By Dr Deryck Pattron, Ph.D.

WOMEN AND HIV

Significance Of HIV And Women?
In the United States the number of reported cases of AIDS in women increased steadily from 1985 to 2002. It is now estimated that 53% of women are infected through heterosexual relationships. About 29 % of women are infected with AIDS through drug use. The highest rates of AIDS among women are found in the Southeast and the Northeast United States.

What Do Women Need to Know About HIV?
Women are at risk for HIV infection. Many women think AIDS is a disease of gay men. But women get HIV from sharing needles and from heterosexual sex.


During sex, HIV is transmitted from men to women much more easily than from women to men. A woman's risk of infection is higher with anal intercourse, or if she has a vaginal disease. The risk of infection is higher if your 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. Having male sex partners use a condom every time or reduce the number of sex partners to just one can lower the chance of HIV infection. Female condoms provide some protection, but not as much as a male condom. Other forms of birth control, such as birth control pills, diaphragms, or implants do not provide protection against HIV. There is not yet any cream or gel that women can use to prevent HIV infection (microbicide). However, many scientists are working to develop one.


Get tested if you think you were exposed to HIV. Many women don't find out they have HIV until they become ill or get tested during pregnancy. If women don't get tested for HIV, they seem to get sick and die faster than men. But if they get tested and treated, they live as long as men.

Viral loads are lower in women. Women tend to have lower viral loads during the first few years of HIV infection. Treatment guidelines suggest considering this for recently infected women with T-cell counts over 350. However, HIV disease proceeds at the same rate as for men.

Gynecological problems can be early signs of HIV infection. Ulcers in the vagina, persistent yeast infections and severe pelvic inflammatory disease can be signs of HIV. Hormone changes, birth control pills, or antibiotics can also cause these vaginal problems. See your doctor to make sure you know the cause.

Women get more and different side effects than men. Women are more likely to get skin rashes and liver problems and to experience body shape changes (lipodystrophy), than men. They also have more problems caused by human papillomavirus or H PV.

Many women are full-time parents in addition to dealing with their health and employment. This can make it more difficult to take medications and schedule medical appointments. With proper support, however, women do very well on HIV treatment.

Women Infected With HIV And HIV Research
Women have been under-represented in most medical research including HIV/AIDS. Most medications have never been specifically tested in women. In 1997 the United States Food and Drug Administration said that more women should be allowed and encouraged to participate in clinical trials. Pregnancy should not be used as a limiting criterion to keep women out of HIV/AIDS research. At present the proportion of women in HIV/AIDS research studies is increasing but is still quite low.

In the early 1990s, two research projects started to study women living with HIV/AIDS from six inner cities in the United States. These research projects included: (1) The Women's Interagency HIV Study (WIHS) recruited 2066 HIV-positive and 575 HIV-negative women; and (2) The Women and Infants Transmission Studies (WITS) enrolled HIV-infected pregnant women and their children. More studies of women with HIV are underway. Pharmaceutical companies are trying to enroll more women into their clinical trials.

Treatment For Women
Women with HIV should be treated by medical practitioners who have a thorough understand of HIV disease and its management for women. Medical practitioners should be aware of the following:

Women get vaginal infections, genital ulcers, pelvic inflammatory disease and genital warts more often and in most cases more severely than uninfected women.

Only 1 woman gets Kaposi's sarcoma, a skin cancer, for every 8 men who get it.

Women get thrush, a fungal infection, in their throats and herpes, a virus that causes cold sores and genital herpes about 30% more often than men.

Women are much more likely than men to get a severe rash when using nevirapine.

Women with fat redistribution on lipodystrophy are more likely than men to accumulate fat in the abdomen or breast areas and are less likely to loose fat in the arms or legs.

Unusual growths related to cervical cancer are more frequent and more severe in women who are HIV-positive.
More women are becoming infected with HIV/AIDS. Early testing and treatment, women with HIV can live as long as men. Women need to know more about how they can be infected, and should get tested for HIV if they think there is any chance they have been exposed.

