This is an excellent and up-to-date overview of the now-voluminous research literature on women and AIDS in the United States. As such, it is a good starting point for student readers and for those seeking a comprehensive guide to the state of contemporary research. Canada is virtually absent from the book and it should be kept in mind that the profile of women with HIV disease in this country is different from the United States. We remain dependent on the somewhat dated book by Jacquie Manthorne, Canadian Women and AIDS, to address the same topic.
A strength of this book is that the author has done her “home work.” The way in which AIDS affects women in the United States is inextricably linked to the fact that HIV disease especially affects women of colour, many of whom have a history of injection drug use, and these women are least likely to have access to medical services in the corporate medical delivery system of the United States. Fifty-six percent of women with HIV disease are African American; another 20 percent are Latinas. Forty-four percent list injection drug use as their risk category; 39% heterosexual transmission. About half of the latter category had a male partner who was an injection drug user. Adequate treatment of issues concerning women and AIDS needs to take all of these factors into account. Media, and unfortunately in many cases, academic focus on middle class white women has tended to reproduce the moral hierarchy that has too often shaped AIDS discourse, thereby implicitly valuing a small category of women constructed as “innocent” against the majority of women with HIV disease who are consigned to silence.
Campbell devotes a good deal of attention to the research literature on HIV transmission through injection drug use, and on the propensity of legislatures to prefer the criminalization of HIV transmission to adequate funding of drug treatment programs. There is also extensive treatment of findings on sexual transmission that point up the difficulty of expecting women to assert a need for safer sex to men on whom they are dependent. There is also good research on the ways in which monogamy expectations act to subvert safe sex messages. Pious injunctions that imply that only “other” people need to practice safe sex because they are not in “good”, that is monogamous, relationships, provides a strong incentive to avoid safe sex because everyone wants to be assured that their relationship is a good one.
The book offers a strong critique of the tendency to direct safe sex education toward women and gay men, thereby relieving heterosexual men of responsibility in HIV transmission. This omission is carried through in the common practice of leaving men out of family planning education and in the neglect of HIV issues in men’s reproductive health. In contrast, the focus on HIV and the reproductive health of women is so great that it tends to overwhelm concern for the health of women apart from reproductive issues. Campbell also wonders why safe sex education directed to heterosexuals so often emphasizes mistrust while health promotion adopted by the gay community takes a pro-sex approach.
There are perhaps a couple of mis-steps in the book. In a discussion of sero-discordant couples, the author argues, “When husbands were at risk of infection, their rate of sustained condom use was higher than when they were the positive partner and risked infecting their wife” (p 130). The footnote for this claim refers to research done in Zaire and one is left wondering if this is a fair generalization for the United States, where similar evidence is lacking. In addition, the book falls into a common rhetorical trap of stereotyping gay men with HIV disease as white and middle class, in order to make the case that “women have more complex socioeconomic, legal, and medical issues than gay men” (p 173). Unfortunately this construction denies the great many indigent white, black, and Latino gay men with HIV disease, not to mention the legal issues occasioned by the fact that the primary caregiving relationships of gay men are denied, or actively suppressed, by a wave of “Defense of Marriage” legislation currently sweeping through the United States.
From a Canadian perspective, there is work to be done to create a contemporary profile of women and AIDS in this country, where the demographics of the epidemic and national medicare result in a somewhat different set of issues. It is also regrettable that a book on the effects of HIV on people in the United States would not even mention the regressive legislation in that country that prevents Canadians and other foreigners with HIV disease from visiting the United States, resulting in ongoing harassment and discrimination by border guards of people they think might be HIV-positive. World AIDS conferences are not held in the United States as it continues to be a country boycotted by the International AIDS Society because of its discriminatory policies.
Overall this is still a good book and a useful introduction to the issues surrounding women and AIDS.
Barry D Adam
University of Windsor
adam@uwindsor.ca
September 1999
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