Women newly diagnosed with HIV or women that are currently not HIV positive but in a high risk lifestyle category may know that many of the treatment options and preventative measures as well as other aspects of the HIV virus are the same for anybody. What should be known, is that there are differences for women, so education on the basics can help women be responsible to themselves, their partner(s) and potentially their children both now and in the future.
Here are some important differences between women and men when dealing with HIV according to the U.S. Department of Health and Human Services:
-Women often have gynecological conditions as a result of HIV infection. These can include persistent and difficult-to-treat vaginal yeast infections, pelvic inflammatory disease, cervical dysplasia (abnormal cell changes in the cervix), and an increased likelihood of developing cervical cancer.
-Women may have concerns about pregnancy and childbirth--whether for a current pregnancy or for the future. It is best to talk with your HIV specialist about these concerns.
-Women who are diagnosed with HIV should have a Pap smear and a pelvic exam as soon as possible. They should have a follow-up Pap smear 6 months later.
-Women are less likely to develop kaposi's sarcoma, a type of cancer that is a common opportunistic infection and an AIDS-defining condition.
-Women are often diagnosed later in the stages of HIV infection, so they can be more susceptible to opportunistic infections.
-Women often must be stronger advocates for themselves and their treatment when engaged in HIV care. Many times women face multiple barriers to care.
Are You At Risk?
-An estimated 284,500 women were living with HIV at the end of 2012, representing 23% of all Americans living with the virus.
-Of women living with HIV, around 11% do not know they are infected. Of women diagnosed with HIV in 2013, 84% were linked to HIV medical care within 3 months. But only 55% of women living with HIV were retained in care (receiving continuous HIV medical care). Only 39% of women living with HIV at the end of 2012 were prescribed antiretroviral therapy (ART), the medicines used to treat HIV, and only 30% had achieved viral suppression.
-Women made up 19% (8,328) of the estimated 44,073 new HIV diagnoses in the United States in 2014. Of these, 87% (7,242) were attributed to heterosexual sex and 13% (1,045) were attributed to injection drug use.
-New HIV diagnoses declined 40% among all women from 2005 to 2014. They declined 42% among African American women, 35% among Latina women, and 30% among white women.
-Women accounted for 25% (5,168) of the estimated 20,792 AIDS diagnoses among adults and adolescents in 2014 and represent 20% (246,372) of the estimated 1,210,835 cumulative AIDS diagnoses in the United States from the beginning of the epidemic through the end of 2014.
Know some risk factors for acquiring HIV if you are not HIV positive and passing HIV if you are positive:
-Women are more likely to get HIV during vaginal sex than men. These are some reasons why:
-Many HIV-positive women with HIV-negative partners worry about passing HIV. Research shows in the United States, men pass HIV more easily than women do. But women can still pass HIV to uninfected partners — both male and female — through all kinds of sex. This is because HIV is in blood (including menstrual blood), vaginal fluids, and in cells in the vaginal and anal walls.
If you are HIV-positive, you can pass the virus at any time, even if you are getting treatment. But you may be more likely to pass the virus if:
The best way to avoid passing any STI, including HIV, if you do have sex, is to always use a condom every time you have sex.
-It is rare, but it is possible for a woman to get HIV through sexual contact with an HIV-positive woman. Experts think this could happen if soft tissues, such as those in the mouth, come in contact with the vaginal fluid or menstrual blood of a woman infected with HIV. A lesbian or bisexual woman should know her HIV status as well as her partner's. That way, she can take steps to protect herself or others from HIV. You can lower your risk of getting HIV by using condoms every time you have sex with men or when using sex toys. Some suggest using dental dams to lower the risk of getting or spreading HIV through oral sex although, not much research has been done to prove that they are effective.
-Female partners of men who are "on the down low" do not know that their partner is also having sex with one or more men. These women have a higher risk of getting HIV, especially if the male partner had unprotected sex with HIV-positive men.
Get PrEP Educated
The recommendations states that PrEP can reduce HIV infection rates. When taken daily as directed, PrEP can reduce the risk of HIV infection by more than 90 percent.
The guidelines say PrEP should be considered for HIV-uninfected patients with any of the following indications:
-Anyone who is in an ongoing sexual relationship with an HIV-infected partner.
-A gay or bisexual man who has had sex without a condom or has been diagnosed with a sexually transmitted infection within the past six months, and is not in a mutually-monogamous relationship with a partner who recently tested HIV-negative.
-A heterosexual man or woman who does not always use condoms when having sex with partners known to be at risk for HIV (for example, injection drug users or bisexual male partners of unknown HIV status), and is not in a mutually-monogamous relationship with a partner who recently tested HIV-negative.
-Anyone who has, within the past six months, injected illicit drugs and shared equipment or been in a treatment program for injection drug use.
Having A Baby
What is the risk that your child will be born with HIV?
The straight answer: if you live in the United States, less than 2%.
It wasn’t always that way. When a woman who is HIV positive has a baby under normal circumstances, the chances that her child will be born with HIV is roughly 25%—one in four.
But, in 1996, a landmark study known as "ACTG 076" showed it was possible to improve those odds dramatically. In this test, women were given AZT—also known as Retrovir (zidovudine)—starting at 14 to 34 weeks of gestation, and then intravenously during labor. Their baby was then administered AZT for the first six weeks of life.
This procedure dropped the rate of transmission from mother to child to just 8.3%—roughly one in twelve, rather than one in four. A huge improvement!
Since then, it has only gotten better. Currently, there are fewer than 250 infants born each year in the United States with HIV, and in almost every case, it was the result of failure to follow established guidelines—often because the mother was non-compliant because of addiction to drugs.
Here are the procedures that have cut down the rate of mother-to-child transmission of HIV so dramatically:
1. Universal prenatal HIV counseling and testing.
In the United States today, expectant mothers are offered the opportunity to have an HIV test. Obviously, doctors can’t do anything to keep your baby from being born with HIV if they don’t know you have it yourself. So this is the universal first step.
2. Antiretroviral prophylaxis.
This is a fancy way of saying: treating the mother with combination HIV therapy. Studies show that mothers who are taking HIV medications and have an undetectable viral load have a very low risk of passing along HIV to their babies. So doctors will often recommend that expectant women start HIV therapy to protect their babies, even if they don’t yet need it for their own health. The higher your viral load, the greater the chance that you will pass on HIV to your child. The lower your viral load, the lower the danger of transmission.
3. Scheduled Cesarean Delivery.
A C-Section can protect your baby from exposure to your genital tract virus during passage through the birth canal. This is generally recommended for women who have a viral load greater than 1,000. Women who have viral loads below 1,000 have very low rates of infected babies, and a C-section doesn’t seem to make any difference.
4. Avoidance of breastfeeding.
A woman can give HIV to a baby who was born healthy through her breast milk. So, in the United States—where bottle-feeding is a safe and practical alternative—women with HIV (even those on HAART), are advised to avoid breastfeeding their children.
Is there anything else you can do to protect your child? Yes! Give up smoking, drinking and drugs—all of these can have a negative impact on your child. And take vitamins prescribed by your doctor that contain folic acid and calcium, which can reduce the rates of certain birth defects.
Of course, there is no absolute guarantee that you will have a healthy child—not for a woman with HIV or a woman who does not have the virus. But, if you follow your doctor’s orders, the odds are good.
Copyright 2016, Positive Health Publications, Inc.
This magazine is intended to enhance your relationship with your doctor - not replace it! Medical treatments and products should always be discussed with a licensed physician who has experience treating HIV and AIDS!