In the early years of the epidemic in the United States, AIDS seemed exclusively like a gay men's disease. In the early 1980s, when the disease first appeared, intravenous drug users and men who had sex with men were the primary sufferers. During that time, as many as 3,000 people a week became infected with HIV, the virus that causes AIDS. Most who were getting sick and dying were gay men; they were the ones who most urgently needed protection and treatment.

But the face of AIDS has changed dramatically in the last 25 years. Worldwide, nearly half of the adults now infected with HIVare women. In the U.S., more than 25 percent of people who acquire HIV each year are women. According to the most recent data, more than 120,000 women in the U.S. are living with HIV or AIDS. The illness poses special challenges and risks for women. More than ever, women have to do what they can to avoid the infection and its complications.

HIV -- the human immunodeficiency virus -- is a germ that attacks the immune system. Once a woman has been infected, she and her doctor must discuss treatment options. In some cases a woman may not have enough of the virus in her system to benefit from treatment, and the downside to early treatment is that the side effects can be magnified by starting drug therapy prematurely. If, however, she has a high "viral load" and her disease is untreated, the virus will multiply in her body and destroy the cells that help fight off germs and disease. If enough of these disease-fighting cells die, she'll develop AIDS, a disease that will make her vulnerable to a wide range of infections and cancers, including cervical cancer and non-Hodgkin's lymphoma. In 2005, more than 4,000 women in the U.S. died of AIDS and its complications.

HIV passes from one person to another through body fluids, especially semen and blood. Most women with HIV get the virus in the same way: Having sex with an infected man who wasn't wearing a condom. Women can also get infected by sharing drug needles with an infected person. In the United States, an estimated 17 percent of women with HIV were infected with the virus because of injection drug use, according to the Centers for Disease Control and Prevention (CDC).

It's important to know that HIV is much harder to catch than a cold. You can't get infected by simply standing near someone who has HIV. You won't get infected through hugs, holding hands, or sharing a cup, either. According to the CDC, there are no known cases in the U.S. of a woman who acquired HIV through sex with another woman, although it's theoretically possible.

Any woman who has unprotected sex with a man or men whose HIV status is unknown is at risk. Any woman who shares needles is also a prime target. Although the disease has reached all parts of the country, it hits some communities harder than others. In 2005, the CDC estimated that African American women were diagnosed with HIV at 20 times the rate of white women. Due to poverty and limited access to health care, many of these women often don't get the treatment they need to keep the virus under control, which makes them especially vulnerable to getting full-blown AIDS. In 2005, black women were 24 times more likely than white women to be diagnosed with AIDS. Shockingly, AIDS was the leading cause of death for African American women ages 25 to 34 in 2004.

Women can dramatically reduce their risk of HIV by following one simple rule: Never have sex with a man who isn't wearing a condom. (Although sex with a condom is certainly safer, bear in mind that condoms are not 100 percent perfect. They can break or leak.) The only women who can let the condom rule slide are the ones in a stable relationship with a man who they know FOR SURE doesn't have the infection.

Keep in mind: Unless he's been recently tested for the infection and unless you know that he isn't having sex with anyone else or sharing dirty needles, you can't be sure that he isn't infected. If you can't be certain, be safe. Insist on a condom every time. And keep a few extra in your purse or bedside table in case he forgets his. Women who have unprotected sex and determine after the fact that they may have had a high risk contact should contact their doctors about the possibility of getting post-exposure prophylaxis (drugs that may kill the virus before it takes hold).

Condoms work best with a water-based lubricant, such as K-Y jelly. A lubricant made with oil, such as Vaseline, can weaken the condom and make it tear, and they shouldn't be used. You should avoid using condoms, foams, and other over-the-counter contraceptives that contain nonoxynol-9, an ingredient that kills sperm and helps prevent pregnancy. Too much of this chemical can weaken your body's defenses against HIV. You should also avoid douching since it removes some of the normal vaginal bacteria that protects against infection. Avoid using lambskin or "natural" condoms, because they do not protect against HIV.

Of course, it's never safe to inject drugs not prescribed by your doctor, and it's really not safe to use needles that have already been used by someone else. Even if you manage to avoid HIV, sharing needles is a good way to get hepatitis and other serious diseases.

Before a woman with HIV can get the help she needs, she has to know about her infection. According to the CDC, nearly one out of four women with HIV in the U.S. dooesn't know that she's infected. HIV doesn't cause any symptoms early on, so the only way to know whether or not you have the virus is to get tested at a testing center, health clinic, doctor's office, or hospital.

