It is now recognized that worldwide, there are more women infected with HIV than men (UNAIDS report 2007). A SERMO member specializing in Hepatology, Infectious Diseases, and Genitourinary Medicine in the UK focuses on the healthcare needs of this group, as they’re a complex and varied, in this article about HIV in women.
In our cohort, the HIV demography has changed from typically seeing a stereotypical white gay man at the end of last century, to seeing a black African man at the beginning of this century only to now more commonly see a black African female with HIV. This latter group is the majority of most large urban based cohorts and routine antenatal screening programs have also contributed to this growing figure. Although homosexual intercourse is the most common mode of HIV transmission of HIV, heterosexual transmission in terms of prevalence is higher. The fact that females often take more responsibility for their health could also be a factor. Conversely, African women often do not access free, confidential healthcare and treatment as readily as men. They may be isolated geographically and economically and may fear rejection by their social and professional networks. Thus, women may need extra assistance to overcome these multiple barriers to healthcare as well as help with childcare and transportation.
Referrals are made to and from many of the other healthcare disciplines such as Sexual and Reproductive Medicine, Obstetrics, Paediatrics, Mental Health, General Medicine, Virology, Immunology, Dietetics and Dentistry. As a result HIV Medicine has evolved into several sub-specialities such as HIV resistance and HIV Pharmacology.
The medical management is complex and may require several consultations for the patient involving a multidisciplinary team. Non-medical issues such as immigration issues, language barriers, asylum status, income and housing issues may also feature heavily. Partners and children must be taken into consideration when devising care plans and testing for HIV in these groups encouraged. Discussion and documentation of safe sex, condom use and Post Exposure Prophylaxis Sexual Exposure (PEPSE) is crucial in terms of avoiding ongoing transmission of HIV and other sexually transmitted infections. Supportive networks such as family, friends and community members are crucial in providing help. HIV charities are often able to provide peer advocate led groups to allow patients to express themselves in their original language. Faith groups are often a source of great solace and guidance in difficult times with confidentiality being fully respected.
The decision to initiate highly active antiretroviral therapy (HAART) is a major one and the patient has to be motivated to do so. Thankfully, we are in a position to offer medication that can tailor the lifestyle of patients and the pill burden has been greatly reduced to just 1-2 pills a day for certain regimens. Adherence and compliance is discussed at each consultation and any possible toxicity monitored. Vaccinations should be encouraged especially in those planning to travel and 3-4 monthly follow-up is recommended for most HIV units in the UK. Annual cervical screening is encouraged as well as up to date sexual health screening for any recent partner change.
All of these measures can have an effect on HIV transmission rates, morbidity and mortality as well as more effective treatment for women with HIV/AIDS.
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