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Women and HIV/AIDS

In the early years of the epidemic in the United States, AIDS seemed exclusively like a gay men's disease. But the face of AIDS has changed dramatically since then.

Worldwide, more than half of the adults now infected with HIV are women. In the U.S., 25 percent of people who acquire HIV each year are women. According to the most recent data, more than 280,000 women and teen girls 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.

What is HIV?

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 2014, 1,783 women in the U.S. died of AIDS and its complications, compared to 4,600 in 2007.

How do women acquire HIV?

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 13 percent of women with HIV were infected with the virus because of injection drug use in 2015, with the rate of infection by shooting up at 32 percent for white women, 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.

Which women are at risk?

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. The CDC found that African American women are more likely than white women to be diagnosed with HIV-AIDS. 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 2015, black women represented 61 percent of the diagnoses of HIV/AIDS among women, even though they only made up about 14 percent of the population.

How can women protect themselves from HIV?

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.

How can a woman with HIV avoid getting AIDS?

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. doesn'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.

How can I keep from spreading the virus to anyone else?

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.

How can pregnant women with HIV protect their babies?

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 about 200 a year. The CDC recommends that all women who are pregnant get HIV tested, because the consequences for the baby are so great and so preventable.

How can women with HIV/AIDS get help and support?

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.

References

Centers for Disease Control and Prevention. HIV/AIDS among women. 2017.

AmFAR. Women and HIV-AIDs. Last updated February 2017. http://www.amfar.org/About-HIV-and-AIDS/Facts-and-Stats/Statistics--Women-and-HIV-AIDS/

World Health Organization. Gender inequalities and HIV.

United Nations. Keeping the promise: An agenda for action on women with AIDS.

Food and Drug Administration. Women and HIV.

U.S. Department of Health and Human Services. Women and HIV/AIDS.

Food and Drug Administration. FDA news release: FDA mandates new warning for nonoxynol 9 OTC contraceptive products. December 18, 2007.

American Academy of Family Physicians. HIV and AIDS: how to reduce your risk.

Mayo Clinic. HIV/AIDS.

Food and Drug Administration. FDA approval of Atripla, 3-drug fixed dose combination antiretroviral.

Centers for Disease Control and Prevention. One test two lives.

Centers for Disease Control and Prevention. Deaths of persons with a diagnosis of HIV infection, by year of death and selected characteristics, 2005 - 37 states. June 2010.

Centers for Disease Control. HIV Surveillance in Women (Slideshow).

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