. The health department, everyone went on high alert to figure out how this, this could have happened. There is a law in the state of Michigan that the individual who diagnoses pregnancy needs to offer HIV testing to the woman. Now there's no law that you have to be tested, right? It's, it's still patient choice, but absolutely women need to be offered testing and actually they're test, offered testing in the first trimester and then again in the third trimester. Just to ensure that infection wouldn't have been acquired during pregnancy. >> I know that another thing that you have done has been to focus especially on women who are living with HIV. I know that you've run a, a monthly group for the women. Leon mentioned it when he talked with us. Tell us about what you see as the special situations of women living with HIV. >> So, for women living with HIV the reason why I have such a, a strong focus and a heart for them, is I feel that the rates of infection for women steadily on the rise, but there's not a lot of funding for women-specific programs. And so, you have women who I think deal with their diagnoses different than men. Not just physically we know that for sure, but mentally and emotionally they deal with their diagnosis differently than men. The physical aspects of it, some of these HIV medications are pregnancy class D. Meaning that, if they were to get pregnant on this medication their baby is more likely to miscarry or their, their child will be stillborn, or if they are born they will have severe deformities. Men do not have to deal with that concern. And so let's say you're 20, you know, 30, even 40, and you want to get pregnant, you have to take in to account what kind of medications you're taking. So that's- >> What are some of the mental, psychological issues? >> So, so a lot of the mental and psychological issues, I think, everyone who's positive, you know, deals with that issue of will I be rejected,. Dealing with issues of a stigma and feeling, kind of stained and, and, and kind of stamped with a scarlet letter of you know, no one's going to want me because I have this diagnosis. But I think particularly, for women, and for moms living with diagnose, diagnosis, they take on a lot of burden of, of being sick, and not really taking care of themself. And taking on the burden of making themselves acceptable to their, their partners. What I mean by that, is, a lot of my female clients, they do not do really good self care. They see themself as the lowest person to take care of. They take care of their family members, they take care of their kids, take care of their partners before they take care of themself. And I think they have a lot to do with gender roles. That women in general, you know, we are socialized to be nurturers. To, you know, take care of the home and take care of all these other people. And we come last. And so when we're talking about someone who's positive, they really need to put themself first and put their health first. I, always caution some of my women clients that you know, you're taking care of everybody else, but if you get sick, who's going to take care of you? And how can you take care of everybody else if you're sick? How can you take care of everybody else if you're not taking care of yourself first? So, I think that's a lot of the mental issues that we've been socialized as women, that we take care of everybody else instead of, ourselves. And then you're dealing with a very, especially black women and Latino women you, culturally you know we are at the whim of our male partners. That there's a lot of that, think of the phrase, so like you know machismo and, just, paternalism. That you have men as the head and we are beneath them. And if we're trying to negotiate safer sex, and I have been socialized that I shouldn't ask you to wear a condom, you should be the one to bring it up. If I'm socialized that I have no power that, the, all these power dynamics in my relationship and I've been told that I don't have the power to really request what I want in my relationship. I don't have the power to talk about sex because then I'm seen as you know, a tramp. I mean, even a popular, producer, will.i.am, said a few years ago that if he ever saw a condom in, a lady's room, a lady's home that he would, it'll be a complete turn off. Like, he would, you know, go away. That this is not something that he wants to be involved in because it just shows that she's having all this sex. But, if a guy has condoms in his room, if a guy has condoms in his apartment, it's seen as a good thing. He's you know, having all these conquests. And so I think, that's the mental piece that a lot of times women deal with that I don't think is kind of discussed when it comes to men who are positive. >> So has that been one of the focuses of your women's groups meetings? >> Yeah, so the, the group is called RISE, Respect In Self Empowerment, and so the focus of the group really is empowerment. That you are important, you have a voice. You are able to live life on your terms. And so the topic every month may change, but the theme will always be about women being empowered to do what they want. And so that could be, you know, being the power to have good health. We had someone come and talk about nutrition. I had a friend come in and do a, a dance workshop so that the ladies got active and danced around. And we talked about how, you know, important it is to be active. Or how whenever there's a new medication out, I bring someone from the pharmaceutical company to talk about that new medication because a lot of times clients will just stay on the same regimen. Which is good if it's working for you, but if there's something out there better, let's talk about something that's out there better. But physicians may say, it's working for you, let's not talk about that. No, I want you to be educated and you again are empowered to make that choice for yourself on whether or not a new medication may be better for you. Or you know, a lot of times ladies come in and I may have an idea of what we're going to talk about because I let them, at the beginning of the year, write down a list of topics, and I just choose from those topics every month. But lately, the ladies just come in and just say hey, I want to talk. So I just let them talk. Because, some times when it comes to group, this is their only chance to vent and unload and get support. >> I have a problem with a child, I have a problem with a teacher, I have a problem with my boyfriend. >> Mm-hm. I mean, it'll, it'll be I have a problem with my partner my kids are driving me crazy. Last year we had quite a few of the ladies relapse. So struggling with addiction. >> Addiction. >> Mm-hm. One night the ladies just talked about struggling with having friends. We just talked about how hard it is to be a good friend, and how hard it is to really find friends that you can trust and invest in. >> Many of these struggles are never over. >> Right. It, it's, it's a continuing, and it's universal struggles, whether you're HIV positive or not. It's struggles that I think women deal with in general. But I think, for the women that are positive, they have this overhanging burden of rejection. >> And the, and the HIV turns up the volume on many things. >> It, right, it does for everything. You know, just being poor is a problem, just being, you know, a woman is a problem, but being poor, a woman and HIV positive, that just takes it to another level. So I really try to give them that space just to vent. >> And I know from talking to you in the past that, on a lighter note, sometimes the focus is pizza and movies. >> Yes, yes. So that's another thing I try to do to balance. >> Have some fun. >> Yeah, balance out, you know, the education and empowerment piece and just giving them that time the, to vent. With having fun events. So, we have a picnic coming up in August, we usually go out to one of the parks in Ann Arbor, have a cook out. Have fun, we go out to the movies, especially there's like a really good women empowerment movie out, I'll buy tickets, we'll all go to the movies. What else have we done? We've done bowling nights, gone out for dinner. The ladies try to get involved with heart two, so they usually have like a AIDS walk team. And we do the AIDS walk a Jackson and in Ann Arbor. And they love that, just being out and about. so, yeah. We try to do some fun things, too, to balance it out. And, some days, I'm, like, we just eat chicken and talk. We just want to [LAUGH] have time to talk about other TV shows and, you know, what our kids are doing. That's been a really cool thing that, lately, a couple ladies who joined the group didn't realize that they had kids at the same school with the same teacher. So it was just really nice for them to connect at HARC, but then, now, they're able to connect outside of HARC, and their kids hang out together. >> I think those women are lucky to have you. >> Oh, thank you. I'm lucky for them. They are just one of the strongest group of women I've ever been involved with. And it is just my privilege that they you know, are willing to meet up with me once a month
