Women of color and HIV/AIDS: Epidemiology, clinical aspects, and management

Abstract

A growing number of women in the USA have been diagnosed with HIV/AIDS since the beginning of the epidemic. The proportion of new HIV/AIDS cases in women has increased from 8% of all cases in 1985 to 27% in 2005. 1 Women of color have borne the brunt of this shift in epidemiology. African Americans and Hispanic women account for more than 80% of new HIV/AIDS diagnoses in women.2 In 2005, the rate of AIDS diagnosis for black women (45.5/100,000) was 23 times higher than the rate for white women (2.0/100,000). The rate for Hispanic women (11.2/100,000) was more than five times higher than that for their white counterparts.1 A myriad of psychosocial, socioeconomic, and health system factors, including poverty, higher rates of other sexually transmitted diseases, drug and alcohol use, low perception of risk, sexual inequality, and lack of access to care and treatment have led to the disparate rise in HIV infection in women of color.3-5 For similar reasons, increasing numbers of HIV cases have also been noted in women worldwide. Globally, women represent more than one-half of all infections amongst adults and are the fastest growing population living with HIV.6 Much of the HIV/AIDS information that was published early in the epidemic was based on data collected from male-predominant cohorts.7 , 8 As the demographics of the epidemic changed, so did the need for research studies investigating the impact of HIV on women. In the early 1990s, research cohorts comprising women were formed.9 , 10 Prospective studies from these longitudinal cohorts and independent research have contributed to an improved understanding of gender-based differences in HIV infection. We now have a better understanding of the environmental factors that impact disease progression in women, gender-specific side effects and toxicities caused by highly active antiretroviral therapy (HAART), and the gynecologic manifestations specific to HIV. Our knowledge of the unique impact that HIV has on women, particularly on women of color, must continue to evolve. As new therapeutics become available, gender differences in efficacy and pharmacokinetics must be determined. As HIV-infected women live longer, the effect of HIV on menopause and on the development of chronic diseases associated with age deserves further investigation. Clearly, many questions remain. This chapter will serve as a reference tool to provide clinical guidance to providers caring for women living with HIV infection. Risk factors for acquiring HIV will be reviewed as will the natural history of HIV infection with and without treatment. Clinical management strategies will be discussed, and the unique aspects of caring for women living with HIV, including the management of women on HAART, will be outlined. The gynecologic manifestations of HIV will be reviewed. An overview of reproductive challenges that women living with HIV face and the management of HIV in pregnancy will be reviewed in detail in a separate chapter. © 2009 Springer-Verlag New York.