Around the world, women now make up half of all people living with HIV, the human immunodeficiency virus (im-myoo-no-duh-fish-in-see), and AIDS, acquired immunodeficiency syndrome. More than 25 percent of new infections are in women.
Women of color are especially impacted by the disease. HIV/AIDS is the leading cause of death for African/American women aged 25 to 34.
Although most of the cases reported early in the epidemic were men, it was not long before AIDS in women was identified. Women contracted the disease primarily by sex with bisexual men or infected drug-using men or through sharing contaminated needles with infected injection drug users (IDUs). The proportion of all AIDS cases that were women and adolescent girls (aged >13 years) increased from 8% in 1986 to 26% in 2001.
The first symptoms of HIV infection are very much the same in men and women, although they may be more pronounced in women. They are similar to those of other acute viral illnesses: fever, joint pain, muscle ache, diarrhea, vomiting and lymphadenopathy. Weight loss, sore throat, rash and oral ulcers are also common.
Women also experience HIV-associated gynecologic problems, many of which occur in uninfected women but with less frequency or severity. Vaginal yeast infections, common and easily treated in most women, often are particularly persistent and difficult to treat in HIV-infected women. Other vaginal infections may occur more frequently and with greater severity in HIV-infected women, including bacterial vaginosis and common STIs such as gonorrhea, chlamydia, and trichomoniasis.
Severe herpes simplex virus ulcerations, which are sometimes unresponsive to therapy with the standard drug acyclovir, can severely compromise a woman's quality of life. Idiopathic genital ulcers, with no evidence of an infectious organism or cancerous cells in the lesion, are a unique manifestation of HIV infection. HPV infections, which cause genital warts and can lead to cervical cancer, occur more frequently in HIV-infected women.
A precancerous condition associated with HPV, called cervical dysplasia, is also more common and more severe in HIV-infected women and more apt to recur after treatment. PID appears to be more common and more aggressive in HIV-infected women than in uninfected women. Menstrual irregularities frequently are reported by HIV-infected women too.
Women whose HIV infections are detected early and receive appropriate treatment survive as long as HIV-infected men. Although several studies have shown HIV-infected women to have shorter survival times than men, this may be because women are less likely than men to be diagnosed early.
In an analysis of several studies involving more than 4,500 people with HIV infection, women were 33 percent more likely than men to die within the study period. The investigators could not definitively identify the reasons for excess mortality among women in this study, but they speculated that poorer access to or use of health care resources among HIV-infected women as compared to men, domestic violence, homelessness, and lack of social supports may have been important factors.