However, the ELISA (enzyme linked immunosorbent assay) test was developed
to screen the nation’s blood supply before used during transfusion procedures
(15). Sharing needles during IV drug use is yet another method of contracting
HIV. Infected users pass the needle back and forth increasing the risk of
spreading HIV. Finally, another method of transmitting this disease is from
mother to infant during pregnancy. Infants may be infected with HIV while in the
womb or possibly at birth if the mother is infected (5). WOMEN AND THE HIV
ILLNESS: HIV/AIDS was first identified in the United States among gay and
bisexual men, and for the first decade of the epidemic, the disease was
primarily associated with homosexuality and intravenous drug use in men (6).
In recent years, there has been a growing realization that HIV/AIDS is spreading
rapidly among women, and rates of HIV infection in women may eventually mirror
those in the global epidemic (6). Approximately 61,4000 women had been diagnosed
with AIDS in the United States as of December 1994 (7). In the last decade, the
proportion of AIDS cases in women has nearly tripled (7). In 1985, there was a
7%increase of AIDS cases among women, which grew to almost 20% in 1996 (8). Of
that total number of cases reported among women, the proportion attributable to
heterosexual contact also increased (9). In 1994, AIDS cases in women
attributable to transmission via heterosexual contact surpassed the number
attributable to transmission via injection drug use; however, sexual contact
with a man who injects drugs accounts for the majority of heterosexual acquired
AIDS cases (9). AIDS is the fourth leading cause of death in women ages 25-44
years in the United States (9), and is the leading cause of death among
African-American women in the same age group (10). Yet women remain understudied
and overlooked. The lack of research specific to women leaves health care
providers unprepared to recognized and respond to women’s symptoms or
experiences and uninformed about their health needs (11). As a result, women are
diagnosed at later stages of clinical deterioration and receive fewer health
care services to help them survive the illnesses associated with AIDS (11).
Therefore, women die sooner from AIDS than men do. Clinical Manifestations: A
recent surveillance study has indicated that from 1995 to 1996 there has been a
23% decrease in the number of deaths from AIDS (6).
There has also been a 6%
decrease in the number of HIV-infected individuals diagnosed with AIDS (6). The
decrease in AIDS-related morbidity and mortality are attributed to the
improvements in the medical care, as well as the increased availability of
therapies. However, these decreasing trends do not concern women infected with
HIV and AIDS. During this same time, women with AIDS-related illnesses increased
by 2% with only a 10% decrease in the numbers of AIDS related death (6). The
differences reported for women are due to the increasing AIDS cases in women and
the lack of drug therapies specific to women (6). In 1982, the Center for
Disease Control and Prevention (CDC) developed a case definition of AIDS based
on a list of related diseases and lab evidence for or against HIV infection
(12). Over the years, this definition has been modified and used for
epidemiological studies and clinical assessments, which frequently tied it to
the provisions of certain health and social services (12). In 1993, the CDC
expanded the case definition for AIDS in adolescents and adults when they added
invasive cervical cancer to the list of AIDS-related diseases (6 12). Although
women develop recurrent and resistant gynecological problems as a consequence of
HIV infection, they do not meet the CDC criteria for an AIDS diagnosis (12).
Hence, without this diagnosis, many women are unable to receive health benefits
and services available to those with an official AIDS diagnosis (12). Further
data that show that women with AIDS do not survive as long after diagnosis as
men and, once diagnosed, become sick faster and die sooner than men with AIDS
(12). Some studies suggest this be attributed to gender differences or to delay
diagnosis of women, inferior access to health care and poor utilization of
service (12). Utilization of the prescribed drug therapies may affect the course
of HIV/AIDS in women. Evidence suggests that a number of HIV-infected women are
reluctant to take antiretroviral drugs because of concerns about their
effectiveness and side effects, as well as beliefs that drugs are experimental
(6). Many women have negative views of available drug therapies because of the
lack of relationship between them and their health care provider’s (6).
Consequently, women decide against taking the drugs to help their HIV infection.
These clinical manifestations underscore the immediate need for more aggressive
study of HIV infection in women.
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