Women and
AIDS/HIV
Women and
AIDS/HIV
This area has endless resources and education available. We will attempt to bring you the basics here, followed by book recommendations, then extensive links. Please do investigate the links for thorough information. Before you read this page, I will honestly tell you, sex is mentioned within this guideline. There is absolutely no way to discuss AIDS without mentioning sex.
The Education and Awareness of AIDS/HIV depends on each and everyone of us.
AIDS Kills!
And it does not discriminate!
We as women need to take a stand!
Not only for us women, but also for our children.
Shunning the AIDS Virus will only cause more fatalities!
EDUCATION and SAFE SEX ARE KEY!
I would like to dedicate a page to the memory of those lost to AIDS. If you have a loved one you would like on this page, feel free to email me at:
If you feel this information doesn't affect you, please read this:
WORLDWIDE 30 MILLION PEOPLE ARE INFECTED WITH THE HIV VIRUS.
1 IN EVERY 100 people are infected.
6 PEOPLE ARE INFECTED EVERY MINUTE!
11.7 MILLION PEOPLE WORLDWIDE HAVE DIED AS A RESULT OF AIDS!
According to the Center for Disease Control (CDC), 1 in 92 American men ages 27 - 39 may be HIV infected, that figure for African Americans rises to 1 in 33. The majority of AIDS cases among women occurs between the ages of 30 - 39. For every American that dies of a HIV - related illness, another becomes infected. There is 1 AIDS - related death every 15 minutes, 1 AIDS diagnosis every 9 minutes, and someone is infected every 13 minutes.
Women and AIDS
Women are the fastest growing population with AIDS, with women of color disproportionately affected. In some places, such as New York City, 1 out of 100 women between 25 and 44 years old are infected with HIV. Heterosexual transmission is responsible for the rapid increase in the number of infected women. Identifying women at risk for HIV, offering counseling and testing for HIV, early treatment, and treatment of infected pregnant women to decrease the rate of perinatal transmission of HIV is crucial. The results of Clinical Trial 076 supported the use of zidovudine after the first trimester of pregnancy, during labor and birth and for the neonate for the first six weeks of life. HIV-infected women need early care and treatment to avoid opportunistic infections.
Overview of HIV/AIDS
HIV/AIDS was first described as an infectious disease in the early 1980s. What little was known of the virus could be disseminated in a short amount of space and time. By now, research pertaining to HIV and its many opportunistic infections has clearly advanced the cause of science as well as provided more effective treatments for persons with HIV. Although there have been many attempts at vaccine development, and many more are currently in clinical trials, there is no vaccine or treatment that protect s those who are uninfected. Weekly, researchers produce information including treatment strategies that can lead to longer, healthier life. The ability to access information about these treatments is critical for people living with HIV, their caregivers, and the information specialists on whom they rely.
HIV/AIDS
The virus that causes Acquired Immune Deficiency Syndrome (AIDS), is the Human Immunodeficiency Virus (HIV). This retrovirus primarily attacks the body's immune system by infecting CD4 cells (helper T white blood cells that are important in fighting in fections) and macrophages (a large mononuclear cell that ingests degenerated cells and blood tissue, removing damaged or aging red blood cells from circulation). Ultimately the infected person's immune system is overcome by the rapid replication of the HIV virus. This leads, in turn, to infections from fungal, bacterial, viral and parasitic sources, as well as to many types of cancer. The presence of one or more specific types of infection or cancer, and/or a CD4 cell count of 200 or less constitutes the Center for Disease Control's (CDC) definition of AIDS. Current clinical management includes using HIV viral load measurements as the primary means of determining disease progression and CD4 counts as an adjunctive means. The progress to AIDS can be slowed and/or temporarily halted by use of combinations of HIV-specific drugs that fight the virus by slowing down or preventing viral replication. The goal of all anti-HIV treatment is for those infected to remain healthier, feel well and live much longer. There is, however, no cure for HIV yet.
The HIV infection phase of the virus is symptom free and may last for as little as two years in some individuals, to as many as 15 years in others. During this phase, the immune system continues to function; however, the HIV virus replicates itself wit h billions of new HIV virus cells in the body each day. In response, the body produces billions of cells each day to fight the virus.