If you've had unprotected sex with a man even once in your life, you should get tested. If that test comes back negative -- meaning that you don't have the virus -- you can breathe a sigh of relief, but don't let down your guard. You should know that it sometimes takes months for a virus to show up on the test. If you think you may have been infected recently, you should get tested again a few months down the road. And if you ever have unprotected sex again with a man who might be infected, you'll need to be tested yet again. If you have had unprotected sex with a high risk individual in the last day or two, you should contact your doctor immediately to consider whether post-exposure prophylaxis is necessary.

If tests show that you have HIV, eventually you will very likely need to take medications known as antiretroviral drugs to slow down the virus and keep it from causing AIDS. If you've only had the virus for a short time, you may not need to take any medication yet. Your doctor will check you regularly to see how you're doing. If the virus has multiplied or if your immune system shows signs of weakness, it's probably time to start taking medications.

HIV drugs can be tricky to take. You may need to take three or more drugs at once -- a drug "cocktail" -- to really keep the virus under control. If you take antivirals, you take more than one drug, but fortunately many people can take them in combination forms, and there are even some regimens where you just have to take one or two pills once a day). It's vitally important that you take your medications as directed. If you miss too many doses, the virus could stage a comeback and attack your body.

Taking your medications is just one part of living well with HIV. You'll also want to get regular exercise and eat a healthy diet -- steps that will help keep your immune system strong despite the infection. You should also avoid cigarettes or illegal drugs.

If you have HIV, you'll want to protect the people around you. Taking your medications is a good start; as long as the virus is under control, you'll be less likely to spread it to anyone else. Even though you already have HIV, it's still very important to use a condom every time you have sex with a man. If you have a female partner and you are having oral sex, use a latex barrier -- such as a dental dam or a cut-open condom that makes a square. . Although it's much easier for a woman to get HIV from a man than the other way around, you can definitely spread the disease to a man during unprotected sex.

If a pregnant woman with HIV doesn't get proper treatment, there's a one in four chance that she'll pass the virus on to her baby. Fortunately, taking AIDS medications can greatly reduce this risk. Thanks to widespread testing and treatment of pregnant women along with giving their newborns antiretroviral drugs soon after birth, the percentage of babies who are born HIV-positive has dropped from 25 percent to less than 2 percent. The CDC recommends that all women who are pregnant get HIV tested, because the consequences for the baby are so great and so preventable.

Many government programs and advocacy groups actively help women with HIV/AIDS. You may be able to find a program that can help you pay for your AIDS medications or a support group that will help you cope with the disease. Contact your local public health department for information about programs in your area.

-- Chris Woolston, MS, is a contributing editor to Consumer Health Interactive. A former staff writer for Hippocrates magazine, he has written for Health, Prevention, and other journals. He writes The Healthy Skeptic, a biweekly column in the Los Angeles Times. He is also the co-author of Generation Extra Large: Rescuing Our Children from the Epidemic of Obesity (Perseus paperback, 2006).

Further Resources

The Body: HIV/AIDS Resource Center for Women

Provides first-person stories, guides to living with HIV, an art gallery by HIV positive women, ask the experts forums, interviews with clinicians, a news center, and other resources specifically for women. http://www.thebody.com/content/art44411.html

WORLD (Women Organized to Respond to Life-Threatening Disease)

An information and support network for women with HIV/AIDS based in Oakland, California. WORLD features regular support groups, peer advocacy and two retreats yearly for HIV-positive women. http://www.womenhiv.org

Women Alive

An organization by and for women living with HIV/AIDS. The group, which began as a small Los Angeles non-profit and became international in scope, offers support, connection, and information about treatments. http://www.thebody.com/content/art56.html

References

Food and Drug Administration. FDA news release: FDA mandates new warning for nonoxynol 9 OTC contraceptive products. December 18, 2007. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2007/ucm109043.htm

American Academy of Family Physicians. HIV and AIDS: how to reduce your risk. http://familydoctor.org/online/famdocen/home/common/sexinfections/hiv/005.html

Mayo Clinic. HIV/AIDS. http://www.mayoclinic.com/health/hiv-aids/ds00005/dsection=symptoms

Food and Drug Administration. FDA approval of Atripla, 3-drug fixed dose combination antiretroviral. http://www.fda.gov/ForConsumers/ByAudience/ForPatientAdvocates/HIVandAIDSActivities/ucm124444.htm

Centers for Disease Control and Prevention. One test two lives. http://www.cdc.gov/hiv/topics/perinatal/1test2lives/

First published July 3, 2009
Copyright © 2009 Consumer Health Interactive

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