Women & AIDS
Segal, Marian, FDA Consumer
Infections with HIV, the virus that causes AIDS, are rising nearly four times as fast in women as in men. While cases of acquired immune deficiency syndrome among men rose 2.5 percent between 1991 and 1992, the increase among women during the same period was 9.8 percent. Among adults, men with AIDS outnumber women about 8 to 1; in adolescents, the ratio is less than 3 men to 1 woman.
"Although in the United States, women currently represent a relatively small percentage of persons with HIV, they are the most rapidly growing segment of the HIV-infected population in this country," says Janet Arrowsmith-Lowe, M.D., medical officer in FDA's division of antiviral drugs, Center for Drug Evaluation and Research.
The disease disproportionately affects minority women. Although African-American and Hispanic women make up 21 percent of the country's female population, they account for 74 percent of women diagnosed with AIDS. This does not mean that a person is at risk simply because he or she is a member of a racial or ethnic minority group; rather, it reflects the higher numbers of minority populations in communities with a high incidence of HIV infection.
In this country, most women who now have AIDS became infected with HIV by injecting illegal drugs. But the rate of infection through sexual transmission has been rising dramatically. According to the national Centers for Disease Control and Prevention, cases diagnosed in 1992 marked the first time since the start of the epidemic that more women were infected through sex (50 percent) than through drug use (44 percent).
CDC reports that, "Many women in the United States are unaware they are at risk for HIV infection, and HIV-infected women often remain undiagnosed until the onset of AIDS or until a perinatally infected child [infected before or during birth] becomes ill."
What You Don't Know Can Hurt You
"A woman may not know her sex partner uses or has used intravenous drugs or is bisexual or has had at-risk sex partners in the past," Arrowsmith-Lowe explains, "and as a result, doesn't seek testing or treatment. Symptoms that could serve as warning signals may go unheeded."
Delayed diagnosis affects survival. "In fact," says Randolph Wykoff, M.D., director of FDA's Office of AIDS Coordination, "the late diagnosis in women contributed to reports in the past that women's survival time is shorter than men's. It's not. If a woman is diagnosed at the same point in the disease as a man, her survival is, on the average, the same. But most HIV-infected women are from poor populations with poor access to health care, whereas many men with HIV are more affluent gay men from areas with better medical resources.
"Probably the biggest contribution that can be made to the survival of someone with HIV is to get them into early treatment, particularly to prevent PCP," says Wykoff. (PCP, or Pneumocystis carinii pneumonia, is a life-threatening infection commonly seen in people with AIDS.)
Based on experience with the gay male population, it appears that education and awareness are important in stemming the tide of HIV infection. Early in the AIDS epidemic, gay men--who were then the hardest hit group--organized and conducted an extensive education program that proved effective in bringing many gay men into clinics for testing and treatment.
"There hasn't been a commensurate education program for women or other men or for children who are potentially at risk for HIV," Arrowsmith-Lowe says, "although greater efforts have recently been targeted to these groups.
"The effectiveness of similar education interventions among heterosexual and drug-using populations at risk remains to be seen, however," she adds, "because community norms regarding risk behaviors must change if individual behavior is to change, and this may be more difficult to achieve among diverse populations."
Government agencies are working together to step up prevention efforts, improve diagnostic and treatment services, and establish community-based health education and risk-reduction programs for diverse populations, including gay and bisexual men, prostitutes, injection drug users, heterosexuals with multiple sex partners, women at risk, homeless people, and youth in high-risk situations, such as runaways and youngsters in shelters or detention centers. …