AIDS infections growing among young women, experts say
BARCELONA, Spain (AP) – The AIDS pandemic is increasingly becoming one of young women, experts say. About half of all new infections are in women and among people in their late teens and early 20s, females account for nearly two-thirds of new cases.
Sex between men and women continues to be the main way HIV is spread in the developing world, where the majority of HIV cases are, and it is difficult for women there to follow prevention recommendations because of their subordinate position in society.
“It is women and girls who are overwhelmingly the casualties of this scourge, and it is getting worse,” said Stephen Lewis, the U.N. secretary-general’s special envoy on AIDS in Africa. “It is a nightmare.”
Scientists at the 14th International AIDS Conference presented several studies on the female face of HIV and on ways to help women protect themselves without having to rely on men to use condoms.
“We’ve got to make sure that the money is going proportionately to those who are paying proportionately the greatest price, and at the moment, the greatest price on this planet is being paid by the women and girls of Africa,” Lewis said.
A University of California, San Francisco, study found that in Zimbabwe, rape is common and negotiating for safe sex to prevent HIV infection is almost impossible for many adolescent girls who become involved with older men in return for clothes and school fees.
The phenomenon of intergenerational sex is driving much of the epidemic in southern Africa, where between one-quarter and one-third of older men are HIV positive, said the study’s leader, Nancy Padian, director of international programs at UCSF’s AIDS Research Institute.
“An intervention to promote economic self-sufficiency is an essential element in any plan to reverse the spread of HIV,” she said.
In some areas, common myths about AIDS – that sex with a virgin cures sexually transmitted infections and that sex with condoms will not release body heat – also work against women, Dr. Suniti Solomon, director of the YRG Center for AIDS Research and Education in Chennai, India, told the conference.
On average, women are becoming infected 10 years earlier than men due to early marriages, rape or being forced into prostitution for economic reasons, said Solomon, whose team documented the first evidence of HIV infection in India.
There is an urgent need for HIV prevention methods that do not require the cooperation of the male partner, Solomon said.
One possibility is microbicides, gels designed to kill HIV. No microbicide has been shown effective yet, but more than 50 candidates are under development.
Research presented at the AIDS conference included studies that looked at whether female condoms, which are more expensive, can be reused and whether it would be feasible to use diaphragms to prevent HIV infection.
A World Health Organization study found that after 300 female condoms had gone through seven cycles of disinfection, washing with soap and water, drying and relubrication, the condoms met thrance requirements.
However, the study suggested that female condoms should be handled carefully and inspected for damage between uses, because repeated wear increased the likelihood of holes.
Another study found that almost 98 percent of Zimbabwean women who were unable to persuade their partners to regularly use a condom used diaphragms as an alternative.
“There is substantial evidence to suggest that protecting the cervix could offer some protection against HIV, but attempts to study physical barriers that protect the cervix such as diaphragms have been stymied,” said Dr. Tsungai Chipato, an obstetrics and gynecology professor at the University of Zimbabwe. “Western researchers simply have not believed that women will use them.”
The next step is to test whether diaphragms can prevent HIV transmission.
“The likelihood is that it should, because the cervix seems to be a more susceptible HIV target than vaginal tissue, so very likely, if you cover the cervix, you could block out some transmission,” said Dr. Helene Gayle, director of AIDS programs at the Bill and Melinda Gates Foundation, who was not involved in the research.
Combining a diaphragm with a microbicide will likely be a strong option, she said.
“Given the urgent need for HIV prevention methods that women can use without their partners knowing about or needing to consent to use, the potential of this existing product can no longer languish unexplored,” said UCSF’s Padian, who led the study.
The issue of whether women will have equal access to treatment also needs exploring, Gayle said.
“On top of women’s increased vulnerability to infection, when treatment becomes available, is it going to be preferentially given to men? These are the kinds of questions that need to be on the radar screen,” she said.
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On the Net:
International AIDS Conference, http://www.AIDS2002.org