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It’s true that HIV is very misunderstood by most of the U.S. population. That’s part of the reason why there is still such a stigma attached to it. If you’re a regular reader of HIV Positive! you’ve no doubt seen how many of our female Positive Profiles, including Michelle Anderson in this issue, thought that HIV was a “Gay white man’s disease” that they weren’t at risk for.

The truth is, 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. According to a Centers for Disease Control and Prevention (CDC) 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.

Here are some fast facts from the CDC 2010 study:

- 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

- 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).

- 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

- 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.

- 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.

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

If you are a sexually active woman, here are some things you should know about 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 very 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.

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!

If you have not tested positive for HIV but have been exposed to any of the risk factors, get tested! The tests are fast, easy and in some cases free.

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. 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 2018, 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!