HIV infection is becoming a chronic illness. This is due to the development of new antiviral drugs. These antiviral drugs, when used in a variety of combinations, can lower viral load, eradicate symptoms, and improve quality and length of life for infe cted persons. New ways of measuring disease progression through viral load tests point the way to how the drug regimens are working. Viral load testing measures viral bRNA, reporting the results in number of copies of the virus. Reduction of viral load is reported by logarithmic increments; the lowest amount of virus is said to be undetectable. New and better treatments of opportunistic infections have also improved quality of life for persons with HIV/AIDS. The U.S. Department of Health and Human Services released guidelines for prevention of opportunistic infections in June 1997 (See ftp://ftp.cdc.gov/pub/Publications/mmwr/rr/rr4611.pdf) More importantly, guidelines for the Treatment of HIV Infection were published by the NIH in June 1997. (See http://www.nih.gov/news/pr/jun97/niaid-19.htm.) These policies and guidelines assist clinicians in understanding and using viral load measures, and a variety of complicated antiviral drug regimens.
AIDS
Eventually a person with HIV progresses to an AIDS diagnosis -- when the HIV virus has caused severe damage to the immune system and the T-cell count falls below a normal level, according to the CDC definition. For many, the progression from HIV infect ion to AIDS is significantly slowed or halted temporarily with HEART. Some people, however, cannot tolerate the drug regimens, do not have insurance to pay for these expensive drugs, or the HIV infection may progress in spite of treatment. Scientists are beginning to better understand how HIV infection can progress at different rates in different people, but there is not a simple explanation at this time.
Drug Therapy
There are three kinds of drugs used to treat HIV infection: nucleoside analogues; non-nucleoside analogs and protease inhibitors. Protease inhibitors, the newest class of drugs, slow the replication of HIV in the body. They are frequently used in combi nation with other drugs to reduce the amount of virus in the blood and to increase the level of T4 cells. Combining more than one drug in therapy is known as combination therapy, and the use of more than one drug therapy is commonly called a "cocktail." Combination therapy has become the standard of care for HIV infection; however, the best time to start this therapy is not yet known. The decision to begin combination therapy is usually based on several factors. These factors include which combination has the best chance of reducing the amount of HIV in the body for the longest time, and which combination will increase the T4 cell count or stabilize the count. Other considerations are the options available if combination therapy stops working; possible side effects; and, what symptoms currently exist. ["Combination Therapy," AIDS Treatment Data Network (September 1996): 1.] http://204.179.124.69/network/trs/22.html#protease. A new test called the viral load test measures how well anti-HIV drug therapy is working. Fact sheets on individual anti-HIV drugs and information about the viral load tests may be received, free of charge, from the AIDS Treatment Data Network by calling 1-800-734-7104.
Great Books to read:
Positively Women: Living With AIDS
Published 1996
Sue O'Sullivan, Editor. A collection of essays on socio-political aspects of AIDS in women.
Until The Cure: Caring For Women With HIV
Published 1994
A collection of expert articles covering law, medicine, nursing, public health, social work, ethics, and psychiatry. Includes personal accounts from women living with HIV. The aim of the book is to improve the quality of care provided to women.
Recovering from the Loss of a Loved One to AIDS
Help for Surviving Family, Friends, and Lovers Who Grieve
By Katherine Fair Donnelly
Reprint Edition
Paperback
Published by Fawcett Books
Publication date: June 1, 1995
LINKS:
National Aids Hotlines, state by state
1-800-342-2437 (24 hours a day, daily)
TTY/TDD: 800-243-7889
English Hotline: 800-342-AIDS
Spanish Hotline: 800-344-SIDA
International line: 301-217-0023
HIV/AIDS Internet Discussion groups and mailing lists
The Largest HIV/AIDS Knowledge Base on the internet
National prevention Information Network
The Journal of American Medical Association
AVERT: Aids Education and Research Trust
The American Foundation For Aids Research
Mothers Voices, A Must visit site for mothers!
Are women at risk?
Yes. In 1997, women comprised 22% of all AIDS cases in the US. Heterosexual contact is the leading risk exposure category for all women (38%), and 29% of those are due to sex with an injection drug user (IDU). Injection drug use accounts for 32% of all cases. 1 The majority of women who have sex with women (WSW) acquired HIV via drug use or sex with a man, although a few women have been identified infected via same-sex contact.
