Women, Families, and HIV/AIDS: A Sociological Perspective on the Epidemic in America (review)

Carole A. Campbell.Women, Families, and HIV/AIDS: A Sociological Perspective on the Epidemic in America. Cambridge: Cambridge University Press, 1999. 190 pp. $49.95 cloth; $19.95 paper.

Carole Campbell, in her book Women, Families, and HIV/AIDS, compiles an impressive collection of literature to describe the different ways that women in the United States are infected and affected by the HIV/AIDS epidemic. Campbell combines an exhaustive review of the literature with data from her own research among HIV-infected women and men to create a sociological profile of the epidemic. Her twelve years of experience working in the field of HIV/AIDS prevention provides her with the capacity to consider thoughtfully the many ways in which women have been impacted by HIV/AIDS as persons living with the infection, as mothers of HIV-infected children and wives of HIV-infected husbands, and as professional caretakers in hospitals and AIDS service organizations. The aim of the book, as described by Campbell, is to create a female profile of the HIV/AIDS epidemic by describing the sociological impact of the epidemic on women. The book is meant to provide an examination of the sociocultural context of the AIDS epidemic and to show how gender roles and expectations affect HIV/AIDS transmission, prevention, and care.

The first chapter serves as background to the remaining six chapters by providing readers with an understanding of the scope and severity of the epidemic among women in the United States. Campbell traces the epidemiology and natural history of the disease with a special focus on women. In 1981, the year when the disease was first identified in women, women comprised 3 percent of the total adult AIDS cases. By 1999, this percentage had increased to 16 percent of the total AIDS cases. After describing the shifting profile of the epidemic, Campbell then dedicates the remainder of the book to understanding the many factors that contribute to this changing profile.

From the title of the second chapter, "Female Reproductive Health and Sexuality," readers are lead to believe that Campbell will review a range of different issues related to HIV-infected women's reproductive health. However, Campbell focuses almost exclusively on decisions around pregnancy. At most, 50 percent of HIV-infected women know their serostatus when they are pregnant, and, in general, even when they are aware of their serostatus, they make reproductive decisions similar to those of HIV-negative women. Clearly the reproductive health and sexuality issues that HIV-positive women face are broader than decisions about pregnancy. There is a notable lack of literature on the reproductive health of HIV-infected women, and Campbell could have used her knowledge of the field to point out these gaps in understanding for the readers.

In the third chapter, Campbell focuses on two categories of women at high risk for HIV: women involved in injection drugs use (IDU), either through their own drug use or through the drug use of their sexual partners, and women involved in the commercial sex work industry. These two categories of women have traditionally been heavily targeted for HIV prevention efforts. Campbell provides an interesting discussion on the gender roles and gender differences among IDUs and, to a lesser extent, among prostitutes. She also considers the barriers to risk reduction and to service delivery within these two categories of women. The fact that both IDUs and prostitutes live on the social and legal margins of society represents their most critical barrier to HIV service delivery. This barrier, however, is mediated by gender. For example, Campbell points out that female IDU's face a greater narrowing of life options than their male counterparts. Female IDUs are more likely to have young children whom they are supporting, are less likely to be employed, tend to have lower self-esteem and suffer from more depression, and...