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Women & HIV
What Positive Women & Women in High-Risk Groups Should Know About HIV.

If you are a woman newly diagnosed with HIV or a woman that is currently not HIV positive but in a high risk lifestyle category you 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 you should know, is that there are differences when you are a woman - some subtle, some not so subtle - so educate yourself on these basics so you can be responsible to yourself, your partner and potentially your children both now and in the future.

Stigma
Jennifer Johnson, MD, MPH for The Well Project stated, "Through studies and anecdotes we know that stigma and discrimination have damaging effects on the health of women and girls. These apply to both women and girls at risk of getting HIV and those already living with it. Across the globe, the lives of women and girls are shaped by a number of gender-based inequalities - social, economic, and political, which may exacerbate HIV-related stigma.  Perhaps the most devastating effects of HIV stigma and discrimination for women are those that result from social rejection and exclusion, which can lead to low self-esteem and depression.

Stigma against HIV/AIDS is also a barrier to testing and treatment. Studies have shown that stigmatizing beliefs and/or fear of stigma keep people from getting tested for HIV, getting linked to or having access to care, staying in care, getting HIV drugs, and taking their HIV drugs correctly."

As HIV treatment advocate Heidi Nass pointed out, “People who get HIV aren’t doing anything differently than most people they know. The only thing that separates you from all the women who’ve had sexual intercourse with a man or shared a needle but didn’t get HIV is that you got HIV.”

Who's At High Risk
According to the Centers for Disease Control and Prevention (CDC) women are at risk of contracting the HIV virus and depending on lifestyle and other issues, some women can be at a very high risk. In a study conducted in 2010, 25% of people 13-years-old and older (1-in-4) diagnosed as being HIV positive are women. African American and Hispanic women are disproportionately affected compared to women of other races and ethnicities. It’s also estimated that 15% of women who are HIV positive are unaware of their status.

Other facts from the CDC 2010 study:

1. Women accounted for an estimated 9,500, or 20%, of the estimated 47,500 new HIV infections in the United States. Most of these (8,000, or 84%) were from heterosexual contact with a person known to have, or to be a high risk for, HIV infection

2. The fourth largest number of all new HIV infections among all people in the United States occurred among African American women with heterosexual contact (5,300 infections).

3. Of the total number of new HIV infections among women in the United States in 2010, 64% occurred in African Americans, 18% were in whites, and 15% were in Hispanics

4. At some point in their lifetimes, an estimated 1 in 32 African American women will be diagnosed with HIV infection, compared with 1 in 106 Hispanic women and 1 in 526 white women.

5. In 2010, the rate of new HIV infections (per 100,000 population) among African American women was 20 times that of white women, and the rate among Hispanic women was 4 times the rate of white women. However, the number of new infections among black/African American women in 2010 (6,100) represented a decrease of 21% since 2008.

6. Young women aged 25 to 44 accounted for the majority of new HIV infections among women in 2010.

How HIV can be spread and increased risk factors for acquiring HIV if you are not HIV positive: - Women are more likely to get HIV during vaginal sex than men. These are some reasons why:

  • The vagina has a larger area than the penis that can be exposed to HIV-infected semen.
  • Semen can stay in the vagina for days after sex, while men are only exposed to HIV-infected fluids during sex. Semen left in the vagina means a longer exposure to the virus for women.
  • Having untreated sexually transmitted infections (STIs) makes it more likely for a person to get HIV. This is especially true for women. Small cuts on the skin of the vagina are hard to notice but may allow HIV to pass into a woman's body.

- 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:

  • You have a vaginal yeast infection or STIs
  • You have recently been treated for a vaginal yeast infection or STIs
  • You were recently infected with HIV
  • Your partner has an infection or inflammation

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.

PrEP
On May 14th, 2014 The CDC recommended new guidelines for the use of Pre-Exposure Prophylaxis or PrEP in HIV prevention. The guidelines requested that health care providers consider advising the use of anti-HIV drugs by uninfected patients who are at substantial risk of infection.

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.

Pregnant or thinking about becoming pregnant?
If you’re a young woman with HIV, you might want to have 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.

Make use of all of the resources available to you!
GET TESTED! If you are not HIV positive but have been exposed to any of the risk factors, get tested! The tests are fast, easy and in some cases free. The sooner you know your status, the better for you so you can seek treatment and counsel and the better for your partner(s).

Studies show that only 35% of women diagnosed with HIV have the virus under control. If you have recently tested positive or have been living with HIV, visit your nearest AIDS Service Organization (ASO), Community Based Organization (CBO) or Faith Based Organization (FBO) to find answers specific to you. Most of these organizations have a person who can answer your exact question because they’ve been in your shoes. Many also have support groups and peer groups. Most importantly, they can refer you to an HIV specialist, which is the most important thing you can do to live a long and fulfilling life with HIV.


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Copyright 2015, 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!