Letter from the Editor
I've worked with incarcerated HIV-infected women for 12 years -- as long as my son is old. He was just a newborn when I started this work, and he has lived in it, and around it, ever since. Likewise, my daughter traveled with me to prison (in my belly), and so her being is woven into all of my memories about caring for women in prison. Greater than 80% of my patients are also mothers of young children. Their talk about their children opens their lives to me and creates that critical bond of trust between patient and physician. Most of these women had primary custody of their children before their incarceration. Who cares for their children when they cannot?
I cannot help but think about my patients' children as I walk through the three steel doors at the prison gate to get to my clinic. I walk through the same doors to leave. Going in, coming out, there is always another child at the gates. I ask: what are we doing? Is anyone thinking about the next generation? What will happen to these children? I certainly don't know any easy solutions, but I can't believe that separating a child from a mother who has HIV, or AIDS, is the right thing to do.
HEPP's tradition has been to publish an article about HIV infection in women around the time of Mothers' Day, in honor of the mothers who work in prisons and jails, in the hope of helping women living with HIV in prisons and jails, and in remembrance of the children of incarcerated mothers. This year, Dr. Onorato of U. Texas Medical Branch summarizes new information on the management of HIV-infected women in corrections, including the impact of gender-related differences in viral load. Betsy Stubblefield summarizes the recent NIJ publication on women and the justice system, highlighting new data on violence against women.
Some good news we'd like to report comes from one of our Advisory Board members: Dr. Lester Wright, Medical Director of the New York State Department of Correctional Services. Although the HIV infection rate among women in the NYDOC had been quite steady at 18-20% for 10 years, the 2000-01 DOH study, still in analysis, appears to show a change. Based on preliminary and incomplete data the rate is in the 14% range. Thus we may be seeing a break in the "steady increase in incarcerated women with HIV infection." That is great news!
After reviewing this issue, readers should be able to describe the management of HIV infection among women and special management issues related to pregnancy, discuss the appropriate management of cervical cytology for women who are HIV infected, and understand the implications of gender and viral load in progression to AIDS.
Anne S. De Groot, M.D.
This article was provided by Brown Medical School. It is a part of the publication HEPP News.