How Serious is HIV in Women?

Only 7% of AIDS cases reported in 1985 in the US were in women and girls. That percentage increased to 27% in 2004. Approximately 71% of women are infected through sex with HIV-positive men (generally with a drug user) and 27% through drug use. In the US, AIDS infection rates are higher in the south-east and the north-east. Almost 64% of infected women in the US are black, despite the fact that only 13% of the US population is black.

Women are at risk of becoming infected with HIV. Many women believe AIDS is a disease of gay men but women are infected with HIV from sharing needles and from heterosexual sex.

During sex, HIV is transmitted from man to woman much more easily than from woman to man. The risk of a woman becoming infected is greater if anal sex is practiced or if she has a vaginal disease. The risk of infection is greater if her sex partner is or was an injection drug user, has other sex partners, has had sex with infected people or has sex with men.

Women should protect themselves against HIV infection. The chances of becoming infected fall if her male partner uses a condom every time they have sex. There is a female condom that offers protection but not as much as the male condom. Other forms of birth control, such as contraceptive pills, the diaphragm or implants do NOT protect against HIV. Several microbicides (creams, gels and foams) that women can use to prevent HIV infection are in the final phase of study.

If you think you have been exposed to HIV, get tested. Many women do not find out they are HIV positive until they get sick or are tested during pregnancy. If women are not tested for HIV, it seems that they get sick and die much faster than men. However, if they are tested and receive treatment, they live as long as men.

The viral load is lower in women. Women tend to have a lower viral load during the first years of infection. Treatment guidelines suggest that doctors should take this into account for recently infected women whose CD4 cell counts are above 350. Nevertheless, the disease progresses at the same rate as in men.

Gynecological problems can be early signs of HIV infection. The appearance of ulcers in the vagina, persistent yeast infections and severe pelvic inflammatory disease can be signs of HIV. These vaginal problems can also be caused by hormone changes, contraceptive pills or antibiotics. See your health care provider to find out the cause.

Women get more and different side effects than men. Women are more likely than men to get skin rashes and liver problems and experience body shape changes (lipodystrophy). They also have more problems caused by human papillomavirus (HPV). Problems caused by HPV do not disappear with the use of antiretroviral therapy (ART).

Besides having to deal with their health and work, many women are fulltime mothers. This may make it difficult to take medications or organize medical appointments. However, with adequate support, women respond well to HIV treatment.

Research in Women

In 1997, the Food and Drug Administration (FDA) decided that women could no longer be excluded from clinical trials just because they could get pregnant. The percentage of women in AIDS-related research is increasing but is still quite low.

At the beginning of the 1990s, two research studies relating to women and HIV began. The WIHS study recruited 2066 HIV-positive and 575 HIV-negative women from six places in the United States. The WITS study enrolled HIV-positive pregnant women and their children. Both research studies looked at women living in lowly areas in US cities.

More studies are being planned in HIV-positive women. Pharmaceutical companies are trying to enroll more women in their clinical trials. This is necessary because women are badly represented in most medical research, not just in relation to AIDS. Most drugs have never been studied in women.

Treatments for Women

HIV-positive women should be treated by health care providers who understand that HIV and its treatment can be different in women.

• Women get vaginal infections, genital ulcers, pelvis inflammatory disease and genital warts more frequently than uninfected women.
• Only 1 woman for every 8 men gets Kaposi’s sarcoma, a skin cancer.
• Women get yeast infections in the throat and herpes (a virus that causes lesions in the mouth and genital region) about 30% more frequently than men.
• Women are more likely to develop a severe rash when using nevirapin.
• Women with fat redistribution are more likely than men to accumulate fat on the abdomen or breasts and are less likely to lose fat on the arms and legs.
• HIV-positive women can get abnormal growth related to cervical cancer more frequently and more severely.

In Short

More and more women are becoming infected with HIV. With early diagnosis and treatment, HIV-positive women can live as long as men. Women must learn about how they can become infected and should get tested if they think there is any chance of infection. This is particularly true for pregnant women. If they test positive for HIV, they can take measures to reduce the risk of infecting their baby.

The best way to prevent heterosexual infection is to use male condoms. Other birth control methods do not provide protection against HIV. Women who use intravenous drugs should not share drug-injection instruments.

Women should ask their health care provider about their vaginal problems, especially if they have yeast infections that do not clear up or vaginal ulcers. These may be signs of HIV infection.

Terra