Over two and a half decades 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. As the years passed, women began to emerge as the changing face of AIDS. The proportion of HIV and AIDS cases among women has more than tripled from 7 percent in 1985 to an alarming 30% in 2005.  The United States Centers for Disease Control and Prevention (CDC) estimates that there were 127,150 women  living with HIV/AIDS in the US in 2005.

However, women remain undiagnosed, or not in care, and The World Health Organization (WHO) estimates a much higher prevalence of between 300,000 and 500,000 HIV+ women in the U.S. in 2005.  WHO estimates that there were between 15.1 -20.9 million HIV+ women worldwide, accounting for almost half of the estimated 39.5 million HIV+ adults in 2006.

HIV has hit the African-American and Hispanic communities particularly hard. Women in these communities account for over 78 percent of all female AIDS cases in the U.S. There has also been an increase in HIV diagnoses in older women (45 and older.)

For women in America, high-risk heterosexual contact is clearly the most prevalent mode of transmission: 72% of new HIV infections are by heterosexual contact. A further 26% have been exposed through injection drug use.

Until recently, very little research had been done on women and HIV. While many questions remain unanswered, there is some information about how HIV-related illnesses affect men and women differently:

• 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 are more likely than men to develop bacterial pneumonia
• Women may have higher rates of herpes simplex infections than men
• When women are first diagnosed, they tend to have lower concentrations of HIV in their blood (lower viral loads) compared to men. In addition, women tend to have lower CD4 cell counts than men with equal viral loads. Yet women seem to progress to AIDS at the same rate

Trials are currently underway to determine how certain HIV drugs affect women differently than men.  If you are thinking about starting treatment, it is important to watch your lab results and talk to your doctor about the best treatment plan for you.

Women tend to be diagnosed with HIV later in the disease than men. In addition, once they know their status, up to 25 percent of women postpone medical care due to several barriers including:

• Limited access to health care due to lack of insurance
• Unstable housing
• Fear of partner violence
• Other responsibilities such as child care or caring for a sick partner
• The stigma associated with HIV
• Active substance abuse
• Depression

If women do receive adequate care and treatment in a timely manner, they appear to benefit from HIV therapy as much as men. However, side effects from some HIV drugs are more significant in women than men.

Gender differences in side effects may be due to an interaction 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 a woman, who will generally weigh less than a man, may get a higher amount of the drug in her body than is needed to be effective.

If you are experiencing side effects, be sure to ask your doctor for help. Do not change your dose or stop your drugs without speaking to your doctor first!

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 (such as gonorrhea, Chlamydia, and trichomoniasis)
• Herpes simplex virus outbreaks
• Pelvic inflammatory disease (PID)

Although there is little conclusive research regarding HIV+ women and menstruation, many HIV+ women report menstrual irregularities. Some have excessive bleeding while others stop menstruating altogether.

Dysplasia, a pre-cancerous condition in the female reproductive system, is more common in HIV+ women, especially in women with advanced HIV disease. It is often more severe and difficult to treat than in HIV-negative women. Untreated dysplasia often leads 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 doctor 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 countsand human papilloma virus (HPV), a sexually transmitted disease that can also cause genital warts.

The Centers for Disease Control (CDC) recommends that:

• HIV+ women have a complete gynecological examination, including a Pap smear, when they are first diagnosed or 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 6 months

More research is clearly 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 if women access care and treatment in a timely fashion. It is important to get tested for HIV on a regular basis. If the results are positive, it is even more important to seek on-going medical and gynecological care. By taking advantage of good health care and treatment, you increase your chances of living a longer and healthier life for you and your loved ones.

1		Centers for Disease Control and Prevention (2005)Table 18 Reported cases of HIV infection (not AIDS), by age category, transmission category, and sex, 2005 and cumulative—38 states and U.S. dependent areas with confidential name-based HIV infection reporting Retrieved May 2007 from:http://www.cdc.gov/hiv/topics/surveillance/resources/reports/2005report/pdf/2005SurveillanceReport.pdf
2		National Institute of Allergy and Infectious Disease. (2006). HIV infection in women: Retrieved May2007 from http://www.niaid.nih.gov/factsheets/womenhiv.htm.
3		Sterling, T. R. et. al.(2001). Initial plasma HIV-1 RNA levels and progression to AIDS in women and men. New England Journal of Medicine, 344(10). 720-725.
4		World Health Organization UNAIDS(2006)Global summary retrieved may 2007 from   http://www.who.int/hiv/mediacentre/02-Global_Summary_2006_EpiUpdate_eng.pdf