Dissemination of HIV: How Serious Is It for Women, Medically and Psychologically?

In the US, women comprise the population group with the most rapidly increasing rate of human immunodeficiency virus (HIV) infection, yet these women--predominantly poor and Black or Hispanic--must face the added trauma of discrimination in the health care system. Even the clinical case definition of acquired immunodeficiency syndrome (AIDS) fails to include recurrent pelvic inflammatory disease, recurrent vulvovaginal candidiasis, and cervical carcinoma in situ, thereby excluding thousands of women from AIDS-related entitlements. Essential for HIV-infected women is empowerment to facilitate sound decision making about choice of partners, barrier contraception, pregnancy, abortion, and breast feeding. The vast majority of women with sex partners in high-risk groups do not use condoms, in part because of fear of loss of the relationship or withdrawal of financial support. HIV-positive women are especially in need of condom use to prevent further transmission and unwanted pregnancy. Pregnancy in HIV-positive women is associated with a 30% chance that the infant will acquire the infection and alarming increases in the ranks of the 20,000 US children already orphaned by AIDS. Nonetheless, the right of HIV-infected women to bear children should be protected, and these women should be given the option of artificial insemination of washed semen and Cesarean section delivery to reduce the risk of transmission to partner and child. Finally, because substance abusing women are not always able to make appropriate decisions about their sexual practices, drug treatment on demand and comprehensive outreach programs for HIV-infected women at shelters, the streets, and shooting galleries must be implemented.