Newsday - June 14, 1988
Laurie Garrett

Feminist health-care advocate Chris Norwood reviewed death statistics on women who died between the ages of 15 and 44 of all causes other than automobile accidents in New York City, Washington, D.C., and the states of New Jersey, Connecticut and Maryland, finding there was what she called "an alarming rise in deaths between 1981 and 1986" in all the areas.

AIDS officially accounts for some of the increase, but in most of the communities studied the rise in premature mortality is at least partially unexplained, Norwood writes in Ms.

Norwood, who has been arguing for several years that the peril of women in the AIDS epidemic is being ignored by government and health-care officials, asserts that the bulk of the unexplained deaths are undiagnosed AIDS cases. If she is correct, official estimates of female AIDS infection and disease should markedly increase.

But it is not clear the bulk of these cases can, indeed, be ascribed to AIDS. Furthermore, it's possible the female cases Norwood feels have been overlooked by health officials represent the same expanded numbers recently acknowledged by health officials for intravenous drug abusers and their sexual partners.

Norwood says premature female deaths jumped between 1981 and 1986 by 21 percent New York City, 18 percent in New Jersey, 30 percent in Connecticut, 8 percent in Maryland and 17 percent in Washington. Some of those increased deaths are officially ascribed to AIDS, but many are recorded as resulting from other infectious diseases, such as tuberculosis, influenza, pneumonia and pelvic inflammatory disease.

According to the relevant health departments contacted by Newsday, the numbers are accurate, and there have been marked increases in premature female mortality throughout the Northeast. But explanations for these increases differ sharply among experts.

Dr. Aliyah Morgan is medical director of the Woodhull/Bushwick Health Center in Brooklyn. She has treated many of New York City's women who fit into the categories described by the Ms. article. She says nearly all these women got infected with the HIV virus through sexual contact with either intravenous drug abusers or bisexual men. Typically, says Morgan, such women initially come down with gynecological problems, rather than the classic symptoms of AIDS.

"I'm talking about women who had ulcers in their vaginas that were treated by ten or twenty doctors and the ulcers never went away. It's not the common gynecological disorders we're talking about here, it's these usually rare things like chancroid ulcerations and so on." Nationally the rates of all sexually transmitted diseases have been rising steadily for the last decade; gonorrhea, syphilis, chlamydia, candida albicans and chancroid. Morgan says women who are infected with the HIV virus often come to the physician for longterm cases of one of these gynecological problems.

Dr. Bonnie Dattel sees the same thing in San Francisco. Dattel, a professor of obstetrics and gynecology and the University of California in San Francsico, says about 2 percent of the city's women are infected with the HIV virus. Typically, she says, they do not fit the Center for Disease Control's definition of AIDS, because they suffer from a variety of "female disorders" that are not considered by the CDC.

"We have seen a steady rise in the incidence of pelvic inflammatory disease in San Francisco, and when we separate it out most of the increase is due to HIV infection," says Dattel. PID is usually dangerous and often fatal. "We're up now to the point where about four percent of all PID cases in San Francisco are HIV-positive. That's up from one percent three years ago."

Dattel says she has treated women for cases of secondary syphilis that could only be diagnosed by referring to textbooks; such cases had never been seen before in the collective memory of the entire Department of Obstetrics and Gynecology. The women were also infected with the HIV virus, and, as far as Dattel is concerned, had AIDS. But the CDC does not count such cases.

Dr. Cyrus Hamidi of the Maryland State Department of Health says, "There's a lot we don't know about this disease in women, and there are a lot of cases in our state that I think should be considered AIDS."

All the experts seem to agree female mortality is up in the Northeast, and at least some of the increase represents AIDS cases that do not fall within the CDC's strict definition of the disease.

Ms. magazine's Chris Norwood says all women who have persistent gynecological problems should see their physician and consider having an AIDS test. "The appropriate way to characterize risk," says Norwood, "is it's certainly higher for black and Hispanic women in certain parts of the country, but ultimately it's the same for everyone."

Authorities with the New York City Health Department strongly disagree. A study done by Dr. Rand Stoneburner shows that the problem of missed AIDS cases is pervasive among inner-city intravenous drug abusers and their sexual partners. A search through medical records of deceased addicts revealed that many officially designated as deaths due to pneumonia, tuberculosis, endocarditis and respiratory disorders also had swollen glands, thrush and other symptoms typical of AIDS.

Dr. Stephen Schultz, deputy commissioner for epidemiology at the New York City Department of Health, says the city has adjusted its estimates of AIDS rates to account for Stoneburner's recently discovered cases. "So we see an increase in AIDS cases; we say there are more in New York than meet the official CDC definition," says Schultz. "A percentage of that would be women, but a percentage would be men. It's not some special female-related problem we're talking about here, it's more drug-related."

Schultz also disputes the assertion that significant numbers of American women are coming down with longterm gynecological disorders related to AIDS. "We're talking here about predominantly sexually active women. If you had four hundred highly sexually active women, what would be the expected rates of PID? What are we comparing these things to? I wouldn't downgrade the impact of HIV mortality on women; I think it's a true phenomenon. But I'm not sure it's any more significant in women than in men" in terms of missed AIDS cases.

Norwood says the bottom line in all this is that all women, particularly those with gynecological infections, are at risk for AIDS. Dr. Bonnie Dattel says that's somewhat overstated, but she warns that women who are concerned "should see a trained AIDs counselor immediately. Call an AIDS hot line."

Stephen Schultz insists the risk remains predominantly in the IV-drug-use population. But, he adds, "the bottom line is that there should be, for everybody, increased use of condoms and the esthetic of rubber love is an important one. All women need to practice risk reduction, no matter who they are."

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