Women and HIV

A Look at the Numbers

Over 25 years have passed since the first diagnosis of AIDS in America. While there were a handful of women among the first cases, AIDS was thought to primarily affect gay men. However, as the years passed, women have emerged as another group hard hit by the AIDS epidemic. Even though more men than women still have HIV in the US, women are catching up. In some countries, HIV+ women outnumber HIV+ men.

The proportion of HIV/AIDS cases among women has more than tripled from 8 percent in 1985 to an alarming 27 percent in 2008. That means that about one in four Americans living with HIV are women. HIV has also become the third most-deadly disease for women, behind only cancer and heart disease.

HIV affects both younger and older women. In fact, an increase in HIV diagnoses has been seen in older women (50 and older).

Minority women, especially African-American women, are most affected. HIV/AIDS is the leading cause of death for African-American women aged 25 to 34. Women in African-American and Hispanic communities make up only 25 percent of the US female population, yet accounted for 82 percent of all female HIV/AIDS cases in the US in 2006.

Heterosexual sex is the most common mode of transmission among women in the US. Nearly three quarters of HIV+ women contracted the virus through sex with an HIV+ man. Heterosexual sex is also the main source of HIV transmission for women in many other countries in Africa, South America, and Western Europe. Sharing HIV-contaminated syringes for injecting drugs is another frequent mode of transmission.

Is HIV Different for Men and Women?

Until recent years, little research had been done on women and HIV. While many questions remain unanswered, available information shows that HIV affects men and women differently in some ways:

• When women are first diagnosed, they tend to have lower viral loads (amount of HIV in the blood) compared to men who are newly diagnosed
• Women generally have a faster disease progression, and lower CD4 cell counts, than men with equivalent viral loads
• Women are more likely than men to develop bacterial pneumonia
• Women have higher rates of herpes infections than men
• Women get thrush (a yeast infection) in their throats more often than men
• Men are eight times more likely than women to develop Kaposi’s sarcoma or KS (a cancer-like disease caused by a herpes virus)

Women tend to be diagnosed with HIV later in their disease than men and fewer women than men are getting HIV treatment. This can have a negative impact on women’s health. Women may postpone medical care and treatment due to a number of barriers including:

• Limited access to health care due to lack of insurance and/or transportation
• Unstable housing
• Fear of partner (domestic) violence
• Other responsibilities such as child care or caring for a sick partner
• The stigma associated with HIV
• Active substance abuse
• Depression
• Lack of financial resources and/or social supports
• Mistrust of the medical establishment

Treatment in HIV+ Women: Efficacy, Side Effects, and Drug Interactions

HIV treatment studies ( clinical trials) have traditionally included very small numbers of women. As a result, most information on the effectiveness and safety of HIV drugs comes from research done in men. This under-representation of women in trials has only recently begun to change.

The good news is that the existing research has found little difference in terms of the effectiveness of HIV treatment. HIV+ women who begin treatment as recommended have been found to do as well as HIV+ men. Although treatment seems to work as well in women, in some cases, the side effects may differ:

Rashes: Researchers say that HIV+ women are more likely than men to experience skin rashes from HIV medications.

Liver problems: Women are more likely to experience liver problems as a medication side effect. In fact, women with a CD4 count above 250 are warned against starting a regimen with Viramune (nevirapine) because of the risk of dangerous liver problems.

Body shape changes: Some studies have found that HIV+ women experience different types of body shape changes than men. Women may experience more fat gain in their breasts and waists.

Weak bones: It is known that women in general are at increased risk of developing osteoporosis (weak bones) after menopause, but studies have also shown that HIV infection increases a person’s risk of losing bone mineral density. This places both HIV+ men and women at increased risk of osteoporosis. However, HIV+ women’s risk for bone weakness is three times higher than HIV+ men’s.

Gender differences in side effects may be due to interactions between HIV therapy and female hormones. It may also be the result of women’s smaller physical size. Standard doses of drugs are usually based upon research done predominantly in men.

This means women, who generally weigh less than men, may get higher amounts of drugs in their bodies than is needed to be effective. This does not mean that HIV+ women should take lower doses of their medications. Until and unless there is proof that women can be treated with lower doses of HIV medications, women should take their medications at the doses currently recommended for all adults living with HIV.

HIV+ women do need to be careful about drug interactions. Certain HIV drugs can affect the levels of other drugs in the body. For example, several HIV drugs can impact the levels of birth control pills.

HIV+ women should be treated by health care providers with experience treating women with HIV. Tell your health care providers about all other medical conditions you have and medications you are taking. If you are experiencing side effects from HIV drugs, be sure to ask your health care provider for help.

Gynecological Issues in HIV+ Women

Certain gynecological conditions are more common, more serious and/or more difficult to treat in HIV+ women than HIV-negative women:

• Some vaginal infections (including yeast infections)
• Bacterial vaginosis
• Common sexually transmitted diseases (STDs), such as gonorrhea, Chlamydia, and trichomoniasis
• Genital herpes
• Pelvic inflammatory disease (PID)

Although little conclusive research is available on HIV and menstruation, many HIV+ women report abnormal menstrual periods. Some have excessive bleeding while others stop menstruating altogether.

Human papillomavirus (HPV) is an STD that causes 99% of cervical cancer and can also cause genital warts. HIV+ women are more likely to be infected with HPV than HIV-negative women. HIV+ women, especially women with advanced HIV disease, are also more likely to develop dysplasia as a result of HPV.

Dysplasia is a pre-cancerous condition. It is often more severe and difficult to treat in HIV+ women than in HIV-negative women. Untreated dysplasia can lead to cervical cancer, a life-threatening illness.

It is very important for HIV+ women to have regular Pap smears. A Pap smear is a screening test your health care provider does to check for changes in the cervix. An abnormal Pap smear can indicate inflammation, infection, dysplasia, or cancer.

HIV+ women are 10 times more likely to have abnormal Pap smears than HIV-negative women. These abnormal Paps are usually associated with low CD4 cell counts and HPV. Girls and women who are 12 – 26 years old should talk to their health care providers about whether they should get the HPV vaccine.

The Centers for Disease Control (CDC) recommends that:

• HIV+ women have a complete gynecological examination, including a Pap smear, when they are first diagnosed and when they first seek prenatal care
• HIV+ women have another Pap six months later
• If both tests are negative, yearly screening is recommended
• Women who have symptomatic HIV infection or who have had dysplasia in the past should receive a Pap smear every six months

Pregnancy and HIV

With the advances in HIV care and treatment, many HIV+ women are living longer, healthier lives. As they think about the future, some of these women are deciding to have the babies they always wanted. HIV+ women who want to be come pregnant should discuss their plans with a health care provider who is very experienced in treating women with HIV.

The good news is that the advances in HIV treatment have also brought down the rate of mother-to-child HIV transmission significantly. If the mother takes appropriate medical precautions, the rate of transmission can be reduced from 25 percent to below 2 percent. In addition, studies have shown that being pregnant will not make HIV progress faster in the mother.

In Conclusion

The numbers of HIV women are growing. This means that all women should be aware of the risk and be tested if there is any possible reason to think they may have been exposed to HIV. If you test negative, you can take steps to stay that way.

If you test positive, you can take step to prevent passing the virus on to others, including during pregnancy. And while there is no cure yet, many HIV+ women are living longer and stronger lives thanks to effective care and treatment.

More research is needed to determine how HIV progresses in women and how HIV drugs affect women’s bodies. However, it does seem that the HIV drugs can benefit women as much as men. By taking advantage of good health care and treatment in a timely fashion, you increase your chances of living a longer and healthier life for you and your loved ones.