Women and HIV Disease

Women currently constitute the fastest growing group of HIV positive persons in the United States and account for approximately 20% of AIDS cases nationwide and 40% worldwide. While the overall death rate from AIDS has declined dramatically in the U.S. in the past two years, the decrease has been substantially less in women than in men. Possible explanations for this discrepancy in death rates include delayed diagnosis of HIV in women, reduced access to medical care, and the fact that the epidemic in women began later than in men.

Aside from the differences in death rates, which may have more to do with social than biological factors, a number of differences may exist between men and women with regard to manifestations of HIV infection and its treatment. Certain opportunistic conditions, such as Kaposi's sarcoma, are much more common in men than women, while other problems, such as recurrent vaginal yeast infections and cervical cancer, are exclusive to women. Furthermore, HIV-related drug levels and drug toxicities may differ between the sexes due to differences in body weight, hormonal milieu, and metabolism.

The growing AIDS case rate in women has implications for children, since the overwhelming majority of HIV-positive children have acquired the virus from their mothers. Children living with HIV/AIDS are not simply smaller versions of their adult counterparts, and, like women, have unique considerations. Major differences between the course of HIV infection in children and adults relate to the child's developing immune system and lack of prior exposure to certain infectious agents.

Because of the growing importance of health issues pertaining to HIV positive women and children, we have devoted this expanded issue of CRIA Update to this topic. A talented group of knowledgeable writers have contributed their expertise to this issue. Mary Jo Hoyt, Director of the Woman's HIV Program at St. Vincent's Hospital and Medical Center of New York City, has provided a thorough review of three important women's health problems and how HIV complicates them: cervical dysplasia, vaginal yeast infections, and menstrual abnormalities. Dr. Emily Erbelding, an expert on sexually transmitted diseases (STDs) at Johns Hopkins, has summarized the basics of STDs in women and how HIV and STDs interact with one another. Jill Cadman, a member of CRIA's Board of Directors, has comprehensively outlined the current state of knowledge of mother-to-child transmission of HIV. AIDS Activist Tim Horn has provided an update on recent advances in pediatric HIV research. Last but not least, Marie St. Cyr has put a more human face on the HIV epidemic in women -- particularly older women -- based on her experiences as Executive Director of Iris House, a center for women living with HIV in New York City.

There are still many gaps in our knowledge of HIV in women and children. Our hope is that the next time we visit this subject further research will have provided us with more information to convey in an even larger publication.

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