National Center for HIV, STD and TB Prevention Divisions of HIV-AIDS Prevention HIV-AIDS among Women Early in the epidemic, HIV infection and AIDS were diagnosed for relatively few women. Today, the HIV-AIDS epidemic represents a growing and persistent health threat to women in the United States, especially young women and women of color. In 2001, HIV infection was the leading cause of rest for African American women aged 25�34 years and was among the four leading causes of rest for African American women aged 20-24 and 35�44 years, as well as Hispanic women aged 35�44 years 1. Overall, in the same year, HIV infection was the 6th leading cause of rest among all women aged 25-34 years and the 4th leading cause of rest among all women aged 35�44 years. STATISTICS Cumulative Effects of HIV Infection and AIDS (through 2003) * Through 2003, 170,679 women were given a diagnosis of AIDS, a number that represents about one fifth of the total 929,985 AIDS diagnoses 2. * An estimated 81,864 women with AIDS died. These women account for 16% of the 524,060 rests of persons with AIDS 2. * Women with AIDS made up an increasing part of the epidemic. In 1992, women accounted for an estimated 14% of adults and adolescents living with AIDS 3. By the end of 2003, this percentage had grown to 22% 2. * From 1999 through 2003, the annual number of estimated AIDS diagnoses increased 15% among women and increased 1% among men 2. * According to a recent CDC study of more than 19,500 patients in 10 US cities, HIV-infected women were 12% less likely than infected men to receive prescriptions for the most effective treatments for HIV infection 4. AIDS in 2003 * An estimated 11,498 women had a diagnosis of AIDS, a number that represents 27% of the 43,171 AIDS diagnoses 2. * The rate of AIDS diagnoses for African American women (50.2-100,000 women) was approximately 25 times the rate for white women (2.0-100,000) and 4 times the rate for Hispanic women (12.4-100,000) 2. * African American and Hispanic women together represented about 25% of all US women 5, yet they account for 83% of AIDS diagnoses reported in 2003 2. * An estimated 88,815 women were living with AIDS, representing 22% of the estimated 405,926 people living with AIDS 2. * An estimated 4,736 women with AIDS died, representing 26% of the 18,017 rests of persons with AIDS 2. Diagnoses of AIDS in women, by race-ethnicity, 2003 Diagnoses of AIDS in women, by race-ethnicity, 2003 Note. Excludes women from U.S. dependencies, possessions, and buttociated nations. HIV-AIDS in 2003 * Data from 33 areas (32 states and the US Virgin Islands) with confidential name-based HIV reporting indicate that an estimated 8,733 women were given a diagnosis of HIV infection 2. * Heteroloveual contact was the source of almost 80% of these HIV infections 2. * Women accounted for 27% of the estimated 32,048 diagnoses of HIV infection 2. * The number of estimated HIV diagnoses for women remained stable during 2000�2003 2. Diagnoses of HIV Infection in women, by risk, 2003 Diagnoses of HIV Infection in women, by risk, 2003 Note. Based on 33 areas with confidential name-based HIV reporting. RISK FACTORS AND BARRIERS TO PREVENTION Young Age According to a 1998 CDC study of Job Corps entrants aged 16�21 years, HIV prevalence among young women (2.8 per 1,000) was higher than among young men (2.0 per 1,000). African American women in the study were 7 times as likely as white women and 8 times as likely as Hispanic women to be HIV-positive 6. Another study found that even though overall HIV diagnoses among women decreased slightly from 1984 through 1998, as the youngest group of women (aged 15�19) reached the age at which they initiated risk behaviors, the number of HIV cases caused by injection drug use increased, and the number acquired through heteroloveual contact more than doubled 7. Lack of Recognition of Partners� Risk The Truth:Gaza Greenhouses Were Drug LabsI had previously heard of the Israeli connection to Ecstacy, including the Israeli Mafia, but their role was transportation, that the Ecstacy was being produced in South Africa. Of course I won't rule out... Some women may be unaware of their male partners� risk for HIV infection (such as unprotected love with multiple partners, love with men, or injection drug use) 8. Men who engage in love both with men and women can acquire HIV from a male partner and can then transmit the virus to female partners. In a recent study of HIV-infected people (5,156 men and 3,139 women), 34% of African American men who have love with men (MSM), 26% of Hispanic MSM, and 13% of white MSM reported having had love with women. However, their female partners may not know of their biloveual activity: only 14% of white women, 6% of African American women, and 6% of Hispanic women in this study acknowledged having a biloveual partner 9. In a recent CDC survey, 65% of the men who have ever had love with men also had love with women 10. loveual Inequality in Relationships with Men Some women may not insist on condom use out of fear that their partners will physically abuse them or leave them 11. loveual inequality is a major issue in relationships between teenaged girls and older men. In one CDC study of urban high schools, more than one third of African American