The Bay Area Reporter - June 12, 1996
G'dali Braverman, ACT UP Golden Gate Writers Pool

If you don't know women living with HIV/AIDS, odds are you don't know what you do and don't have in common with them. But given the shift in epidemiology on an international scope, we men stand to learn a lot from women living with HIV/AIDS in the 21st Century. For now, researchers are just beginning to quantify differences between HIV-positive men and women, and their counterparts who are "at risk of infection."

A nationwide natural history study known as WIHS (Women's Interagency HIV Study) began in 1995 to follow 2,610 women over a four-year period. Seven major urban centers were included in this study: SF/Bay Area, LA, DC, Bronx/NY, Chicago, Boston, and the State University of Brooklyn. Participating women will be seen every six months to complete a two- to three-hour interview and have a complete physical, including GYN Exam, bloodwork, and pap smear.

Preliminary results have been released to women who participated in the Southern California Consortium. While more comprehensive data will be presented at the International AIDS Conference in Vancouver next month, the following information should serve as a primer on issues related to women's health.

The cycle

In an effort to determine whether HIV causes menstrual abnormalities, women were asked to report on amenorrhea - the loss of menstrual periods. While there was not an overall significant difference between HIV-positive (5.5%) and at-risk women (3.6%), there was a significant difference when one selected for women at later stage of disease based on CD4 counts of less than 50. Approximately 12% of these women reported amenorrhea, which would indicate that HIV does effect menstrual cycles.

This single piece of information is important when one considers that women frequently discover their HIV status at much later stages of disease. Amenorrhea could serve as a warning sign, prompting women to consider HIV testing and treatment.

Additionally, hormonal imbalances, or deficits, can cause severe psychological impact upon a person living with HIV. Identifying the symptoms and early signs is an important task for patients and their doctors.

The role of STDs

Another important variable in reviewing risk of infection is a person's STD (sexually transmitted disease) history. We know from other studies that 29% of youth presenting with an STD at a public health clinic were actually diagnosed with two or more concurrent STDs. We also know that active STDs such as herpes serve as highly effective conduits for HIV transmission.

In the WIHS study it was determined that HIV-positive women are more likely to have had a history of STDs than HIV-negative women. The rates amongst infected women were: gonorrhea (34%), syphilis (20%), herpes (25%), warts (25%), and trichomonisis (38%).

Interestingly, at time of entry into the WIHS study, the HIV-positive women were less likely to have an active STD. However, once again, decline in t-cells was associated with chronic infections such as HPV (venereal warts). Certain strains of HPV have been shown to correlate with progression to cervical, as well as rectal cancers. Early detection and treatment can significantly reduce the risk of progression to cancer.

Hepatitis

The WIHS study also sought to determine the factors influencing infection with Hepatitis B and C. For HepB it was determined that women with a history of drug use (injection or other) had a higher rate of infection. Prior exposure to syphilis and HIV infection also correlated with higher rates of infection. Overall, women living on the East Coast were more likely to be infected with HepB. This was based on a comparison of women in LA and NYC.

The incidence of Hepatitis C infection among HIV-positive women was approximately 40%. It was found at a rate of 90% in women with a history of injection drug use. HepC is associated with liver damage (cirrhosis) and liver cancer.

Psychosocial concerns

While more than 50% of the HIV-positive women who participated in this study reported using alternative or complimentary therapy, 70% stated that they did not share that information with their primary care physician. Although only 19% of women reported using Chinese herbs, 37% said that they meditated or used prayer, and 52% reported regular exercise. High rates of overall utilization of alternative therapies (fewer than 40%) existed amongst Latinas and African-Americans, as well as Caucasian women.

Based on the preliminary data, fully two thirds of the women participating in the study reported being victims of physical or sexual violence. The reported violence was at the hands of either a current or past partner, with 31% stating that an incident had occurred within the last 12 months. The risk of being or becoming a victim of domestic violence correlated strongly with current and past drug use. Clearly this speaks to the need for risk reduction, education and primary HIV-care programs to identify women at highest risk for domestic violence.

Early data from WIHS seems to indicate that depression, which was seen in 56% of overall participants (regardless of HIV status), was a product of factors such as violence, substance use, and poverty. At this time there is no information as to whether discounting HIV's physiological effect in creating, or exacerbating, depression applies to women at all levels of CD4, or stage of disease. Certainly, in examining other variables, we have seen that people at later stages of disease present with different symptomatology.

Sex, sexuality, and contraception

Since the birth of the AIDS activist movement, the women's HIV community has repeatedly been told that woman-to-woman transmission of HIV is low- or no-risk. It has been difficult to ascertain to what degree this assessment is a product of the CDC's (Centers for Disease Control) homophobia or general lack of tracking of women's sexual practices.

Interestingly, the WIHS study is finding that 25% of women reported overall history of same-sex encounters. This is despite the fact that 88% of HIV-positive women self-identified as "heterosexual." One would hope that it won't take the entire four years of this natural history study before education and prevention programs begin targeting across the present narrowly defined categories for sexual orientation.

Although an equal proportion (8%) of HIV-positive and -negative women practiced anal sex, HIV-infected women were more likely to use barrier contraception (condoms and/or dental dams) for anal/vaginal or oral sex. Unfortunately, there were no differences in rates of use for various birth control options. One would have hoped that oral contraception would have been less frequently utilized by HIV-positive women. In the general population, this form of birth control has been associated with higher incidence of breast and cervical cancers. Given the already increased risk for cervical cancer in women with HIV, it is important that these women be monitored for HPV and CIN (Cervical Intraepithelial Neoplasia) to determine whether birth control pills may create a yet higher risk of progression to invasive disease.

It is hoped this study will help determine the rates at which physicians continue to allow their patients, who have a history of HPV, to use oral contraceptives as part of a birth control plan. Too often natural history studies neglect to incorporate any assessment of standards of care and their impact on HIV disease progression in a given population.

Acknowledging the work of women living with HIV/AIDS

The month of May marked the fifth anniversary for WORLD - Women Organized to Respond to Life-threatening Diseases. It's hard to believe that it's been over five years since the day that Rebecca Denison came to her first ACT UP/Golden Gate meeting and expressed her frustration over the SF AIDS bureaucracy and its lack of interest in serving women with HIV/AIDS. Like many a front-line activist, she simply had to go out and create a grassroots organization to meet the specific needs of people with HIV who didn't happen to be males or Caucasians.

Today, WORLD stands out as a leading voice in a small group of highly dedicated national women's AIDS organizations. We are fortunate to have it in our own backyard (Oakland), where it is readily accessible to service providers throughout the Bay Area. It was thanks to WORLD that the SF/Oakland site for WIHS was finally completely enrolled. When local researchers were unable to enroll the targeted number of women, WORLD organized a team of women to serve as outreach workers and recruiters for the study. Their efforts resulted in a rapid and complete enrollment of study. t

If you would like to learn more about women living with HIV, or would like to volunteer some time to an organization that brings you back to the intimate days when we used to organize in people's living rooms instead of conference rooms, call WORLD at (510) 658-6930. ACT UP/Fight Back/Fight AIDS!
960612
BR960602

Always watch for outdated information. This article first appeared in 1996. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 1996. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .