HIV Risk and Vulnerability

A variety of demographic, behavioral, and social factors place people at risk for becoming infected with HIV and other STIs. Traditionally cited risk factors include, for example, age, multiple sexual partners, partners with multiple sexual partners, history of STIs, and drug and alcohol use. Early on in the AIDS epidemic, there was a tendency to refer to “high-risk groups”— those groups of people who have historically contracted the infection in large numbers. This often included, for example, sex workers and homosexuals. These types of categorizations may lead some people to assume that they are not at risk for infection if they do not belong to these groups.

Over time, experience taught that risk is not based on who you are, but rather on what you do. The idea of risk behaviors is that HIV/AIDS does not discriminate. Anyone who engages in a behavior that exposes him or her to HIV is at risk for infection. This includes:

• Anyone of any age who engages in unprotected oral, vaginal, or anal intercourse with anyone other than an uninfected, mutually monogamous partner
• Anyone whose partner engages in unprotected intercourse with others
• Drug users who share needles and other drug works
• Anyone who receives an injection with a potentially contaminated needle or syringe
• The sexual partner(s) of an injection drug user
• Recipients of transfusions or treatment with blood or blood products in regions where reliable screening of the blood supply does not occur
• Anyone who uses potentially contaminated tattoo needles or other skin-piercing instruments
• Any workers or clients at health care facilities who come into contact with blood, blood products, unclean needles, or surgical instruments
• A fetus or nursing child of a mother who is infected with HIV

This understanding, along with the experience that identifying groups of people as “high risk” leads to unjust stigma and discrimination, has led to a shift in the language from “risk groups” to “risk behaviors.” The distinction between risk groups and risk behaviors is important.

Vulnerability

More recently, there has been a growing recognition that in addition to these individual behaviors or characteristics, certain social, economic, and political forces make people or groups of people vulnerable to infection. In a sense, HIV/AIDS does discriminate. Some factors that affect social vulnerability include gender inequalities, economic power, youth, cultural constructs, and government policies.

Women, in particular, may be vulnerable to infection because of gender inequalities and lack of power within sexual relationships, which make it difficult, if not impossible, for them to negotiate safer sex with partners. Lack of economic power can lead to vulnerability as some women are forced to enter into sex work or to form temporary partnerships to barter sex for economic survival. Furthermore, because of women’s greater biological vulnerability to infection transmission, they face greater risk of infection.

Young people of both sexes are vulnerable to infection for many reasons: social, biological, behavioral, and demographic. For example, young men often face tremendous pressure to be sexually active and are, therefore, less likely to seek information about how to protect themselves and their partners for fear of appearing inexperienced. Young women, on the other hand, may be particularly vulnerable for biological reasons (less mature tissues may be more readily permeated or damaged) and for social reasons, including lack of economic resources or negotiating power.

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