HIV in Women
A stereotype exists in the United States that AIDS is a gay disease. Although AIDS was first documented among homosexual men is this country in 1981, according to the U.S. Centers for Disease Control (CDC), the total AIDS cases attributable to women in the U.S. has increased from 7 percent in 1985 to 20 percent in 1996. Today, the CDC reports that over 40,000 new HIV infections occur in the U.S. each year and about 30 percent are women. AIDS stereotypes can prevent women, and their healthcare providers, from seeing themselves at risk for HIV infection. Other HIV stereotypes include the female prostitute and the injection drug user. However, the CDC estimates that approximately 75 percent of new infections among women were through heterosexual sex, and 25 percent were through injection drug use.
Worldwide, the CDC reports that as of December 2000, 16.4 million women were living with HIV/AIDS, accounting for 47 percent of the 34.7 million adults living with HIV/AIDS, and that over 80 percent of adult HIV infections are due to heterosexual transmission. AIDS is not a gay or straight or a male or female disease. AIDS is a human disease.
What are some of the issues that are unique to women living with HIV/AIDS? Here are some alarming CDC statistics:
One in five HIV-infected women is uninsured.
Approximately 50 percent of women with HIV have at least one child under the age of 15 years.
African American women are 13 percent of the U.S. female population, but represented 63 percent of newly reported female AIDS cases in 1999.
In 1999, the AIDS case rate for African American women was 49 per 100,000, compared to 14.9 for Latinas, and 2.3 for white women.
HIV/AIDS is now the third leading cause of death among women ages 25 to 44, and the leading cause of death among African American women in this age group.
Although AIDS deaths in this country are down overall, AIDS deaths in women are rising.
Why are women, especially African American women, not accessing care and treatment as readily as men? The reasons are multiple and complex. Women have families and life difficulties that they often put before their own healthcare. They may be isolated geographically and culturally and may fear rejection by family, church, or community. There is often distrust of the healthcare system, especially among minority women, because of a history in this country of abuses of people of color in research. Since it is more difficult to get women involved in necessary research, we don't know a great deal about the differences in treating men versus women as far as medication doses or side effects. We do know that esophageal candidiasis is an opportunistic infection that occurs more often in women than men, and conversely, that Kaposi's sarcoma is commonly seen in gay men but rarely in women.
What else do we know about women with HIV/AIDS? We know that menstrual disorders, such as amenorrhea (lack of menstruation), and hypermenorrhea (excess menstruation) are frequently reported by HIV-positive women. There is lack of evidence whether low CD4 counts or high HIV viral load levels have an effect on menstrual function. Menstrual disorders in women with HIV infection may be related to a combination of factors such as chronic disease, weight loss, contraception, agents used to stimulate appetite, or substance abuse. More studies are needed to understand the relationship between HIV in women and abnormal menstrual periods.
Women with HIV/AIDS are 10 times more likely to have abnormal Pap smears of the cervix than women who are HIV negative. These abnormal Paps are associated with the presence of HPV (human papilloma virus or genital wart virus) and low CD4. In 1993, the CDC included cervical cancer as an AIDS-defined diagnosis. Even with treatment of abnormal Pap smears, women with HIV infection tend to have higher recurrences of abnormal Pap smears than women without HIV infection. Adequate screening and treatment programs are needed to prevent progression of abnormal Pap smears to invasive cancer. In 1998, the CDC recommended that women with HIV have a Pap smear every 6 months and that if they have two consecutive normal Pap smears, then an annual Pap can be done.
Some studies suggest that women with HIV tend to have more vaginal yeast infections, especially those with declining CD4 counts. Women should consult their healthcare providers for the most effective treatment of yeast infections.
There are many other topics such as pregnancy and menopause that need to be considered when discussing women and HIV. Although we've made significant advances in the decline of transmission of the virus from mothers to babies during pregnancy, we need many more studies on the safety and doses of HIV drugs used for women during pregnancy. There is very little information on treatment of menopause in women with HIV infection. Likewise, there is almost no information on hormonal replacement therapy and interactions with HIV drugs for post-menopausal women.
Women with HIV may need extra assistance to overcome the multiple barriers to accessing healthcare and treatment. Women often need intensive case management, peer advocacy, mental health and chemical dependency services, help with childcare and transportation, and specialized prenatal care, as well as easier access to treatment and clinical trials. All of these measures can have an impact on transmission, death rates, and more effective treatment for women with HIV/AIDS.