All authors generated ideas, discussed the main concepts, and collaboratively wrote the article. Most HIV prevention literature portrays women as especially vulnerable to HIV infection because of biological susceptibility and men's sexual power and privilege. Conversely, heterosexual men are perceived as active transmitters of HIV but not active agents in prevention. Although the women's vulnerability paradigm was a radical revision of earlier views of women in the epidemic, mounting challenges undermine its current usefulness.
We review the etiology and successes of the paradigm as well as its accruing limitations. We also call Heterosexuals dont get aids an expanded model that acknowledges biology, gender inequality, and Heterosexuals dont get aids power relations but also directly examines social structure, gender, and HIV risk for heterosexual women and men.
Virtually invisible in the earliest phases of the US epidemic, then treated as stigmatized vectors of the virus, women were expected to protect themselves by insisting on male condom use—despite feminist recognition of the reasons this expectation would fail. How, why, and for whom did women become Heterosexuals dont get aids primary vulnerable victims of the HIV epidemic? More important, does this transformation serve the current needs of those at risk for HIV?
Here we consider the etiology and evolution of what we have termed the vulnerability paradigm, a model that has been latent within the research literature and policy lexicon, but a ubiquitous model 5 — 9 that we wish to name explicitly. According to this paradigm, women are susceptible to HIV because of biological differences in susceptibility, reduced sexual autonomy, and men's sexual power Heterosexuals dont get aids privilege. Conversely, heterosexual men are active transmitters of HIV but not active agents of prevention.
The paradigm assumes not only that women but not men want to prevent HIV but lack the power to do so, but also that men are more likely than women to bring HIV into the partnership. The model tends to ignore how heterosexual men contracted HIV themselves and how variability in biosocial and cultural contexts influences women's and men's probability of infection if exposed.
To be sure, both biological susceptibility and gendered power dynamics drastically disadvantage women worldwide. However, the vulnerability paradigm can also mask women's power and agency. the model Heterosexuals dont get aids that women want to protect themselves, but men do not.
Similarly, men, but not women, are presumed to engage deliberately in risky practices. Finally, the paradigm applies gendered, structural understandings and interventions to women's behaviors 9 but not to men's, especially heterosexual men's. Even by the s, when it was recognized that women were acquiring HIV heterosexually, 1415 and when almost 20 women had officially died of AIDS, 16 women were absent from clinical trials, 17 and the Centers for Disease Control and Prevention's AIDS case definition failed to include certain common disease manifestations unique to women.
Over time, greater clinical understanding of HIV in women e.
But it was not untilafter vociferous legal and advocacy "Heterosexuals dont get aids" mounted by women's groups, 20 that the Centers for Disease Control and Prevention finally expanded its AIDS case definition, 21 leading to a dramatic escalation in the number of women officially recognized as having AIDS.
But visibility did not automatically lead to increased public health aid to HIV-positive women. Two kinds of heterosexually infected women appeared in the discourse: This phenomenon would be seen with prostitutes in several other parts of the world, among whom AIDS was considered to be a largely feminized disease from which men needed to be protected.
Furthermore, even among feminist advocates, efforts Heterosexuals dont get aids feminize the discourse were slow after the disease had been identified with gay men for so long. Treichler in particular has documented the lackluster feminist response to AIDS when it was primarily a gay epidemic. Epidemiological developments throughout the s continued to highlight heterosexual transmission as a major route of infection for US women.
Inheterosexual contact surpassed injection drug use as women's predominant route of infection. They argued that women were more vulnerable to HIV than men, both because of their greater biological susceptibility Heterosexuals dont get aids exposed to HIV and their greater social vulnerability to being exposed to an HIV-positive partner.
Although women's greater biological susceptibility is now well accepted, this was not assumed early in the epidemic, when the vagina, as opposed to the anus, was thought by scientists to be a rugged tissue that protected women from infection. Plausibility was strengthened by analogy with other albeit bacterial sexually transmitted infections, such as chlamydia and gonorrhea, which exhibit different transmission probabilities from men to women than from women to men.
Prospective studies of serodiscordant couples 3031 and of men's contacts with female sex workers 3233 then showed that women have upward of twice the probability of infection if exposed to HIV. Thus, the growing epidemiological understanding of gender differences in transmission probabilities through Heterosexuals dont get aids intercourse came to serve as the lynchpin the vulnerability paradigm.
The model rested even more compellingly, however, on arguments concerning women's social vulnerability. At first, epidemiological profiles strongly contributed to the recognition of women's greater social vulnerability stemming from gender inequalities that increase their likelihood of being exposed to HIV i. Surveillance statistics showed that the women most likely to contract HIV heterosexually were predominantly Black and Latina and were living in the poorest sections of US cities that were hardest hit by the deindustrialization of the s.
The epidemiological and social profile of women in many international pandemics also supported the notion of the vulnerable woman.