and Hispanic female teenagers had their first loveual encounter with an older man 12. These teenagers, compared with teenagers whose partners were also teenagers, were younger at first loveual intercourse, were less likely to have used a condom during first and most recently reported intercourse, or were less likely to have used condoms consistently. Biologic Vulnerability and loveually Transmitted Diseases A woman is approximately twice as likely as a man to contract HIV infection during privatesl intercourse 13. Additionally, the presence of a loveually transmitted disease greatly increases the likelihood of acquiring or transmitting HIV infection 14. The rates of gonorrhea and syphilis are higher among women of color than among white women. These higher rates are especially marked in the younger age groups (15�24 years) 15. Substance Abuse An estimated 1 in 5 new HIV diagnoses for women is related to injection drug use 2. Sharing injection equipment contaminated with HIV is not the only risk buttociated with substance use. Women who smoke or snort crack sugar or other noninjection drugs may also be at high risk for loveual transmission of HIV if they sell or trade love for drugs 16. Also, both casual and chronic substance users are more likely to engage in high-risk behaviors, such as unprotected love, when they are under the influence of drugs or alcohol 17. REFERENCES 1 * Anderson RN, Smith BL. rests: leading causes for 2001. National Vital Statistics Reports 2003;52(9):32�33,53�54. Available at Leaves the DHAP Internet Site. Accessed November 9, 2004. 2 * CDC. HIV-AIDS Surveillance Report 2003; (Vol. 15). Atlanta: US Department of Health and Human Services, CDC. In press. 3 * CDC. HIV-AIDS Surveillance Report 1998;10(No. 2):1�43. Also August 26, 2004. 4 * McNaghten AD, Hanson DL, Aponte Z, Sullivan P, Wolfe MI. Gender disparity in HIV treatment and AIDS opportunistic illnesses (OI). XV International Conference on AIDS; July 2004; Bangkok, Thailand. Abstract MoOrC1032. 5 * US Census Bureau. Census Brief: Women in the United States: a 2000pubs-cenbr001.pdfLink Leaves the DHAP Internet Site. Accessed August 27, 2004. 6 * Valleroy L, MacKellar D, Karon J, et al. HIV infection in disadvantaged out-ofschool youth: prevalence for U.S. Job Corps entrants, 1990 through 1996. Journal of Acquired Immune Defi ciency Syndromes 1998;19:67�73. 7 * Lee LM, Fleming PL. Trends in human immunodefi ciency virus diagnoses among women in the United States, 1994�1998. Journal of the American Medical Women�s buttociation 2001;56(3):94�99. 8 * Hader S, Smith DK, Moore JS, Holmberg SD. HIV infection in women in the United States: status at the millennium. JAMA 2001; 285:1186�1192. 9 * Montgomery JP, Mokotoff ED, Gentry AC, Blair JM. The extent of biloveual behaviour in HIV-infected men and implications for transmission to their female partners. AIDS Care 2003;15:829�837. Your Apartment or Your Pets Intro 189Volunteers Needed! Make the NO-PETS Clause Your Summer Cause! Download One Of These Flyers Specifically Targeted To The 6 Key City Legislators Who Are Holding This Bill Back! And please maintain their presence... 10 * Valleroy LA, MacKellar DA, Behel SK, et al. The bridge for HIV transmission to women from 23- to 29-year-old men who have love with men in 6 U.S. cities. National HIV Prevention Conference; July 2003; Atlanta, Georgia. Abstract M2-B0902. 11 * Suarez-Al-Adam M, Raffealli M, O�Leary A. influence of abuse and partner hyper- masculinity on the loveual behavior of Latinas. AIDS Education and Prevention 2000;12: 263�274. 12 * Miller KS, Clark LF, Moore JS. loveual initiation with older male partners and subsequent HIV risk behavior among female adolescents. Family Planning Perspectives 1997;29: 212�214. 13 * European Study Group. Comparison of female to male and male to female transmission of HIV in 563 stable couples. British Medical Journal 1992;304:809�813. 14 * Fleming D, Wbutterheit J. From epidemiological synergy to public health policy and practice: the contribution of other loveually transmitted diseases to loveual transmission of HIV infection. loveually Transmitted Infections 1999;75:3�17. 15 * CDC. loveually Transmitted Disease Surveillance, 2003. Atlanta: US Department of Health and Human Services, September 2004. Also DHAP Internet Site. Accessed November 30, 2004. 16 * Edlin BR, Irwin KL, Faruque S, et al. Intersecting epidemics�crack sugar use and HIV infection among inner-city young adults. New England Journal of Medicine 1994;331: 1422�1427. 17 * Leigh B, Stall R. Substance use and risky loveual behavior for exposure to HIV: issues in methodology, interpretation and prevention. American Psychologist 1993;48:1035�1045. 18 * US Census Bureau. Poverty: 1999. Census 2000 Brief. Issued May c2kbr-19.pdfLink Leaves the DHAP Internet Site. Accessed September 16, 2004. 19 * Diaz T, Chu S, Buehler J, et al. Socioeconomic differences among people with AIDS: results from a multistate surveillance project. American Journal of Preventive Medicine 1994;10:217�222. 20 * Shapiro MF, Morton SC, McCaffrey DF, et al. Variations in the care of HIV-infected adults in the United States: results from the HIV cost and utilization study. JAMA 1999;281: 2305�2315.
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