This is especially true for pregnant women. If they test positive for HIV, they can take steps to reduce the risk of infecting their babies.

The best way to prevent infection in heterosexual sex is with the male condom. Other birth control methods do not adequately protect against HIV. Women who use intravenous drugs should not share equipment.

Women should discuss vaginal problems with their doctor, especially yeast infections that don't go away or vaginal ulcers or sores. These could be signs of HIV infection.

Tailoring HIV Prevention Programmes to Fit Your Needs
As community-based organizations seek to reduce the number of new HIV infections, it is important to tailor standardized prevention messages and specifically address communities considered hard to reach. Women respond to unique social, economic and political pressures that must be incorporated into HIV prevention programmes. Every approach may be different, but encouraging dialogue between community-based organizations, policy makers and clients will go a long way to reducing HIV infections in increasingly diverse communities.

The challenge of meeting the constant demand for new, innovative and successful HIV prevention strategies can only be addressed through the development of additional HIV prevention models for diverse communities.

What Works In HIV Prevention?
Several models have been developed with the hope of expanding or enhancing HIV/AIDS strategies. This is by no means a comprehensive list of programmes, but rather innovative approaches that may be useful in the prevention of HIV.

Peer Education And Outreach Model
Peer education and outreach programmes have long been the main components of HIV prevention efforts. The prevention model incorporates a number of traditional behavioural theories and models which emphasize the importance of peer groups and role modelling.

Comprehensive Women's Health Promotion Model
This model focuses on individual risk and behavior change and incorporates broader health and social themes and provides support above and beyond the delivery of HIV prevention information. The model focuses on overall health and wellness and attempts to mitigate some of the "extra-individual" factors that make protection against HIV and other sexually transmitted diseases difficult for women. These factors include: the fact that women are often underinsured compared to their male counterparts and that their caregiver responsibilities may make access to health services and information more difficult.

Multifaceted Empowerment Model
This model expands the traditional notion of HIV prevention to incorporate a number of "extra-individual" factors that affect the lives of women, although it does not include direct medical services. By focusing on issues beyond HIV, this model enables women to address the social factors that may cause them to face competing demands that affect their attempts to minimize HIV risk behaviors. Individual feelings of powerlessness in relationships are addressed, but overall leadership, involvement and activism are encouraged to reinforce individual behaviour change. This programme empowers women as architects of their own solutions rather than passive gatherers of information.

Cultural Affirmation Model
This is a comprehensive model that focuses exclusively on women: HIV infection is viewed in a larger context to encourage individuals to change their own behaviour and to become active in improving their local environment. The cultural affirmation model is empowering through positive reinforcement, rather than focusing on risk behaviour and implicitly assigning blame for poor health.
This model incorporates race and ethnicity in HIV prevention because these factors are relevant to everyday life. Targeting both men and women in HIV prevention efforts promotes the idea that men and women share responsibility for protection against HIV infection. While drawing upon common bonds among women, the model also emphasizes the diversity within the community. Open dialogue increases everyone's comfort level and makes HIV prevention more manageable for both men and women.

References
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Centers for Disease Control and Prevention. (2000). HIV/AIDS Surveillance Report. Midyear edition 12(1).
DiClemente, R. and Wingood, G. (1995). A randomized controlled trial of HIV sexual risk-reduction intervention for young African-American women. Journal of the American Medical Association 274(16), 1271-1276.
Hader, S., Smith, D., Moore, J., and Holmberg, S. (2001). HIV infection in women in the United States: Status at the millennium. Journal of the American Medical Association, 284(9), 1186-1192.
Hogan, K. (1998). Gendered visibilities in black women's AIDS narratives. Gendered Epidemic: Representations of Women in the Age of AIDS (pp.185). New York: Routledge.
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About the Author

Dr Pattron is a Public Health Scientist in the Ministry of Health, Trinidad.