Women are one of the fastest growing populations being infected with HIV, and the number of AIDS cases among women increases steadily each year. Women under 30 made up 22% of AIDS cases among women in 1996. Because the time from HIV infection to developing AIDS can be long, many of these women acquired HIV in their teens. 2
African American and Hispanic women have been disproportionately affected by AIDS. AIDS rates for African American and Hispanic women are 17 and 6 times higher than for white women. In 1997, African American women made up 60% of all female AIDS cases, Hispanics 20% and Whites 19%. 1
What places women at risk?
Male-to-female transmission is estimated to be eight times more likely than female-to-male; 3 in 1997, 38% of women contracted HIV through heterosexual contact, as opposed to 7% of men. Reasons for this are twofold: there are more men than women in the US infected with HIV, which increases the likelihood that women would have an infected sex partner; and HIV is more easily transmitted from men to women due to the greater exposed surface area in the female genital tract. 1
Sexually transmitted diseases (STDs) other than HIV can increase the risk of new HIV infections at least two to five times. Genital ulcers and immune response associated with STDs make it easier for HIV to enter the body. There are an estimated 12 million new cases of STDs every year, and populations at highest risk for HIV infection also have disproportionately high rates of other STDs. 4 Treatment of STDs can be an effective HIV prevention strategy.
Injection and non-injection drug use puts women at increased risk for HIV infection and is strongly linked to unsafe sex. In one study, female IDUs reported sharing needles 32% of the time, and obtained used needles from their regular sex partner 71% of the time. 5 Women who smoke crack cocaine, particularly women who have sex in exchange for money or drugs, are at high risk for HIV infection via sexual transmission. 6
Sexual abuse and coercion places many women at risk. In one study, physical and sexual abuse were "disturbingly common" throughout life among women at high risk for HIV infection. Childhood sexual abuse (42%) and physical abuse (42%) was also common. Women who have been abused are more likely to use crack cocaine and have multiple sex partners. 7 Public health agencies need to raise public awareness about sexual abuse and coercion and help women and men develop the skills needed to prevent it.
What are barriers to prevention?
Women do not wear the condom. For women to protect themselves from HIV infection, they must not only rely on their own skills, attitudes, and behaviors regarding condom use, but also on their ability to convince their partner to use a condom. Gender, culture and power may be barriers to maintaining safer sex practices with a primary partner. HIV prevention strategies must target both women and men in heterosexual couples and address gender norms in sexual decision-making. 8
Women are disproportionately represented among the poor. Because of this, women are less likely to have health insurance and access to health care services. Many minority women living in poverty are also disproportionately affected by HIV. For these women, the struggle for daily survival may take precedence over concerns about HIV infection, whose impact may not be seen for several years. 9
Like many people in committed relationships, women may find intimacy in their relationship to be more important than protection against HIV. Unsafe sex may be linked to emotional and social (not necessarily financial) dependence on men. The ideal of monogamy, including assuming their partner's fidelity, may increase AIDS risk denial. 10
What are the methods for protection?
Women are more likely to protect themselves from pregnancy using methods that do not depend on partner cooperation, such as oral contraceptives. However, oral contraceptives like the pill do not protect against STDs and HIV. Female-controlled methods to prevent HIV transmission are needed. Traditionally, abstinence, condoms and dental dams have been the main methods of protection. In 1993, Reality®, a female condom, was introduced on the market but to date, results have been mixed as to its efficacy, affordability and interest in use.
Vaginal microbicides that would prevent STD transmission but allow for pregnancy have been developed and piloted in some prevention programs. Further efforts need to include large-scale efficacy trials and to increase scientific interest and support from pharmaceutical companies to develop microbicides that prevent HIV infection. 11
What is being done?
