(By Marian Segal FDA Consumer) 

Infections with HIV, the virus that causes AIDS, have been rising faster in women than in men. The percentage of female infected adults and adolescents increased steadily, from 7 percent in 1985 to 18 percent in 1995. And although total deaths from AIDS declined by 12 percent overall in the first half of 1996, deaths among women with AIDS rose by 3 percent during the same period. 

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 about 75 percent of women diagnosed with AIDS. This does not mean that a person is at risk simply by being 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 heterosexual transmission has been rising dramatically. Of 13,996 women whose AIDS cases were reported between July 1995 and June 1996, 36 percent were infected through injection drug use and 40 percent through sex. 

What You Don't Know Can Hurt You

A woman may not realize she is at risk for HIV. For example, she 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. She may disregard symptoms that could serve as warning signals and therefore, not seek testing or treatment. 

"Delayed diagnosis affects survival," says Theresa Toigo, associate commissioner for the Office of Special Health Issues in the Food and Drug Administration. "The late diagnosis of women has contributed to past reports 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," says Toigo. 

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. 

Other illnesses and infections in women that should prompt concern about possible HIV infection include pelvic inflammatory disease (PID), cervical dysplasia (precancerous changes in the cervix), yeast infections of the mouth and throat, and any sexually transmitted disease, such as genital ulcers and warts and herpes infection. 

Treatment

Available data suggest that drugs used to treat HIV work similarly in men and women. These drugs are usually grouped by the way they fight the virus.

Data that became available in 1996 has given new hope to people with HIV infection. For the first time, combinations of new and older agents and the availability of the newer monitoring techniques have demonstrated that therapies can dramatically reduce the amount of virus measurable in the blood. This is often associated with improved health.

prevention

Armed with knowledge about risks and prevention, women can do much to protect themselves from HIV infection. According to CDC, as of December 1995, about half of all reported cases of AIDS in adult and adolescent women were due to injection drug use, and about another third resulted from heterosexual transmission. Transfusion of blood or blood products accounted for another 5 percent. 

The risk of transmission of HIV from transfused blood has been substantially reduced since 1985, due to the HIV-1 antibody and antigen test kits to screen blood donors for HIV-1. Antigens, which are the virus' own proteins, can be detected about a week earlier than antibodies. In addition, blood products used to treat hemophilia have been treated with cryoprecipitate. 

The most important risks for women are using injection drugs, having unprotected sex with someone who uses or has used injection drugs, and having unprotected sex with a man who has had sex with another man. Having multiple sex partners also increases risk of infection. 

Safer Sex

In the United States, the odds of a woman becoming infected from a man are much greater than the reverse. In one recent study of 379 couples, researchers found a 1 percent rate of female-to-male transmission of HIV, compared with a 20 percent rate of male-to-female transmission. 

"The surest way to protect yourself against HIV infection and other STDs is not to have sex at all, or to have sex only with one steady, uninfected partner," states the Surgeon General's 1993 report on HIV infection and AIDS. The following advice for women who are not in such a relationship and engage in sex:

The man must wear a condom every time you have sex, whether it's vaginal, anal or oral, and must use it properly.

Even women infected with HIV should have their partners use a condom to protect themselves from infection by other sexually transmitted viruses or bacteria and to help protect against infection from another strain of HIV. Many researchers believe that infections with more than one strain of HIV may lead to more rapid progression of disease or to introduction of resistant forms of the virus. 

Do not rely on other forms of contraception for protection against HIV. 

In April 1993, FDA announced that birth control pills, implantable contraceptives such as Norplant, injectable contraceptives such as Depo-Provera, IUDs, and natural membrane condoms must carry labeling that states these products are intended to prevent pregnancy but do not protect against HIV infection and other STDs. FDA has approved the marketing of male condoms made of polyurethane as effective in preventing STDs, including HIV. The polyurethane condom is an alternative for individuals allergic to latex. 

The Reality Female Condom, made from polyurethane, may afford some protection against STDs, but it is not as effective as latex condoms for men. In approving the device, FDA required the labeling to indicate that for "highly effective protection" against STDs, it is important to use latex condoms for men. The male and female condom cannot be used at the same time. If used together, both products will not stay in place. 

In addition, there is no evidence that diaphragms, or spermicides protect against HIV transmission. 

Drug Use

If you use illegal drugs, try to get treatment to help you stop.

If you can't stop injecting illegal drugs, never share your equipment with anyone or reuse equipment used by someone else. HIV may be found in any equipment used to inject drugs, including needles, syringes, cotton, and "cookers" (containers used to mix and heat drugs for injection).

If you share or reuse injection equipment, clean and disinfect it between uses by flushing needles and syringes with water until they are visibly clear of blood and debris and then completely filling the equipment several times with full-strength household bleach. The longer the syringe is full of fresh bleach, the more likely the virus will be killed. (Some suggest the syringe should be full of bleach for at least 30 seconds.) After each bleach filling, rinse the syringe and needle several times by filling with clean water. 

Mother and Child -- the HIV Connection

According to the Surgeon General's 1993 report on HIV infection and AIDS, about 1 in 4 of babies born to HIV-infected women at that time became infected before or during birth. Scientists have been trying for some time to discover what influences whether or not a child will be affected. 

No one is certain when viral transmission occurs. Possibilities include: during childbirth, from exposure to maternal blood or vaginal fluids; or earlier in pregnancy, when there may be a mixing of blood or passage of the virus across the placental wall. 

Apart from the timing of transmission, studies suggest that the likelihood of the child becoming infected may correlate with the mother's health during the pregnancy or birth. In the June 9, 1993, Journal of the American Medical Association, Michael E. St. Louis, M.D., and his colleagues reported that a baby is more likely to become infected if the mother is in the very earliest stage of infection (when the virus is thought to be abundant) or in an advanced stage of disease, or if the membrane surrounding the placenta is inflamed. 

A child can also become infected after birth through breast-feeding

The national Centers for Disease Control and Prevention had received reports of more than 6,000 cases of AIDS in children infected before or during birth or through breast-feeding, as of Dec. 31, 1995. Not surprisingly, experts predict that as more women of childbearing age become infected, the number of infected children will also rise. A disturbing prospect under any circumstances, the significance of this projection is most poignant for minorities in New York City, where AIDS is already the leading cause of death in Hispanic children 1 to 4 years of age and the second leading cause of death for African American children of the same ages.