For much of the 25 years that
HIV/
AIDS has existed in the United States, the disease was thought to impact mainly gay white men. However, today in the U.S. about 25% of new infections are in women, especially women of color, and 70% of new infections in women occur through heterosexual sex.
Here is a brief review of HIV statistics related to women:
• In 2004, 64% of women living with HIV/AIDS were African American, 19% were white and 15% were Hispanic
• In 2002, HIV/AIDS was the leading cause of death among African-American women ages 25-34, and the sixth leading cause among all women in this age group
• In women who receive
combination HIV therapy during pregnancy, the risk of HIV
transmission to the newborn drops below 2%
Is HIV different for men and women?
Most of the effects of HIV and AIDS are similar for men and women, but there are some biological and social differences. Women are more susceptible to HIV infection through heterosexual sex. Certain
opportunistic infections associated with HIV are unique to women, such as recurrent vaginal yeast infections, severe pelvic inflammatory disease and cervical cancer. Women's responses to HIV therapy may also differ from those of men. Women may have more difficulty accessing health care, due to factors such as lack of transportation or an added responsibility of caring for others, especially children.
Current guidelines about when to start treatment are the same for men and women, and are based on
viral load and
CD4 cell counts. Because of gender differences, some medical experts believe that the guidelines should recommend that women consider starting treatment at lower viral load levels than men. Others argue that no change is required since the overall health outcome is the same. If you are thinking about starting treatment, it is important to keep track of your test results and talk to your healthcare provider about the best treatment plan for you.
Differences in care and treatment
Women tend to be diagnosed with HIV later in the disease than men. In addition, once they know their HIV status, up to 25% of women postpone medical care due to several barriers, including:
- Limited access to health care due to lack of insurance
- Other responsibilities such as child care or caring for a sick partner
- The stigma associated with HIV
- Active substance abuse
- Depression
If women do receive adequate care and treatment in a timely manner, they appear to benefit from HIV medications as much as men. However,
side effects from some HIV treatments are more significant in women than men, including rash. Gender differences in side effects may be due to an interaction between HIV medications and female hormones. It may also be the result of women's smaller physical size, possibly resulting in a higher amount of the medication in the body than is needed to be effective.
If you are experiencing side effects, be sure to discuss them with your healthcare provider. Do not change your dose or stop your medications without first consulting your healthcare provider.
Pregnancy
Another important issue for women with HIV is pregnancy. For an HIV-positive woman who is thinking about having a baby, or is already pregnant, many questions arise. What is the risk of passing HIV to the newborn? Can treatments lower this risk? Are HIV medications safe to take during pregnancy?
In the United States, approximately 25% of pregnant HIV-positive women who do not receive any medications pass the virus to their babies. If women do receive combination HIV therapy during pregnancy, however, the risk of HIV
transmission to the newborn drops below 2%.
For HIV-positive women who are pregnant or are of reproductive age, the U.S. Department of Health and Human Services recommends the following:
- The goals of treatment and the reasons for starting medications should be the same as other adults
- Medications containing efavirenz should be avoided
- Prevention of mother-to-child transmission should be an additional treatment goal during pregnancy
- Choice of treatment to use should take into account the known safety and effectiveness information of each individual medication during pregnancy
Gynecological issues
Certain gynecological conditions are more common, more serious and/or more difficult to treat in HIV-positive women than HIV-negative women:
- Some vaginal infections (including yeast infections)
- Bacterial vaginosis
- Common sexually transmitted diseases (such as gonorrhea, chlamydia and trichomoniasis)
- Herpes simplex virus outbreaks
- Pelvic inflammatory disease (PID)
- Dysplasia, a pre-cancerous condition in the female reproductive system
It is very important for HIV-positive women to have regular pap smears.
A pap smear is a screening test your healthcare provider does to check for changes in the cervix. An abnormal pap smear can indicate inflammation, infection, dysplasia or cancer.
HIV-positive women are 10 times more likely to have abnormal pap smears than HIV-negative women. These abnormal pap smears are usually associated with low CD4 cell counts and human papilloma virus (HPV), a sexually transmitted disease that can also cause genital warts.
The Centers for Disease Control and Prevention (CDC) recommends the following:
- HIV-positive women have a complete gynecological examination, including a pap smear, when they are first diagnosed or when they first seek prenatal care
- HIV-positive women have another pap smear six months later
- If both tests are negative, yearly screening is recommended
- Women who have had dysplasia in the past should receive a pap smear every six months
