Even after a quarter century of HIV/AIDS, and despite all of the education programs about how the virus is transmitted and who is vulnerable, many people still regard the disease as affecting mostly gay white men and (usually male) intravenous drug users. One of the most overlooked populations, in everything from education to prevention to treatment, is women.
Worldwide, approximately as many women as men are living with HIV, but there are important differences between women and men in the underlying mechanisms of HIV infection and in its social and economic consequences. These stem from biology, sexual behavior, and socially constructed gender differences between women and men in roles and responsibilities, access to resources, and decision-making power.
People living with HIV are often confronted with a variety of physical ailments related to the disease or as a result of receiving treatment. Many may not realize, however, that dealing with a serious illness like HIV can also involve threats to one’s mental and emotional health. One of the most serious issues for people living with HIV is depression. While the public is bombarded by advertising for drugs to treat depression, few people understand what depression is, the negative impact that it can have on quality of life, or the many treatments available. Moreover, the experience and treatment of depression can vary significantly depending on age, gender, or other life circumstances. In this article, we will focus on the causes of and treatments for depression among older women with HIV, one of the fastest growing groups of individuals living with the virus.
Increased attention to the HIV epidemic globally has encouraged HIV policy advocates to look at HIV prevention efforts among women in the U.S. and to explore how they can be improved.
I found out I was positive in 1994 when I tried to sell my blood. I thought this was an easy way to get extra cash and help others at the same time. I never would have guessed what I was about to learn.
As if living with HIV, as a woman, weren’t hard enough, numerous HIV-positive female immigrants – documented or undocumented – living in the United States face significant obstacles. Not only must HIV-positive immigrants contend with fears of deportation or losing their residential status, they may also face significant challenges procuring lifesaving healthcare and social services in a foreign country where immigration policies are in a state of flux.
About 18% of AIDS cases in the U.S. female population are said to be in women older than age 50, and numbers of cases are expected to increase as women of all ages survive longer due to improved drug therapy and other treatment advances.
Many HIV-positive women are reluctant to become pregnant because they fear they will pass the virus to their fetuses or that they will become too sick or disabled to care and provide for their children properly. But with counseling and guidance, along with comprehensive healthcare and treatment, many HIV-positive women can have healthy, HIV-negative children.
It has been five years since ACRIA last took an in-depth look at the hepatitis C virus (HCV). But it remains a serious and, unfortunately, very common comorbidity of HIV. HIV both increases the likelihood of contracting HCV and complicates its treatment. Thus education about HCV transmission, risk, and treatment are critical for people with HIV, as is support for those who are coinfected with both viruses.
Many people living with HIV must deal with not only one virus, but also with a co-traveler: hepatitis C virus (HCV), which infects liver cells. For some, the liver is only slightly damaged since it is able to make new cells and bounce back. But for others, HCV infection can lead to cirrhosis (severe liver damage), and the liver can lose some or all of its function. Finally, HCV may cause cancer of the liver and liver failure in some people.
The decision to start treatment for hepatitis C must be shared by doctor and patient, and everyone with a chronic hep C infection should be evaluated for treatment. But since the treatment can cause difficult side effects, and is less effective in people who also have HIV, education and support are critical if it is to be worthwhile. This article will highlight the current state of treatment and the issues people coinfected with HIV should know before they begin.
My name is Donald and I'm an addict. I can say that today only because I'm in recovery after years of use and abuse. I managed to experience and experiment with a lot of different drugs, starting with alcohol and marijuana, on to LSD, PCP, uppers and downers, even some speed. But heroin was my drug of choice. I started injecting when I was 22 years old.
The pressing need for new hepatitis C treatments has spawned a surge of activity in the pharmaceutical industry. Virtually all major drug companies, and a host of small biotech start-ups, have research and development programs aimed at developing new hepatitis C medications. There is potentially a multibillion dollar market for hepatitis C virus (HCV) treatment, providing a strong financial incentive for drug discovery. Yet attempts to develop new medications have been fraught with pitfalls and uncertainty, and many once-promising candidates have failed in clinical trials due to safety concerns or lack of potency.
Allow me to introduce myself. My name is Donna Y. Kennedy. I am a 51-year-old African-American. I am a woman, wife, mother, grandmother, daughter, sister, aunt, godmother, cousin, friend. Oh, by the way, I am coinfected with HIV and hepatitis C. I was diagnosed with HIV in 1984 and with hep C in 1997. I would like to share with you my experience with hep C treatment.
