The focus of this year's World AIDS Day [12/1] was on the two populations most vulnerable to the disease worldwide -- young women and children. That is where the Adolescent AIDS Program at New York's Children's Hospital at Montefiore wants to help. For more than 15 years, it has been providing young people infected with HIV with medicines and emotional and community support.
The Adolescent AIDS Program uses a small, comfortable facility in a decidedly "first world" New York locale. But Dr. Donna Futterman, who runs the center, says adolescent girls and young women in New York -- like their counterparts in the developing world -- are far more likely to be infected with the virus than adolescent boys and younger men. "In fact," she says, "the peak age of infection for young women is five to 10 years younger than it is for males."
Dr. Futterman offers several reasons. "Younger women frequently have older partners," she says, "and young women can be victims of sexual violence. Young women in many cultures around the world are not empowered to make choices about who they are going to have sex with. Historically throughout the world, women have sex with older partners, and the rate of HIV infection among older men is higher and [so] their [female partners'] risk of running into this is higher."
26-year-old "Denise" is an HIV-positive New Yorker with a steady job and a fairly happy life. She was only 12 years old when she learned she had contracted the disease. That was in 1990, during an era in which HIV usually meant death - and soon.
"I automatically assumed I was going to die after receiving the diagnosis," she says. "I didn't have a support system and it was just devastating for me because I wasn't living at home. I was living in foster care and I just felt alone." Her outlook changed after she learned that people can live a long time with HIV. "Then I started to realize that maybe I do have a chance of living a normal healthy life with this virus," she says.
Often girls like Denise contract the AIDS virus when they are raped. Sometimes, they fall under the sway of an older man and do not know how to safely refuse his sexual advances. For Denise, they key is to gain the skills and confidence to assert control. "You have the option to say 'no,'" she says. "You have the option of getting birth control. You have the option of using a condom because it is your life."
Dr. Futterman is quick to point out that very young children cannot make the choices that could prevent HIV infection. Most contract the virus from their mothers while in the womb. "Children are extremely vulnerable to this infection if their mother has HIV, doesn't know it and doesn't take medicine," she says. "One of four of them will be born with AIDS." She reports that "many of them are surviving their childhood even up into adolescence…but they've grown up with this disease hanging over their heads."
Director Donna Futterman says she has high hopes that the progress that's been achieved in the battle against AIDS can be extended to parts of the world that are still waiting for effective treatments. "One of our intense goals is that we can learn to share the bounties of treatment that we have in the United States and the Western world with underdeveloped countries throughout the world," she says, "so that anywhere in the world that someone is infected with HIV they have the chance for treatment and a long life."
Dr. Futterman says she has learned a great deal from the way other cultures cope with this modern-day plague. "When I travel and work in Africa," she says, "I see they are more advanced in many ways than we are here in the United States. So viewing this as a 'one world' problem, we can all learn from each other's approaches."