Recruiting women as community leaders was the basis for an effective HIV prevention program among low-income urban women living in housing developments. Women opinion leaders were trained to lead risk reduction workshops, provide HIV educational materials and condoms, and conduct HIV education through community events. The women effectively mobilized their residential community through tailored prevention messages and activities. 12
Because women at risk are not always visible as a specific population or community, programs must strive to be where women are. A program provided HIV prevention services for women visiting their incarcerated male partners at San Quentin State Prison. The program, based at the visitor's center, trains women visitors as HIV educators, and the educators provide group and individual peer education. The program is low cost and has been well-accepted by visitors and by the prison. 13
Interventions that promote HIV counseling and testing for both members of a couple should be considered. The California Partner Study provided couple counseling in combination with social support to serodiscordant heterosexual couples (where one partner is HIV positive and the other HIV negative). As a result, condom use increased and no new HIV infections were reported among the couples. 14
Most drug treatment programs are staffed by men and oriented towards male clients. Allowing pregnant women to enroll in drug treatment, and allowing women to bring children with them would be helpful. In San Francisco, CA, a women-only needle exchange program was well accepted and used by female drug users. The number of needles exchanged and number of visits was similar between women who attended the women-only exchange versus mixed gender exchanges. However, women who visited the women-only exchange were more likely to receive health care and to receive additional health promotion services such as food, vitamins, coupons and clothing. 15
What needs to be done?
Because women are more likely to be infected by men, and AIDS cases due to heterosexual contact are increasing, programs that specifically target men (especially IDUs) will have a beneficial impact on women. Needle exchange and drug treatment are important strategies, since almost half of all infections in women are due to injection drug use. Encouraging women to seek STD diagnosis and treatment should also be a part of effective HIV prevention strategies.
More research needs to be done on modes of HIV transmission and risks for women, including woman-to-woman transmission. Innovative, women-specific interventions need to be evaluated. A comprehensive HIV prevention strategy uses many elements to protect as many people at risk for HIV as possible. Interventions that address sexuality, family, culture, empowerment, self-esteem and negotiating skills, as well as interventions located in varying community settings are especially important.
Says who?
1. CDC. HIV/AIDS Surveillance Report. 1998;9:10.
2. CDC. Update-HIV/AIDS and women in the United States. Fact sheet prepared by the CDC. July 1997.
3. Padian NS, Shiboski SC, Glass SO, et al. Heterosexual transmission of human immunodeficiency virus (HIV) in Northern California: Results from a ten-year study. American Journal of Epidemiology. 1997;146:350-57.
4. Wasserheit JN. Epidemiological synergy. Interrelationships between human immunodeficiency virus infection and other sexually transmitted diseases. Sexually Transmitted Diseases. 1992; 177:167-77.
5. Leonard LE, Baskerville B, Hotz S. Risk factors for needle sharing in women who inject drugs. 11th International Conference on AIDS, Vancouver, British Columbia. 1996. Abstract #TuC2503.
6. Edlin BR, Irwin KL, Faruque S, et.al. Intersecting epidemics: Crack cocaine use and HIV infection among inner-city young adults. New England Journal of Medicine. 1994; 331:1422-7.
7. Vlahov D, Wientge D, Moore J, et al. Violence among women with or at risk for HIV infection. 11th International Conference on AIDS, Vancouver, British Columbia. 1996. Abstract #TuD135.
8. Gomez CA, Marin BV. Gender, culture, and power: Barriers to HIV-prevention strategies for women. The Journal of Sex Research. 1996;33:355-362.
9. Farmer PE, Connors MM, Simmons J., editors. Women, poverty, and AIDS: Sex, drugs, and structural violence. 1996. Common Courage Press, Monroe, ME.
10. Sobo EJ. Choosing unsafe sex: AIDS-risk denial among disadvantaged women. 1995. University of Pennsylvania Press, Philadelphia, PA.
11. Phillips DM. Microbicide development: progress and obstacles. Third Conference on Retroviruses and Opportunisitic Infections. 1996.
12. Coley BI, Sikkema KJ, Perry MJ, et al. The role of women as opinion leaders in a community intervention to reduce HIV risk behavior. National Conference on Women and HIV, Pasadena, CA. 1997; Abstract #206.3.
Contact: Brenda Coley 414/456-7746
13. Collaborative programs in prison HIV prevention.
Contact: Barry Zack, Centerforce, Health Programs Division, San Quentin, CA: 415/456-9980.
14. Padian NS, O'Brien YR, Chang Y, et al. Prevention of heterosexual transmission of human immunodeficiency virus through couple counseling. Journal of Acquired Immune Deficiency Syndrome. 1993;6:1043-1048.
15. Lum PJ, Guydish JR, Brown E, et al. An innovative needle exchange program exclusively for women is well accepted by female injection drug users in San Francisco. International Conference on AIDS, Geneva, Switzerland. 1998. Abstract #43261.
Contact: Paula Lum (415) 597-4965.