This year’s conferences covering HIV/AIDS and liver disease featured numerous presentations concerning hepatitis B virus (HBV) and hepatitis C virus (HCV) infection in people with HIV. Below are highlights from several of the most interesting reports.
In the past decade, since the advent of HIV combination therapy, we have made enormous strides in the treatment of HIV. Drug regimens have been simplified and pill burdens greatly reduced. Effective treatments for drug side effects have brought us closer to the goal of making HIV a "chronic manageable" disease. People with the virus today can expect to live longer and healthier lives than at any time since the epidemic began.
When HIV was first discovered in the early 1980s, scientists were optimistic that a vaccine to prevent infection could be developed in a matter of years. Unfortunately, that optimism was misplaced, and HIV has turned out to be a tricky foe for vaccine researchers.
One of the drawbacks of the condom is that its use may be controlled by the insertive partner - so it can sometimes be difficult for the receptive partner to make sure that one is used. Even the female condom requires a partner's cooperation for proper use. Add to this the fact that many men don't like the feel of male condoms and that they can sometimes make it difficult to maintain an erection, and you can see why microbicides are being studied, especially when the aim is to provide women with a prevention tool they can control.
One of the more surprising discoveries of the last decade was that HIV meds could not only treat HIV infection, but also prevent it. Using these drugs soon after exposure to HIV has become an accepted practice, but using them before exposure remains controversial. Here's what we know about both of these approaches.
"Are you clean?" I looked down at the guy who was asking me this. As opposed to what, I wondered. Dirty? Well, I did take a shower before I left the house. So, yeah, I was clean.You see, I had been talking to this guy on a phone sex line (this was before internet hookups) for almost an hour when he invited me out to his house in Brooklyn - at two in the morning. All he wanted was to have oral sex, he said. The subway ride took about an hour, with a ten-block walk to his house. And after all that, just before we were ready to start, he decides to try to find out my HIV status.
I came to New York City, like many other gay men, looking for a place where I could be myself and escape the repressive, conservative, and homophobic society of my native Chile, where you can't talk about sex, period. What I actually found - in the city where the Stonewall Riots happened and the gay rights movement began - was an only slightly less homophobic society. I found a city facing the same problems as other societies that preach abstinence or perfect behavior as the only way to deal with the complicated issue of human sexuality.
In this issue we examine the unique health concerns faced by people living with HIV – from changes in appearance and the health risks associated with altered fat distribution, to anemia and depression in women living with HIV, to key oral health considerations. With two articles on aging and HIV, ACRIA continues to examine treatment for the growing number of older adults with HIV. We also have a great report from the recent Conference on Retroviruses and Opportunistic Infections (CROI) that includes an update on new antiretroviral drugs in clinical trials and the FDA approval pipeline.
Ten years ago, shortly after the approval of protease inhibitors, clinicians began reporting changes in the body shape of people with HIV. The first reports of what came to be known as lipodystrophy noted fat loss in the face, arms, legs, and buttocks, along with fat gain in the abdomen and sometimes in the breasts and back of the neck (“buffalo hump”). The loss of fat (lipoatrophy) was specifically fat beneath the skin, known as subcutaneous fat. In contrast, the gain of fat in the abdomen tended to be fat around the internal organs, known as visceral fat. People also frequently had high triglycerides and cholesterol levels and sometimes high blood sugar or diabetes. These problems raised concern about the long-term risk of heart disease in people with lipodystrophy.
Women carry a heavy load when it comes to living with HIV. Poverty and access to health care are among the predominant factors causing poorer health outcomes for women with HIV. The HIV Cost and Services Utilization Study (HCSUS), a national study of people with HIV receiving regular medical care, found that women with HIV were disproportionately living in poverty. Nearly 64% of the women in the study had annual incomes below $10,000, compared to 41% of men. At the same time, many of these women were also the primary caretakers of children under the age of 18. Postponing medical care due to lack of transportation, being too sick, or having to take care of others are familiar reasons that women are more likely to receive delayed treatment than men.
By itself, fatigue is not a “disease.” When persistent and severe, however, fatigue (feeling tired all the time, lacking stamina, having too little energy to do things) can disrupt one’s life, interfering with daily activities, socializing, or fulfillment of goals such as returning to work, enrolling in school, or improving life circumstances in other ways.
