12.11.2009 – 11:34
Women with HIV: A Growing Challenge
- With Women Comprising Over Half of the Global HIV/AIDS Population,(1) Leading Experts to Convene to Explore the Impact of Gender on Treatment and Care
With 33 million individuals infected, HIV/AIDS has long been classified as a global epidemic.(1) But with 17 million women between the ages of 15 and 49 years who are living with HIV/AIDS and its significant social impact on females, this disease has also transformed into a crisis of gender inequality.(2) In fact, young women now make up over 60% of 15 to 24-year-olds living with HIV/AIDS.(2) This is not limited to just developing countries. In 2007, over 30% of new HIV-1 infected individuals in Western Europe were women.(3)
To address the issue of gender and HIV/AIDS, leading experts from across Europe convened today at a meeting titled "Gender Perspective -- HIV and Women" sponsored by Bristol-Myers Squibb. Topics included, among others, research on HIV treatment, the management of HIV/AIDS during pregnancy, the effects of treatment on contraception, psychosocial aspects of care and the impact of HIV/AIDS on families.
"The AIDS epidemic has had a unique and powerful impact on women and in turn, there is a clear medical need to understand women as a specific population of HIV patients. This is due to a myriad of factors, including the role that gender plays in determining an individual's vulnerability to HIV infection and ability to access the best care," said Jane Anderson, PhD, MD, Director, Centre for the Study of Sexual Health and HIV, Homerton University Hospital, UK. "This meeting is an important step in giving a voice to this issue and truly addressing the needs of this often silent majority."
The Unknown Risks
One of the risk factors for many women acquiring HIV is often the undisclosed risk behaviour of their male partners.(4) Women may be unwittingly placed at risk if their male partner participates in an unknown sexual relationship.(4) Females also may be impacted by cultural expectations that encourage men to have multiple partners.(2) Beyond this, there is a culture of silence around sexual and reproductive health.(2) Men and women are likely to increase their risk of HIV infection simply by fulfilling their expected gender roles.(2)
The Physical Vulnerability
According to a World Health Organization (WHO) report, women are more physically susceptible to HIV infection than men.(5) Male-to-female HIV transmission during sex is about twice as likely to occur as female-to-male transmission.(5) Woman's sexual organs leave her more exposed to the virus than men.(6) Younger women are at even greater risk as their vaginas are not as well lined with protective cells.(6) The presence of a sexually transmitted disease (STD) escalates the risk of HIV, but 50 to 80% of STDs in women are asymptomatic or go unnoticed.(6)
Response to the Disease
Equally of note, once women have contracted HIV, their bodies respond to the disease differently. Women have demonstrated differences in HIV viral load, drug pharmacokinetics and drug-related side effects, such as severe rashes, body fat redistribution and depressive symptoms.(7)(8) "Although existing data suggests that women respond to the disease and its treatment differently than men, there is a lack of information to guide decision-making about choice of therapy and dosing," Professor Jane Anderson said. "Many physicians struggle with the challenge of appropriately treating their female patients."
The social impact of HIV/AIDS on women transcends all aspects of life. Studies suggest that women experience HIV-related stigma and discrimination more frequently, are at a greater risk of facing the harshest and most damaging forms, and find it more difficult to cope with prejudice.(9) In some instances, women are physically assaulted and are forced to change their place of residence because of their status.(9) Fear of stigma and its consequences also hinder access to routine reproductive health services and information, putting women at a greater risk of HIV infection.(9) Women's access to HIV prevention and treatment services is also limited.(9) Thus, tackling barriers such as stigma and discrimination that inhibit women from using those services when available is vital.(9)
"As a woman and mother living with HIV, every aspect of my life is severely impacted by my condition. Whether it is the struggle to take care of your family, maintain your livelihood or regulate your health, for many women living with HIV is a dire situation," said author and meeting speaker Ophelia Haanyama Orum. "By relaying advances in research and key gender findings, the medical community will now have a better understanding of data they need in order to make more informed treatment decisions and provide better care to their female patients. This greater understanding of the dynamics of HIV/AIDS and women can then hopefully translate into decreased mortality and higher quality of life for the many millions of women that are impacted by this deadly disease."
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(1) Joint United Nations Programme on HIV/AIDS. Report on the Global AIDS Epidemic. 2008. Available at http://www.unaids.org/en/Kno wledgeCentre/HIVData/GlobalReport/2008/2008_Globa l_report.asp. Accessed 11 September 2009
(2) Joint United Nations Programme on HIV/AIDS et al. Women and HIV/AIDS: Confronting the Crisis. Available at http://www.unfpa.org/hiv/women/report/chapter1.html. Accessed 11 September 2009
(3) EuroSurveillance. HIV/AIDS Surveillance in Europe: Update 2007. Available at http://www.euro.who.int/document/e92074.pdf. Accessed 6 October 2009
(4) Centers for Disease Control and Prevention. HIV/AIDS Among Women. 2008. Available at http://www.cdc.gov/hiv/topics/women/resources/factsheets/women.htm. Accessed 11 September 2009
(5) UNAIDS. Report of the Global AIDS Epidemic. 2004. Available at http://www.unaids.org/bangkok2004/GAR2004_html/GAR2004_00_en.htm. Accessed 11 September 2009
(6) Joint United Nations Programme on HIV/AIDS. Facing the Challenges of HIV/AIDS/STDS: A gender-based response. Available at http://data.unaids.org/Topics/Gender/FacingChallenges_en.pdf. Accessed 11 September 2009
(7) Murri, R. et al. Access to Antiretroviral Treatment, Incidence of Sustained Therapy Interruptions, and Risk of Clinical Events According to Sex. J Acquir Immune Defic Syndr. 2003 (34): 189.
(8) The Well Project. Pharmacokinetics. Available at http://www.t hewellproject.org/en_US/Treatment_and_Trials/Things_to_Consider/P harmacokinetics.jsp. Accessed 11 September 2009
(9) The Global Coalition on Women and AIDS. Keeping the Promise: An Agenda for Action on Women and AIDS. Available at http://data.unai ds.org/pub/Booklet/2006/20060530_FS_Keeping_Promise_en.pdf. Accessed 11 September 2009
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