The Feminization of HIV by Jennifer Wider, MD

(Washington DC, 1/23/03):  For the first time since the discovery of the human immunodeficiency virus (HIV), women account for approximately half of those affected worldwide. According to the United Nations annual report, AIDS Epidemic Update 2002, approximately 50 percent of new HIV cases were women and a disproportionate number of cases under the age of 15 were also female. The total number of infections more than tripled from seven percent in 1985 to 25 percent in 2001 among female adolescents, according to data from the Centers for Disease Control and Prevention.

Research has established that factors related to biologic sex play a major role in determining male and female vulnerability to the HIV infection. As of 2001, heterosexual intercourse was responsible for more than 80 percent of adolescent and adult HIV cases. Heterosexual sex renders a woman more vulnerable to HIV because the semen comes in contact with a large mucosal surface area, which can readily absorb the virus. Thus the transmission of HIV from a man to a woman is two times more "efficient" than the transmission of the virus from a woman to a man.

The HIV epidemic in sub-Saharan Africa has played a significant role in this worldwide gender shift. Roughly one in 11 adults are infected, of which 58 percent are female. African women are at higher risk of infection than African men in the same age group, according to "Growing, Evolving HIV/AIDS Pandemic is Producing Social and Economic Fallout" from the January 1, 2003 issue of The Journal of the American Medical Association. A variety of cultural and social factors prevent women from refusing sex or mandating safer sexual practices. Consequently, African women are more likely to engage in sex with older partners who have had more sexual encounters, raising their chances of being exposed to HIV. There is also limited exposure to safe-sex education programs for both genders. According to a November, 2001 CNN report, the number of child rapes have increased in South Africa due to a prevailing myth that having sex with a virgin can protect a person from contracting AIDS.

"In parts of Africa, genital ulcer disease is quite prevalent and ulcers on sexual parts facilitate the transmission of HIV," according to Jonathan Samuels, MD, infectious disease specialist and vice president of medical affairs at St. Catherine's Hospital in Smithtown, New York. This is another risk factor contributing to the growing number of female HIV patients in Africa.

While the growing numbers of HIV cases in Africa contribute significantly to these changing demographics, changes in incidence in the U.S. also contribute. "There are larger numbers of women infected, especially in minority communities where many times it is unacceptable to discuss the topic," explains Dr. Samuels. The inability to engage in open discussion about the disease prevents educational efforts in communities that need it the most.

Although African-American and Hispanic women comprise roughly 25 percent of the total American female population, together they represent more than 82 percent of HIV cases in the U.S., according to research conducted by the National Institutes of Health. Women of ethnic and racial minorities have been disproportionately affected for the last ten years.

Women in general experience different symptoms of HIV than men. While both genders experience the early, non-specific manifestations of the disease including low-grade fever, lethargy, night sweats and weight loss, women are more likely to encounter a more severe weight loss which can result in wasting syndrome. Men are eight times more likely to develop Kaposi's Sarcoma, a rare skin cancer. Some studies have shown HIV-infected women to be more susceptible to the herpes simplex virus.

With respect to the transition to AIDS (Acquired Immunodeficiency Syndrome), there are also sex differences. HIV affects white blood cells in the body called CD4 lymphocytes; when CD4 cells fall below 200mL of blood, a person is at greater risk of developing full-blown AIDS. Scientists have shown that HIV-infected women will die at higher CD4 cell counts than men, and since CD4 counts determine when to begin antiretroviral treatment, therapy may be delayed for HIV-infected women.

The Society for Women's Health Research is the nation's only not-for-profit organization whose sole mission is to improve the health of women through research. Founded in 1990, the Society brought to national attention the need for the appropriate inclusion of women in major medical research studies and the resulting need for more information about conditions affecting women. The Society advocates increased funding for research on women's health, encourages the study of sex differences that may affect the prevention, diagnosis and treatment of disease, and promotes the inclusion of women in medical research studies. Dr. Donnica Moore has been a member of the Society since 1990 and is a past member of its Board of Directors.

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Created: 1/23/2003  -  J. Wider, MD
Reviewed: 1/24/2003  -  Donnica Moore, MD