Preventing HIV In Women

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HIV is generally thought of as affecting primarily gay men, but the statistics don’t bear this out. One in every four HIV-positive Americans is female. Worldwide, the proportion is twice that: half of all people living with AIDS are women, meaning globally, AIDS is as much a problem for women as for men. In much of the developing world, condom use is low, AIDS is poorly understood, and women’s sexual autonomy is severely curtailed, meaning transmission to women from their male partners is common.

In addition to the prevalence of HIV among women, there are also some symptoms and effects of the infection that are unique to female patients. Researchers report findings that middle-aged women with HIV show declines in cognitive abilities and functioning. The researchers said this decline happens even among patients who maintain their medication regimens. It is thought to be a result of depression and anxiety. This was not previously recognized because of the epidemiology of the illness; when HIV was infecting primarily younger people, and life expectancy after infection wasn’t very high, women with AIDS simply were not reaching perimenopause, when signs of the decline appear. Now that women are being infected at older ages and living longer, this symptom is becoming more apparent.

The good news is that advances in HIV prevention are helping women as well as men to avoid becoming infected, and there are some options being developed specifically for women, particularly women in situations where disease prevention needs to be surreptitious and undetectable, such as a woman whose partner is HIV-positive and won’t acknowledge it, and takes offense at anything she does to protect herself, or when taking preventative measures carries a stigma in the community.

One technique is an antiretroviral vaginal ring, similar to contraceptive rings that are placed inside the vagina and deliver medication internally. The antiretroviral drug ring lasts a month, during which it delivers a steady dosage of two medications, dapivirine and maraviroc, which respectively prevent the virus from replicating, and prevent it from getting inside cells to infect them. The effectiveness of these drugs is enhanced when they are used "on site," and the virus encounters them almost immediately upon transmission. A film with only dapivirine was also tested. Both the ring and the film were both found to be effective at delivering the drugs without discomfort.

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