Our bodies make us more susceptible to HIV infection
he Academy of Women’s Health blogger Mitzi Perdue talks to Gina M. Brown, M.D., an obstetrician/gynecologist and medical officer at the NIH Office of AIDS Research. Dr. Brown manages Microbicides and Women’s and Girl’s research issues.
Mitzi Perdue: Women Are Biologically at Greater Risk Than Their Male Partners for HIV Infection
Gina M. Brown, M.D.: During sex, the HIV virus is in the semen. HIV-infected semen can be present in the vagina for days after intercourse, putting a woman at risk for a longer period of time. In contrast, a man is at risk during the actual time of intercourse, but, afterwards, he no longer faces the lingering risk experienced by a woman.
Furthermore, a woman’s own genital tract immune system can be compromised if she has an STD, making her more vulnerable to HIV infection. During ovulation there may also be an increased window of vulnerability. In addition, women who are pregnant are at increased risk for HIV infection as a result of changes in the genital tract immune system.
The Standard Questions About Partners Are Not Enough
Typically health-care providers will ask about the number of sexual partners a woman has had. However, in many cases, a woman who becomes infected may have had only one or two partners in her life. The issue isn’t just the numbers of partners she has had, it is how many partners her husband/partner has had. In high-risk communities, it is important to offer HIV tests to women even though they may have had few partners.
Objectives in Treating HIV-Infected Individuals
The objective in treating an HIV-infected individual is to achieve undetectable viral loads. Few, however, actually achieve this, and women achieve this goal at a far lower rate than men. The Centers for Disease Control and Prevention looked at 1.2 million people with HIV and found that only 80 percent knew they were infected. Of these, only 62 percent were connected to HIV treatment; 41 percent were actively continuing in treatment; 36 percent were receiving antiretroviral therapy; and only 28 percent were able to adhere to their treatment well enough to achieve undetectable viral loads. The challenge for health-care providers is to ensure that their patients with HIV are aware of their HIV status, get treatment and adhere to the treatment. In the case of women, this is particularly problematic. At every stage of the “HIV/AIDS treatment cascade,” that is, the stages from knowing they have HIV to reaching an undetectable viral load, more women fall off the treatment cascade sooner and faster than men.
Women May Adhere Less to Their Treatment Than Men
Women may adhere less to their treatment than men because of the many other things going on in their lives. Often their HIV treatment may not be highest on their list of priorities. They may be contending with physical, emotional, or sexual violence, or substance abuse may be an issue. Part of the health-care provider’s job is to know about these issues and to collaborate with other specialists, such as substance abuse experts, social workers or mental health-care providers. Enabling women to adhere to their treatment program may involve a lot more than listening to their lungs, taking their blood pressure and writing a prescription. Try to find out why an individual didn’t take her medication and then, if necessary, call on specialists in other fields to assist. It may take several specialists to enable the patient to adhere to her treatment.