USC Health Now

Monday, March 10, 2008, is National Women and Girls HIV/AIDS Awareness Day, sponsored by the U.S. Department of Health and Human Services (HHS) to shed light on the changing demographics in the ongoing AIDS epidemic. Here, a USC professor and expert on women and HIV talks about the changing face of the disease.

by Veronica Jauriqui

In 2002, then United Nations Secretary-General Kofi Annan described the ongoing AIDS crisis as the “feminization” of an epidemic. Since the 1990s, the number of women infected with HIV has grown exponentially. Today more than half of new HIV infections occur in young women ages 13 to 24. In many developing countries, like those in sub-Saharan Africa and the Caribbean, more than 60 percent of adults living with HIV in 2007 were women.

According to Andrea Kovacs, M.D., professor of pediatrics and pathology at the Keck School of Medicine of USC and director of the school’s Maternal Child and Adolescent Program for Infectious Diseases and Virology, the face of HIV is today a woman’s face.

“Globally, the problem of HIV and women is catastrophic. Most of the infected women are in complete monogamous relationships, meaning that their only risk factor is they are married,” Kovacs says. “This is compounded by limited access to health care, to education and to antiretroviral medications.”

Statistics in the U.S. paint a similarly somber picture of the epidemic. One in every four Americans infected with HIV is under the age of 21 and close to a quarter of HIV infections occur in women, according to the U.S. Centers for Disease Control and Prevention (CDC).

“Fifty percent of infected women have no clue how they got infected or no idea who their infected partner was,” Kovacs says. “The purpose of this day is to teach women and girls how to take control of their lives, to understand their risks and how they can protect themselves. It’s all about empowerment.”

Women and HIV

The World Health Organization estimates that 17.5 million women worldwide are infected with HIV. In Third World countries, women with HIV are ostracized and their children are often taken away, says Kovacs. In countries like Mozambique, she says, higher rates of mortality have created veritable communities of orphans.

In the U.S., an estimated 240,000 women are infected. The fastest growing risk group, according to the HHS, is through heterosexual transmission, accounting for more than half of all new infections. Says the HHS, male-to-female transmission of HIV is between two to four times more efficient than female-to-male transmission. Those of African-American or Hispanic descent have the highest infection rates among women.

With the increased access to antiretroviral medications, HIV may have become a chronic disease in the United States. But Kovacs warns that lower death rates shouldn’t lessen the severity of the issue.

“Nobody thinks they’re at risk,” Kovacs says.

Protect Yourself

The CDC recommends that women be tested for HIV as part of their routine annual check-up. New “rapid” testing can provide an HIV status in 20 minutes and bring an end to the often-agonizing two-week wait for results.

Kovacs recommends that women getting an HIV test should also consider being tested for other sexually transmitted diseases, like chlamydia or the human papillomavirus (HPV). Some, including the herpes simplex virus, can increase a woman’s likelihood of contracting HIV.

“Chlamydia can cause sterilization, HPV can lead to cervical cancer. We are talking about a whole bag of issues. There are many different diseases with many different ramifications. Getting educated is extremely important,” she says.

But just as important as getting tested is being able to talk with your partner about safe sex practices like condom use.

“Young women and adolescent girls especially have a more difficult time negotiating their needs in a relationship. Open communication with a partner is critical to protecting yourself,” she says.

Kovacs suggests mothers get comfortable talking about sex with their adolescent daughters. Four million teenagers contract sexually transmitted diseases each year, according to a Kaiser Family Foundation report.

“It’s about teaching young women to take control of their life and learning to say ‘no,’” she says.

Get Educated

Kovacs recommends both the National Institutes of Health (www.nih.gov) and the CDC (www.cdc.gov) as excellent resources for information on HIV trends among women. For women or adolescent girls who may have questions about their HIV risk or are looking for personal health information, Women Alive (www.women-alive.org) or the HHS Web site (http://www.4women.gov/hiv/) are good places to start.

The U.N. also has information about the global perspective and how to get involved through its United Nations Development Fund for Women (www.genderandaids.org).