Volume 17, No. 2, Spring 2009
By Jean Talbert, M.D.
The face of the HIV/AIDS epidemic in the United States has changed tremendously since it was first identified in 1981. What was once primarily a disease of men who have sex with men, intravenous drug users and those who had received blood transfusions is now much more diverse.
Women are the fastest growing group and currently account for 25 percent of all new cases. Of the new HIV infections among women, 80 percent were acquired through sexual contact with infected men. The majority of infected women are under age 25 but increasing proportions are being seen in women of all ages, even those over age 60. Many are unaware that they are HIV positive.
Although the number of new cases has declined from its high in the mid eighties, there are still an estimated one million people in this country living with HIV/AIDs, with approximately 45,000 new cases per year. Women of color are at particularly high risk.
Several factors have contributed to the increasing risk of HIV infection in women. Many women are unaware of risk factors in their sexual partners. They may not know that their partner uses IV drugs, has unprotected sex with other partners or has sex with men. Some may be aware of risk factors, but are unable to protect themselves due to fear of abuse or abandonment.
Women also are biologically more vulnerable to HIV transmission through heterosexual contact. They’re twice as likely to contract HIV from an infected male than vice-versa.
Substance abuse is another major risk factor among women. HIV can be transmitted via shared needles, but women who abuse substances also are more likely to engage in risky sexual behavior or exchange sex for drugs and money.
Several different strategies have been promoted to lower the risk of acquiring HIV. Abstaining until you are in a relationship with only one person and knowing their HIV status is the most effective. Latex condoms with lubricants can minimize the transmission of most sexually transmitted infections. Other methods of birth control do not protect against HIV and spermicides containing nonoxynol-9 may actually increase the risk.
Avoidance of illicit drugs is encouraged as HIV and hepatitis are both easily transmitted by shared needles, syringes and other drug paraphernalia.
Early diagnosis and treatment improves long-term survival. It also provides opportunities to learn how to avoid infecting others. Universal screening of pregnant women has been tremendously successful. Treatment is initiated during the pregnancy and the baby is treated postpartum.
The transmission rate is lowered further when pregnant women with measurable HIV counts are delivered by cesarean section before labor and when breastfeeding is avoided. As a result, neonatal infection rates in this country have declined by 95percent.
It is now recommended that everyone between the ages of 13 and 64 be screened at least once for asymptomatic HIV. Testing should be available through any healthcare provider. Independent test sites may be found at www.hivtest.org. Improved screening is the next major step towards ending this epidemic.
(Dr. Talbert is a board certified OB/GYN specialist practicing with Cape Obstetrics, Midwifery & Gynecology in Falmouth and Sandwich, 508-457-0088.)