The New Face of HIV

Advocates like Bridge and Squires are working to change those perceptions. At hospitals like Thomas Jefferson, Squires said, doctors are now taking a multidisciplinary approach to their female patients with HIV so that they get consistent and up-to-date information. "As part of the intake evaluation of any woman with HIV in her childbearing years, there should be a full discussion about the management of her reproductive potential, what her aspirations are and whether she needs to be on medication," Squires says.

While most women with a fresh diagnosis of HIV aren't planning to get pregnant anytime soon, Squires says,  "those feeling often change over time." By bringing up the topic early and often, clinicians can increase the odds that their patients will make the necessary changes in their treatment regime to minimize the chances that they pass the infection on to their babies.  For example, Squires says, most people with HIV don't start medication as soon as the diagnosis is made because there are risks as well as benefits to to each of the more than 20 different drug therapies now on the market. But a woman planning to get pregnant in the near future, would be wise "to consider starting therapy early to help control the viral replication," she says. "You want the viral load (the amount of HIV virus in the blood) to be as low as possible to decrease the risk of transmission."

Women also need to hear that many of the medications approved by the Food and Drug Administration for HIV "have specific guidelines and caveats for use in women," Squires says. Initially, all the drug research was done on men. But in recent years, more information has been surfacing about gender differences. For example, researchers have found that women are more likely than men to experience liver toxicity and rashes when taking the drug nevirapine. Squires says she now makes a point of going over all the drug options with women, and explaining gender-specific side effects, to help them make an informed choice. Women should also be told which HIV meds can lower the effectiveness of oral contraceptives. Usually, doctors will recommend that HIV-positive women use a second line of defense, such as condoms, which also reduce the chance of spreading the infection to their partners.

Perhaps most important, for women to manage HIV most effectively, Squires says, an early diagnosis is essential.  That means making sure that clinicians test heterosexual women in monogomous relationships too. These days,  she says,  it's recommended that anyone having sex should be tested regularly. " [Many women] do not perceive themselves as being at risk because ... they are in monogamous, stable relationships, and they assume that they can tell if someone has HIV. They may not realize that it takes years for the symptoms to appear," she says. "I can't tell you how many women I care for are totally surprised that they have HIV."

That may change as both doctors and patients become more aware of the rising rates of HIV and AIDS in women.

© 2007