Women and AIDS : Prevention, Safer Sex

by Food and Drug Administration (FDA)

(Page 3 of 4)

Similarly, PID, syphilis, gonorrhea, and genital warts may be harder to treat in HIV-infected women. PID, which normally produces fever and pain, may go unnoticed in an HIV-infected woman because her body hasn't been able to mount the immune response that causes these symptoms. Therefore, her infection may worsen for quite some time before she gets medical help.

Syphilis, effectively treated with penicillin in an otherwise healthy woman, may require higher doses or different drugs and have a lower cure rate in an HIV-infected person. Genital warts, which are associated with cervical cancer and obstruction of the urinary bladder, may require laser surgery.

Cervical dysplasia, too, can lead to cervical cancer. In HIV-infected women, cervical dysplasia appears to be more common and may progress more quickly to cervical cancer than in uninfected women. For these reasons the American College of Obstetrics and Gynecology and most practitioners recommend that women with HIV have Pap tests twice a year to make sure cancer is detected and treated early.

The federal government, in June 1997, recommended that all people with AIDS receive a combination treatment of three antiviral drugs, including one protease inhibitor. It also recommended that most people with early HIV infection also receive the combination therapy.

Prevention

Armed with knowledge about risks and prevention, women can do much to protect themselves from HIV infection. According to CDC, as of December 1995, about half of all reported cases of AIDS in adult and adolescent women were due to injection drug use, and about another third resulted from heterosexual transmission. Transfusion of blood or blood products accounted for another 5 percent.

The risk of transmission of HIV from transfused blood has been substantially reduced since 1985, due to the HIV-1 antibody and antigen test kits to screen blood donors for HIV-1. Antigens, which are the virus' own proteins, can be detected about a week earlier than antibodies. In addition, blood products used to treat hemophilia have been treated with cryoprecipitate.

The most important risks for women are using injection drugs, having unprotected sex with someone who uses or has used injection drugs, and having unprotected sex with a man who has had sex with another man. Having multiple sex partners also increases risk of infection.

Safer Sex

In the United States, the odds of a woman becoming infected from a man are much greater than the reverse. In one recent study of 379 couples, researchers found a 1 percent rate of female-to-male transmission of HIV, compared with a 20 percent rate of male-to-female transmission.

"The surest way to protect yourself against HIV infection and other STDs is not to have sex at all, or to have sex only with one steady, uninfected partner," states the Surgeon General's 1993 report on HIV infection and AIDS. The following advice for women who are not in such a relationship and engage in sex:

• The man must wear a condom every time you have sex, whether it's vaginal, anal or oral, and must use it properly.
• Use a new condom for every act of intercourse.
• Use condoms made of latex rubber. Natural membrane condoms have microscopic holes the virus may be able to pass through.
• Put the condom on as soon as the penis becomes erect and remove it promptly after ejaculation.
• Use only water-based lubricants. Oil-based lubricants (such as petroleum jelly, cold cream, baby oil, and cooking shortening) weaken the condom and can cause it to break.

Most failures with condoms are user failures — failure to use the condom at all or failure to use it correctly. Condoms also provide protection from STDs such as syphilis, gonorrhea, chlamydia, herpes, and genital warts. This is important for preventing HIV infection as well, because sores from these diseases provide easier access for the virus to enter the blood stream. People with STDs should consider themselves at risk for HIV.

Even women infected with HIV should have their partners use a condom to protect themselves from infection by other sexually transmitted viruses or bacteria and to help protect against infection from another strain of HIV. Many researchers believe that infections with more than one strain of HIV may lead to more rapid progression of disease or to introduction of resistant forms of the virus.

Do not rely on other forms of contraception for protection against HIV.

In April 1993, FDA announced that birth control pills, implantable contraceptives such as Norplant, injectable contraceptives such as Depo-Provera, IUDs, and natural membrane condoms must carry labeling that states these products are intended to prevent pregnancy but do not protect against HIV infection and other STDs. FDA has approved the marketing of male condoms made of polyurethane as effective in preventing STDs, including HIV. The polyurethane condom is an alternative for individuals allergic to latex.

The Reality Female Condom, made from polyurethane, may afford some protection against STDs, but it is not as effective as latex condoms for men. In approving the device, FDA required the labeling to indicate that for "highly effective protection" against STDs, it is important to use latex condoms for men. The male and female condom cannot be used at the same time. If used together, both products will not stay in place.

In addition, there is no evidence that diaphragms, or spermicides protect against HIV transmission.

About the Author

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FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.