U.S. Women Accounting for Higher Percentage of AIDS Cases, Particularly in South, Among Minorities
Women are accounting for a higher percentage of all AIDS cases in the United States, up from 6.7% in 1986 to 18% in 1999, and by 1999 represented 32% of new HIV diagnoses, a study published in the March 7 issue of the Journal of the American Medical Association reports. Researchers from the CDC's National Center for HIV, STD, and TB Prevention examined the changing epidemiology and social implications of the disease by reviewing data from journal articles from January 1981 through July 2000 and scientific conference presentations from January 1999 through July 2000. By analyzing surveillance and prospective-cohort studies including at least 20 women, Dr. Shannon Hader and colleagues ascertained that by the end of 1998, 38% of newly reported AIDS cases in women had acquired HIV through heterosexual intercourse. However, many women had no identified or reported risk factor for contracting the virus, so researchers "estimated that a total of at least 54% of women newly reported with AIDS in 1998 acquired HIV through heterosexual sex." In addition, 61% of these cases were reported among black women. In 1998, AIDS was the fifth leading cause of death among U.S. women between the ages of 25 and 44 -- up from the sixth leading cause in 1990 -- and the third leading cause of death for black women in this age group. Black and Hispanic women are "disproportionately" affected by HIV, accounting for nearly 75% of all HIV infections among women ages 13 to 24. Younger women are also at a higher risk for contracting HIV, as 26% to 50% of all heterosexual HIV transmission occurs in teens or those in their early 20s.
While the AIDS epidemic in U.S. women orginally began among intravenous drug users in the Northeast, it now "centers" on women with heterosexual risk factors in the South, the region reporting some of the highest STD rates in the country. The researchers found that by the end of 1998, 41% of all newly reported AIDS cases among women were in the South, with Texas and Florida contributing half of the Southern cases. In addition, women in rural areas are "increasingly affected" by HIV. For example, in Alabama, the greatest concentration of AIDS cases were in rural areas of the state. Researchers also noted that HIV rates are increasing among Southern and black men, but said that the "overall trends for women are distinct" (Hader et al., JAMA, 3/7). The high incidence of STDs in the region may explain the rapid spread of HIV, infectious disease expert Dr. Myron Cohen told WebMD.com. Being infected with an STD increases the risk of becoming infected with HIV as the body is "more open to accepting the infection," he said (McKeown, WebMD.com, 3/6).
Women Less Likely to Use HIV Therapies
The researchers found that natural history, progression, survival and the occurrence of HIV-associated illnesses, except those of the reproductive system, appeared to be similar between HIV-infected men and women, as did efficacy of antiretroviral therapy. However, women "may be less likely than men to use these therapies," as drug use, risky sexual behaviors, depression and unmet social needs "interfere" with women's use of HIV prevention and medical resources. By 1998, 80% of women with AIDS in surveillance studies took anti-HIV drugs, however women are less likely than men to receive antiretroviral therapy, "perhaps because they are often black, less educated, or injection drug users -- factors associated with lower likelihood of using antiretroviral medications." The report notes that 75% of the women reported taking the drugs as directed or almost as directed. Common reasons for nonadherence to prescribed therapy included a lack of understanding of how to take the pills, forgetting refills, depressed mood, life stress, anxiety and pain. Rates of significant depressive symptoms and adverse life events among HIV-positive women and those at risk for acquiring the virus exceeded 60%. In addition, more women than men lack health insurance, use the emergency room for outpatient care and report poorer physical functioning and barriers to health care. On a positive note, two of the studies that were reviewed showed that HIV-positive women were more than twice as likely as uninfected women to report consistent condom use, especially with uninfected partners. The researchers concluded, "[A]s the third decade of the HIV epidemic begins, continued research on HIV basic science and clinical research leading to advances in care is needed; however, emphasis should also be placed on applying existing knowledge about HIV prevention and treatment in women by enhancing use of available health services and including greater use of antiretroviral therapy options, treating depression and drug use, facilitating educational efforts and providing social support to reduce competing needs that prevent women from taking control of HIV prevention and treatment" (JAMA, 3/7).