As I further my medical training, I find that the management of HIV remains intricate, requiring both an increasing understanding of the disease and a growing tool set. So many resources come into play when deciding on a treatment regimen, including information on when to start, what to start with, side effects, and how and when to use resistance test results (which continue to mesmerize me with their bright green and red boxes). These tools, combined with an arsenal of over 20 HIV medications, have helped us to optimize treatment regimens. Yet even with these, resistance continues to limit treatment options. The need for a greater arsenal of HIV medications remains strong – luckily for us, it looks as if we have several promising candidates on the horizon.
Being a practicing general dentist in Manhattan – specifically Greenwich Village – for 35 years, I’ve seen the worst of the AIDS epidemic and, if such a word can apply, the best. Back in the late í70s and early ‘80s, AIDS was a little-known entity with, sadly, dire consequences. Most of us did our jobs, but those were difficult times. HIV was territory that most dentists had never explored. We learned a lot and did what we could. While some of us insisted that we not strip away all semblance of dignity from people with the virus and deny them the simple basics of dental care, many dentists did not even want these patients in their waiting rooms.
As we age, there are common body changes that often result in physiological vulnerabilities and medical conditions as well as an increased risk of illnesses and diseases. For people with HIV, there is the added complexity of hidden effects from the virus itself or from the medications used to control HIV and prevent complications. It is not always possible to sort out a single cause for a specific problem in each individual, and multiple factors probably interact to influence the outcome. In this article I will discuss the effects of common aging processes, the known effects of the virus, and the results of certain HIV treatments. Fortunately, in many cases it is possible to address these comorbidities in beneficial ways.
Even though, since the beginning of the U.S. epidemic, at least 10% of people with AIDS have been over the age of 50, our health and social policies have generally neglected this population. Now the proportion of people living with HIV who are older is rising; in some cities, 25% or more of all people with HIV are over 50. Ageism and stereotypes contribute to the belief, among the general pubic and among health care providers, that older adults are not at risk for HIV infection.
Since the advent ten years ago of the life-extending treatments known as HAART, many of us have focused on the myriad of issues that have arisen from vast numbers of people living longer with HIV. We have been working toward the goal of making HIV disease a more manageable, long-term condition and improving people’s quality of life. ACRIA in particular has worked to identify and bring to popular attention, including the attention of elected and public officials, the challenges faced by people living with HIV disease and the new physical, mental and social problems that come with getting older.
Diving into the world of HIV treatment for the first time can be intimidating: dozens of meds, lab tests, medical terms and differing opinions that may make you feel like you need to go to medical school in order to make the right decisions.
Exposure to HIV and infection with HIV are not one and the same. You can be exposed to HIV numerous times without getting infected. But once HIV is transmitted, a series of events occurs. Acute, or initial infection, is the first stage after transmission. About three to four days after initial transmission of HIV, people experience a dramatic rise in their viral load (the amount of HIV in the blood). The virus multiplies very quickly and spreads into all parts of the body, including the lymph nodes, genital tract, and central nervous system.
Choosing a good health care provider, be it physician, nurse practitioner, or physician assistant, is a complicated process that can leave people unhappy and frustrated. But finding a good provider is important. Here are some observations on how you can increase your chances of finding the right clinician for you.
I am not a good person about going to the doctor. Whenever I went, they wanted to take blood to see what was wrong with me, and I didn’t want that because it might come back HIV positive. I remember when I lived in California a couple of years ago, I got shingles. I was told it was due to stress and I was like, “Okay - I just lost a friend in a car accident, which I saw, so it must be that.” The doctor never told me that shingles is an HIV-related illness, so I went on thinking I was okay.
ACRIA was founded in 1991 to address the need for more community involvement in AIDS research. Since then, we’ve conducted many clinical trials of both pharmaceutical drugs and alternative treatments for HIV and its related conditions. And though research for new treatments is important, understanding the daily issues faced by people with HIV is also essential, so ACRIA has begun to do behavioral research that doesn’t involve drugs.
New York State offers a number of ways for people with HIV to get coverage for their medical expenses. You don’t need private health insurance to get expert medical care and access to medications. If you don’t know where to begin, find someone who does: talk to a local AIDS service organization, ask your case manager, or call the numbers below.
The AIDS Drug Assistance Program (ADAP) is a national program that was started by the U.S. government in 1987 to provide free or low-cost drugs to people with HIV who have limited financial resources. Generally, these are people who have an income that is too high for Medicaid, but who don’t have private health insurance because their employer doesn’t offer it or because they can’t afford it.
This information is designed to support, not replace, the relationship that exists between you and your doctor.