Issues for women with heterosexually transmitted HIV disease

The encouraging outcome of new antiretroviral therapies has not been accompanied by a decrease in the incidence of HIV disease. There are reports of increases in AIDS in select geographical areas, minorities, and women. In 1997, 39% of cases in women were from heterosexual contact, whereas in men 7% of cases were from heterosexual contact. It is the most common mode of transmission in women globally and the only category of transmission in which the incidence of opportunistic infection has increased in the United States. Female anatomy, physiology, and sexual practices contribute to increasing risk of transmission, although there are no major biomedical differences in development of the disease related to gender. Two case examples illustrate the vulnerabilities, life-settings, pressures, and methods of coping for this population. Extensive discussion and review of the literature on the epidemiology, testing, disclosure, health care services, and prevention of transmission in women bring into focus strategies for improved education, diagnosis, care, and treatment.