HIV in Women: Recognizing the Signs

, University of South Florida College of Medicine; , University of South Florida College of Medicine; , James A. Haley Veterans' Hospital; , University of Florida College of Medicine

Disclosures

Social Aspects of HIV in Women

Women with HIV infection may face more actual and perceived barriers to health care access than their male counterparts. The majority of HIV-infected women are from minority groups. Poverty and competing health needs of children have been identified as major obstacles to health care usage. Interviews conducted between 1990 and 1992 with 291 women with AIDS showed that 90% of the women were unemployed, 83% had an annual household income below $10,000, and about 50% had a child younger than 15 years of age. Only 14% of these women were married.^[61] Other factors that may prevent women from disclosing their status or seeking medical care are fear of social isolation and stigmatization, culturally based mistrust of medical care systems, and fear of domestic violence. Addiction to alcohol and drugs is also an important consideration. Clinicians must recognize the critical role of these social factors and strive to intervene in as many areas as possible. A multidisciplinary model of family-centered HIV care that provides health care, psychosocial support, case-management services, and child-care support has been shown to be successful.^[62] The multidisciplinary team should also provide counseling on such issues as nutrition, self-esteem, death, and bereavement.

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Abstract and Introduction
Factors That Facilitate Sexual Transmission to Women
Speed of Disease Progression and Extent of Mortality
Common Opportunistic Infections in Women
Gynecologic Presentation
Social Aspects of HIV in Women
Conclusion
Tables
References
Sidebar: Epidemiology of AIDS Among Women

Sidebar: Epidemiology of AIDS Among Women

In many regions outside the US, the rates of HIV infection among men and women are almost equal. The World Health Organization estimates that in the year 1992 as many as 4.5 million women became infected with HIV.^[1] In 1993, the Global AIDS Policy Coalition estimated that 7.9 million women worldwide were infected with HIV, compared with 9.9 million men. These data translate to a worldwide M:F ratio of 1.25, but in some countries the incidence of HIV infection is higher among women than men. In sub-Saharan Africa, for example, the M:F ratio is 0.89.^[2] The rate of increase of AIDS in women is staggering. In 1985, only 7% of AIDS cases were in adult women. By 1994, women accounted for 18% of reported AIDS cases.^[3] Women of all ages and races are affected, but overall, 84% of AIDS cases in women have been diagnosed in women between 15 and 44 years of age.^[4] African-American women represent the highest proportion (54.6%) of women with AIDS, followed by Caucasian women (24.1%) and Hispanic women (20.5%).^[4] AIDS is currently the leading cause of death among black women between the ages of 25 and 44 and is the third leading cause of death among all women in this age group in the US. In 1994, the death rate attributable to HIV disease for black women aged 25 to 44 years surpassed that of white men in the same age group.^[5]

Heterosexual transmission is the most common mode of HIV transmission for women worldwide and is the fastest-growing category in the US. Heterosexual contact has been identified as the risk factor in over 38% of AIDS cases among women in the US, while injection drug use was the defined risk factor in 39%.^[4] In 21% of AIDS cases among women, no risk factor was reported, but it is felt that past heterosexual encounters account for most of these cases. On re-investigation of more than 5000 female adult and adolescent AIDS cases previously classified as "risk not reported," heterosexual contact was identified as the risk factor in 66%.^[4] In specific populations, such as Hispanics, and in certain locations, such as New York City, heterosexual contact is the major mode of transmission.^[4,6]

Intravenous drug use remains a major risk factor in the US, representing 39% of new cases of AIDS during the period July 1994-June 1995.^[4] In addition to the direct risks associated with intravenous drug use (ie, the inadvertent inoculation of infected blood from contaminated needles), women who abuse drugs frequently place themselves at further risk by engaging in unprotected sex with high-risk male contacts in exchange for drugs or money.^[7,8]

Less commonly, transmission of HIV among women may occur as a result of transfusion of blood products. This was of greater concern before routine screening of the blood supply for HIV was introduced in 1985. Currently, the risk of transfusion-acquired HIV in the US is estimated to be 1 in 493,000 units of blood transfused.^[9] In underdeveloped regions of the world, however, transmission from unscreened blood products and unsterilized medical instruments continues to be a significant mode of HIV transmission.

References

Anastos K, Greenblatt R: Clinical update: HIV in women: Epidemiology and natural history. HIV: Advances in Research and Therapy 4:11-20, 1994.
AIDS in the World. Boston, Global AIDS Policy Coalition, 1993.
Centers for Disease Control and Prevention. Update: AIDS among women--United States, 1994. MMWR 44:81-84, 1995.
Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report 7:1-34, 1995.
Centers for Disease Control and Prevention. Update: Mortality attributable to HIV infection among persons aged 25-44 years--United States, 1994. MMWR 45:121-125, 1996.
Pennisi E: AIDS becomes more of an equal opportunity epidemic: As HIV infection rates soar in women, experts focus on understanding and treating AIDS in this population. ASM News 61:236-240, 1995.
Brown LS, Primm BJ: Sexual contacts of intravenous drug abusers: Implications for the next spread of the AIDS epidemic. J Natl Med Assoc 80:651-656, 1988.
Melnick SL, Sherer R, Louis TA, et al: Survival and disease progression according to gender of patients with HIV infection: The Terry Beirn Community Programs for Clinical Research on AIDS. JAMA 272:1915-1921, 1994.
Schreiber GB, Busch MP, Kleinman SH, et al: The risk of transfusion-transmitted viral infections. N Engl J Med 334:1685-1690, 1996.

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