HIV Treatment Differences?
Because women have traditionally been excluded from or underrepresented in HIV medication studies, it is still not well understood how women may differ from men in their response to HIV treatment. This underrepresentation trend only recently began to reverse, and the findings have been mixed. For instance, ongoing, large-scale studies -- such as the Women's Interagency HIV Study, the largest study looking at HIV-positive women in the United States -- have found little difference in terms of the effectiveness of HIV treatment. Women with HIV who begin treatment as recommended have been found to do as well as men with HIV.
However, although HIV treatment seems to work as well in women with HIV, the side effects of HIV infection and HIV treatment may differ. Researchers say that women are more likely than men to experience liver problems and skin rashes from HIV medications. In fact, women with a CD4 count above 250 are warned against starting a regimen with Viramune (nevirapine) because of the risk of dangerous liver problems.
Some studies have also found that women with HIV experience more body shape changes, such as thinning legs and fat gain in their breasts and waists, than do men. Meanwhile, results from the Women's Interagency HIV Study show that HIV-positive women are more likely than HIV-negative women to experience menstrual irregularities, genital warts and ulcers, human papillomavirus, vaginal infections and pelvic inflammatory disease -- and that HIV-positive women also tend to get more severe cases of these diseases.
In addition to differences in health complications, there are signs that HIV itself may impact women in at least a slightly different way than men. For instance, researchers have found that once a woman has been infected, she has noticeably lower amounts of HIV in her blood at the beginning, yet loses immune cells and develops AIDS as fast as a man.
Unfortunately, the implications of this difference -- not to mention a number of other factors, such as the role of female hormones and the menstrual cycle -- is not easy to pinpoint. A great deal of research remains before scientists can fully understand the ways in which women and men differ when it comes to HIV and HIV medications.
Minority Women and HIV/AIDS
In the United States, African Americans now account for 68% of all new HIV diagnoses among women. About four out of every five women and girls living with AIDS are African American or Hispanic, although these two groups make up fewer than 25% of females in the United States.
Currently, AIDS is the single most-common killer of African-American women ages 25 to 34, the third most-common cause of death for African-American women between 35 and 44, and the fourth-leading cause of death for African-American women ages 45 to 54, as well as Hispanic women ages 35 to 44.
Why is there such a huge racial disparity? Two basic reasons: poverty and culture. Let's take Hispanic women in California, a state with a huge Hispanic population: Hispanics in the United States were nearly three times more likely to be uninsured as non-Hispanic whites, and many are undocumented immigrants who are afraid to use public services. Poverty in this country, like anywhere, means lack of access to the latest HIV medications and other cutting-edge treatments.
Adaora A. Adimora, M.D., M.P.H., who recently led a study looking at heterosexually transmitted HIV among African Americans in the southeastern United States, noted that "poverty may be an underlying determinant of these [risk] behaviors and a contributor to infection risk even in people who do not have high-risk behaviors."
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The cultural effect also appears to be a potent one. "In 2007, we have a system that has in many ways created a stigma -- testing is for undesirables, people who have 'deviant' behavior," says Women Alive's Carrie Broadus. "Where was the message that this disease could be passed heterosexually?" she says. "We've had that message for homosexuals, IV [intravenous] drug users, hemophiliacs. But we did not create a system for women of color. Men who have sex with men is a subset of men who have sex with women -- but women aren't part of the equation, just men with men."
By failing to spread the cultural message that every woman of color may be at risk for HIV, prevention, testing and treatment simply never became a priority.
In addition, some African-American women distrust the medical establishment -- a distrust that many tie to the infamous Tuskegee syphilis experiments in the mid-20th century, but that could also be due to a large number of other factors. Regardless of the reason, the result is the same: Many African Americans may shy away from available HIV testing and treatment services.
Culture can play an important role in another way: Some deeply religious women may believe that whatever happens to them is God's will and there's nothing they can or should do about it.
The potential impact of migrant workers on North America's HIV epidemic is also frequently overlooked. Shelley Davis, deputy director of the Farmworker Justice Fund, Inc., works with female farmworkers in the United States -- the majority of whom are of Mexican descent -- to provide HIV prevention education.
"In traditional Mexican society, women didn't discuss sex with anyone, including their partner/spouse. They stay home on a pedestal, period," she says. "Men, on the other hand, are encouraged to have multiple sexual partners. When men migrate for six months at a time, they are likely to have sex with prostitutes, other men or other women. There is also a reluctance to use condoms with casual or regular partners. Thus, when the men come home, they may have a sexually transmitted disease, but they don't discuss it with their female partner or use a condom. So women get infected with HIV/AIDS in the U.S. and in Mexico."
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