Bridging the Gender Gap in HIV Diagnosis and Care

Since its emergence in 1981, the human immunodeficiency virus (HIV) has been viewed by the Western world as a disease that primarily affected men. Yet in mid 1996, the World Health Organization (WHO) estimated that globally 42% of the 21 million adults living with HIV infection were women. They also reported that the proportion of infected women continues to grow in developed and underdeveloped countries. The clinical course and complications of HIV infection are similar in women and men, but women are frequently not diagnosed until they present with advanced HIV disease because they are not usually perceived to be at risk. Some manifestations of acquired immune deficiency syndrome (AIDS) are unique to women, and these clinical manifestations may be the first recognizable indications of AIDS in women. For example, gynecologic symptoms develop in more than 70% of HIV-infected women, and these are often the presenting clinical manifestation. Although management principles for women are nearly identical to those of men, there are some unique aspects. The authors review specific manifestations of AIDS in women, discuss the issues of contraception and pregnancy, and address the psychosocial and economic issues contributing to the gaps that exist in the current level of care.