Book Review

Women and AIDS: Psychological Perspectives

N Engl J Med 1994; 331:60-61July 7, 1994

Article

Women and AIDS: Psychological Perspectives
(Gender and Psychology.) Edited by Corinne Squire. 196 pp. Newbury Park, Calif., Sage, 1993. $55 (cloth); $19.95 (paper). ISBN: 0-8039-8587-8 (cloth)

It has never been easy being female on this planet. An editorial in the The New York Times (Feb. 14, 1994), inspired by the most recent human-rights report by the State Department on the condition of women worldwide, reminds us that “no one social, religious, or ethnic group has known discrimination as constantly throughout recorded history.” To that historical burden add the increasing effect of the human immunodeficiency virus (HIV) infection on women. AIDS is now the leading cause of death among women between the ages of 25 and 44 years in many of our largest cities and is the fourth leading cause of death among women in that age group nationwide. Women of all ages continue to provide most of the home care for people with AIDS.

There is certainly a need for a good, readable, practical book on the particular challenges that confront the woman with HIV infection or AIDS; the woman caring for family members, perhaps in two or more generations, who are HIV-positive; and care givers interested in the particular medical and psychological needs of such women. Women and AIDS: Psychological Perspectives examines the specific effect of the HIV epidemic on women rather than seeing them either as hapless victims or “vessels of transmission,” but the theoretical focus of the book limits its clinical usefulness.

The book is divided into four sections. The first examines HIV infection and reproductive issues; the second looks at women's perception of the risk of AIDS and behavioral change; the third reviews the experience of women who are care givers, focusing on a psychologist and volunteers; and the last discusses the representation of women and AIDS in scientific policy and the media. Despite the authors' obvious empathy for women handicapped by HIV infection, sexism, racism, and poverty, however, only in the section on risk and behavioral change is there any flavor of the real experiences of such women.

Historical trends and scientific endeavors are seen somewhat darkly through the glass of a firmly feminist perspective, and that which is of value often becomes lost in rhetoric and jargon. Thus, the delay in recognizing heterosexual transmission as a legitimate risk is viewed as intentional and malevolent, and further epidemiologic tracking of trends in vertical transmission is deemed unnecessary since such studies have already been done and, at any rate, were unfairly skewed in their focus on maternal, rather than paternal, transmission. Even more disturbing is the suggestion that a bias against women or even a genocidal intent lies behind the difficulties found in transferring to the heterosexual community the gains of relatively successful efforts to change high-risk behavior among the homosexual and drug-using populations or the lack of emphasis on safe sexual behavior by lesbians.

Women and AIDS is part of the series Gender and Psychology, edited by Sue Wilkinson, which is directed at an audience interested in feminism or psychology or both. Since women have learned from experience to be suspicious of the good will and good intentions of the scientific establishment, there is merit in the idea of exploring the AIDS epidemic from women's point of view. Some of the questions raised by the book are thought-provoking and important. How can women be empowered to take control of their own sexuality in heterosexual relationships? How can society strike a balance between the need for timely diagnosis and treatment of HIV in a fetus or neonate and the wish of the mother to remain uncertain of her own HIV status? How well are individual rights protected in scientific studies, particularly in Third World countries but perhaps even in more developed societies? Focusing almost exclusively on a feminist analysis, however, the book lacks the breadth of perspective that would have made it of interest to a wider audience and encouraged more open debate.

Mary Alice O'Dowd, M.D.
Montefiore Medical Center, Bronx, NY 10467