Data About Women Has Profound Impact
I want to talk about a topic that might have an even bigger impact on society than the speculation about wonder drugs. The fact that we are finally seeing some data to rectify the criminal absence of any real research about the course of AIDS in the bodies of women. I don't just mean transmission of HIV, although most researchers act as if women's only disease issues relate to their social role as mothers. I think that researchers in Vancouver experienced less enthusiasm about the mandatory testing of pregnant women and newborns, which has been such a hot political topic in this country.
Scientists and clinicians now know considerably more about the conditions of maternal-child transmission. The longer the time from the rupture of the membranes around the fetus (waters breaking) and actual birth, and the higher the viral load of the woman, contribute to the likelihood that HIV transmission will occur. Remember that the demand for mandatory testing was based on data from ACTG 076, which stated that high-dose intravenous AZT in women during delivery could lower transmission rates. However, the newer findings that AZT monotherapy is obsolete make the arguments for mandatory testing and treatment very different.
Women have been objecting to ACTG 076's recommendations based on two arguments. One was the violation of civil rights in marking one particular group for mandatory testing. (AHF's Michael Weinstein, one of the loudest (male) proponents of mandatory testing and treatment of women, told a colleague he just didn't believe women could be trusted to do "the right thing" without doctor's orders.) But the other argument made against 076 was that we knew nothing about the long-term effects of extremely high-dose AZT on women and children. If a woman's body is flooded with 1600 milligrams of IV AZT per hour during delivery, does this create AZT-resistant virus in her body and the child's? Does so much AZT reach toxic levels far too quickly? Counseling about the new protease inhibitors and all the options, and funding to pay for the better drugs will naturally increase the likelihood that women will voluntarily act to prevent infection of their newborns without having to risk injury to themselves.
But women have bodies and lives even when they aren't giving birth. Yet researchers have done almost no work to see how MAC or PCP progresses differently in women's bodies. Mardge Cohen, M.D. has finally confirmed what women have been saying for years: women with HIV have abnormal menstrual cycles. She showed that some menstrual abnormalities are similar to those of the poorest, drug-using women without HIV. (See Menstrual Irregularities: WIHS Study Sheds A Little Light.) The research is important, because women were always told that these symptoms were all in their heads.
Meanwhile, data are now showing that women have high rates and quicker progression of lymphomas and some opportunistic infections, but there are few investigations of how women absorb medications for these conditions. The WIHS also showed that up to 65% of the women in their study had in the past or were currently having a primary intimate relationship with other women; yet there is no research on how these women may access care differently or less often because lesbian behavior is still stigmatized or ignored. This is not an issue about transmission, but simply a call for more research about the medical consequences of HIV for the many different types of women who are getting the disease.
Worldwide, almost half of all cases of AIDS are among women. In Los Angeles, the numbers are smaller due to the large numbers of gay/bisexual men (mainly African-American, Latino and Asian/Pacific Islander) among new cases. The Los Angeles statistics about new infections show that African-American women and Latinas have the fastest rising increase in incidence of AIDS. And this points to another important issue raised in Vancouver: prevention efforts are undergoing a very dramatic change. A study of Puerto Rican women in the Bronx, indicated that education and jobs were the factors that were most likely to predict these women's use of condoms. Instead of treating decisions about safe sex as individual problems, researchers are looking at the context in which women and men are making sexual choices.
Women Alive has called for new research on a problem which is very significant in Los Angeles: most new infections to women come from HIV+ men who were infected through sex with another man. Many of these men consider themselves completely straight, and cannot be reached through gay/bisexual prevention campaigns. Many are also involved with transgend-er women, so easy labels for their sexuality need to be reexamined.
Bi or Straight?
In one remarkable study in Britain, researchers ran small classified ads in heterosexual dating pages and in sporting magazines with the following message: "Do you like to get off with other men also? We are sex researchers. Call us for a completely anonymous, confidential interview." The researchers had 64,000 calls in one week! It is clear that empowerment of women to question their partners' sexual lives and to act to prevent infection to themselves is of paramount importance. Equally important is the fight to eradicate the homophobia that makes it difficult for these men to disclose the whole range of their sexual behavior with men and women.
This article was provided by Women Alive. It is a part of the publication Women Alive Newsletter.