Women are inadequately provided with HIV services and education and are differentially denied access to these. Divisions of race, ethnicity, economic class, and religion, among others, are compounded by sexual discrimination within each of these categories.

Review of current data on women with AIDS reveals that the reporting methods used convey a false impression that women are not at significant risk. Moreover, the persons indirectly affected by AIDS are predominantly women — mothers, sisters, partners, family members, teachers, and human service workers. Thus, AIDS is more of a women's issue than the statistics imply.

Women, as a gender-defined class, face major cultural obstacles to service, beginning with their characterization as "vessels of infection and vectors of perinatal transmission." Women are considered not as individuals worthy of attention, but merely as sources of the infection of others, that is, men and children.

Examples of barriers to service, of SOP (standard operating procedure), are explored through focusing on specific groups of women and their concerns: the unique peri-treatment issues of women intravenous drug users and their minority status among male users; the inability of mainstream health promotion campaigns to adequately address the gender differences within the minorities; the disregard for the reproductive rights of the mother in the rush to protect the fetus from HIV infection, and the lack of supportive care for the woman who chooses to continue her pregnancy; the blame placed on women prostitutes for "heterosexual spread," hiding the reality of their risk level and obstructing their utilization as models and instructors of risk-reduction activities; and the hostility and twin burden of sexual discrimination and homophobia directed toward lesbians (including those working in AIDS service organizations), which deny these women the ability to access and eliminate their own risk, if any.

The last section of the article explores gender-specific approaches to service delivery and proposes formats for change.

The opinions expressed herein are the personal opinions of the author and do not necessarily reflect the policies ofthe Massachusetts Department of Public Health.



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