United Press International - June 15, 2005
Ed Susman

Actually, sex has become the leading path of transmission for women, researchers at the Centers for Disease Control and Prevention report.

"In 1985, in the early days of the epidemic, more than half the women who were infected with HIV were injecting drug users," said Dr. Lisa Fitzpatrick, an epidemiologist with the CDC in Atlanta.

"In 2003, about 71 percent of women with HIV were infected through heterosexual contact," she said at the 2005 National HIV Prevention Conference.

The AIDS epidemic currently raging through Africa and Asia has been fueled by heterosexual transmission of the disease, but in Western societies the epidemic was first seen in men who have sex with men and then in injecting drug users.

According to new statistics, sex between men and women in the United States has become the second leading cause of transmission -- exceeding injecting drug users in 2001. Men having sex with men remain the single most common transmission route for HIV in the United States, said Kate Glynn, another CDC epidemiologist.

"As infection spread from men who have sex with men into the injecting drug user community, women were more likely to be exposed to more individuals with HIV," Glynn said, explaining the dynamics of the U.S. epidemic. "We have seen that shift now as heterosexual transmission has become more common."

In much of the rest of the world, more women are infected than men. Glynn said about 76 percent of people with HIV in the United States are men. The CDC estimates more than 1 million Americans are infected with the human immunodeficiency virus, which causes AIDS -- a disease with no cure, although there is treatment for those who can afford it.

Fitzpatrick said that among women who have been infected, the overwhelming majority are women of color: African-Americans and Latinas.

About 70 percent of U.S. women are white, but 67 percent of U.S. women with AIDS are African-American and another 16 percent are Latinas, Fitzpatrick noted during a news briefing.

The rate of HIV infection has struck women the hardest in the South. Although just 29 percent of U.S. women live in that region, Fitzpatrick said they comprise 76 percent of new HIV infections.

The infections increasingly strike young women in the South harder than elsewhere, she said. About 8 percent of new infections occurred in teenagers ages 13 to 19 in southern states, compared with 2 percent in the rest of the country. HIV-infection rates in the South are two to six times higher than in other regions.

The region is challenged in coping with HIV infections because it has the highest poverty rate in the nation, as well as the most uninsured individuals and the fewest high school graduates, Fitzpatrick added.

She and colleagues at the CDC have tried to discover what is driving the current epidemic and found that economics plays a major role. They interviewed 31 HIV-positive women and 101 HIV-negative women. The two groups of women displayed little differences in their typical age of sexual debut, the number of their sexual partners and their unsafe sexual practices and experience with sexually transmitted diseases.

They found, however, that women with HIV infection were:

-- 4 times more likely to be unemployed;

-- 3.2 times more likely to trade sex for money, drugs or shelter;

-- 2.8 times more likely to have a partner that was incarcerated;

-- 7.3 times more likely to be on public assistance;

-- 10.6 times more likely to have a history of herpes, and

-- 10 times more likely to have had fewer discussions with partners about sexual history.

Knowing a partner's sexual history is key to avoiding infection, said Gail Wyatt, a professor of clinical psychology at the University of California, Los Angeles. Such discussions should include the number of past and present sexual partners, the HIV status of one's partner, his history of sexually transmitted diseases, his history of drug use and his history of incarceration -- all of which are relevant to whether that person is at high risk of carrying the virus.

"Partners should be discussing these things before they take their clothes off," Wyatt said.

She said knowing where the epidemic is focused provides information to develop interventions aimed at the most vulnerable women -- and some of those interventions are showing promise.

Wyatt said intensive classes for HIV-positive women who were sexually abused as children have resulted in significant reductions in unsafe sexual practices and in adherence to treatment regimens -- both of which could reduce the risk of transmission from the women to their uninfected partners.

Ed Susman covers medical research and related issues for UPI Science News. E-mail: sciencemail@upi.com

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