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% in 1985 to an alarming 26% in 2008. In 2008, The United States Centers for Disease Control and Prevention (CDC) estimates that approximately 280,000 women were living with HIV/AIDS in the U.S.

However, women remain undiagnosed, or not in care, and UNAIDS estimates that between 14.2 and 16.9 million women were living with HIV worldwide in 2007, accounting for half of the estimated 33 million HIV-positive people.

HIV has hit the African-American and Hispanic communities particularly hard. Women in these communities make up a combined 25% of the U.S. female population, yet accounted for 82% of all female HIV/AIDS cases in the U.S. in 2006.  An increase in HIV diagnoses has also been seen in older women (45 and older.)

For women in the U. S., high-risk heterosexual contact is clearly the most prevalent mode of transmission: 32% of new HIV infections in the U. S. are acquired through heterosexual contact, while 18% of those newly infected were exposed through injection drug use.  Heterosexual intercourse is also the primary source of HIV transmission for women in many other countries in Africa, South America, and Western Europe.

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

• When women are first diagnosed, they tend to have lower concentrations of HIV in their blood (lower viral loads) 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 may have higher rates of herpes simplex infection 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)

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 their disease than men. In addition, once they know their status, up to 25% 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 from HIV drugs, 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 women living with HIV (HIV+) 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 little conclusive research is available on HIV 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 causes 99% of cervical cancer and can also cause genital warts. Girls and women who are 12 - 26 years old should talk to their doctors 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 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

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+ positive women who want to be come pregnant should discuss their plans with a doctor 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. For more info, click here.

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 ongoing 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.