Hiv and Aids

HIV and AIDS

Be Smart, Be Safe

She was 32 and an executive with a small New England oil company. She had slept with only two men in her life: a guy in Alaska way back in the eighties and her husband.

The guy was a three-week fling while she was working on the Alaska Pipeline. She found out he used drugs and ditched him. But now she has found that the tryst was more than a mistake--it was life-threatening. Although she feels and looks good, she is infected with the human immunodeficiency virus (HIV)--the virus that causes acquired immune deficiency syndrome, or AIDS.

HIV destroys the immune system, leaving the body open to a wide range of infections that a healthy immune system could normally overcome. In the most advanced stages, HIV is diagnosed as AIDS. AIDS does not attack only gay men, as some thought when it was discovered in the 1980s. It is spreading throughout the heterosexual population, and it attacks anyone--male and female, young and old, regardless of race.

In 1992, AIDS was the fourth leading cause of death among U.S. women ages 25 to 44, behind cancer, accidental injury and heart disease.

It's believed that 100,000 American women are infected with the virus; in more than half of these adolescent and adult women, the infection has progressed to AIDS, report the Centers for Disease Control and Prevention (CDC) in Atlanta.

Yet even when the total number of women who died from AIDS more than tripled in one year--from 4,603 in 1992 to 16,417 in 1993--a national survey conducted for the American Medical Women's Association revealed that 70 percent of American women were not concerned about contracting HIV.

The Dangers for Women

Women who become infected with HIV usually get it through an exchange of blood or semen during sexual intercourse or when they share hypodermic needles with infected individuals.

Through June 1994, 48 percent of HIV-infected American women contracted the virus through intravenous drug use, 36 percent through heterosexual intercourse and 5 percent through blood transfusions or tissue transplants, according to the CDC. Eleven percent of women do not know how they acquired the infection.

In intravenous infection, the virus goes directly from the needle into the bloodstream and then to the lymph nodes, where it finds immune system cells to infect, says Charles Carpenter, M.D., associate director of the AIDS Program and professor of medicine at Brown University in Providence, Rhode Island.

With intercourse, however, the virus must work its way through vaginal secretions into cells that line the vagina, then get into the bloodstream and the lymph nodes. Infection occurs in roughly 1 of every 100 episodes of sex with an infected partner in which condoms are not used, says Dr. Carpenter.

But there are two ways during vaginal intercourse in which the virus can take a shortcut: One is to zip through a cut or abrasion in the vaginal wall and into the bloodstream. The other is to use the presence of a sexually transmitted disease, which increases the risk of transmission by at least three to five times, says Judith Wasserheit, M.D., director of the CDC's Division of STD/HIV Prevention.

STDs such as herpes or syphilis, which produce open sores, accelerate transmission the same way cuts or abrasions do. STDs such as gonorrhea or chlamydia, which do not have open sores, actually act as bait for the virus. Their presence draws immune system cells to the genital area. The virus can then attach itself to an immune cell and multiply.

Risks with Intercourse

HIV-infected semen is twice as likely to transmit the virus as infected vaginal fluids, doctors say. Not only does semen carry more of the virus than vaginal fluids, but the vagina provides more surface area for absorption than does the male urethra.

The risks go up sharply for women who have anal sex, which is practiced by an estimated 25 to 30 percent of women in the United States, Mexico and Canada. The risk of HIV transmission during anal sex is more than twice as great as the risk with vaginal sex. Among couples who participated in anal sex without condoms, 28 percent of uninfected partners became infected.

Besides abstinence, the best weapon in the fight against sexual transmission of the AIDS virus is the latex condom.

How effective are condoms? Well, just 1 percent of them break. But if you're counting on condoms, it's essential to use them all the time. In a study of 256 heterosexual couples in which one partner was HIV-positive, the European Centre for Epidemiological Monitoring of AIDS in France found that condoms prevented transmission in about 15,000 episodes of intercourse among couples who used condoms all the time. Among couples who used condoms at least half the time, nearly 13 percent of the initially uninfected partners were eventually infected. Among couples engaging in vaginal intercourse who refused to use condoms at all, 15 percent of initially uninfected partners contracted HIV.

Calming Your Fears

There have been worries over the years about HIV infection being passed through transfusions and operations, through equipment and needles at dentists', doctors' and electrologists' offices, and even at nail salons and tattoo parlors.

The American Red Cross and other blood banks say they test donated blood for the presence of HIV, and they have vowed that the nation's blood supply is without risk. Hospitals have also announced stepped-up safety precautions--from the use of latex gloves to more stringent monitoring of sterilization of equipment--to protect all patients and health care workers.

At medical offices, experts advise that you watch for signs of good hygiene and ask questions if you think there are dangers. When you have a blood test, tell the technician you want her to use a new needle (although she probably will anyway). Ask the dentist or dental hygienist to explain the office's disinfection procedures to you.

Although no cases of HIV infection have been traced to nail salons or electrologists' offices, experts advise you to take your own clippers, files, electrology needles and other equipment with you if you're concerned.

But remember this: It's nearly impossible for HIV to infect any human being unless it is in body fluid, adds Dr. Wasserheit. "Most organisms, including HIV, do not survive very long on surfaces." So even if the virus were present on food, dishes, towels, telephones, toilet seats or even tampons, the chance of transmission is just about zero.

Pregnancy and AIDS

Pregnant women who are infected with the AIDS virus have a good chance of giving birth without infecting their babies, especially if they take the drug zidovudine (AZT), reports the CDC. In a study conducted by the National Institutes of Health in Bethesda, Maryland, and the National Agency of Research on AIDS in France, researchers placed approximately 180 HIV-infected women on AZT when they were between 14 and 34 weeks pregnant. The drug was also given intravenously during labor and to each newborn every six hours for the first six weeks of life.

According to preliminary reports, the investigators found that 25 percent of babies born to HIV-infected mothers who did not take AZT were born with the AIDS virus. Eight percent of babies born to mothers who took the drug were infected at birth.

Doctors advise women to have an HIV test when they find out they're pregnant in order to safeguard their children, even though it isn't known if AZT causes birth defects, says Dr. Carpenter.

Protecting Yourself

AIDS is a threat to everyone. And studies of small groups of the general population--members of the Army Reserve, Job Corps candidates and urban residents--indicate that many adolescent females are being infected with HIV at the same rate as men are. Here's how to prevent transmission of the virus.

Always use condoms. Latex condoms are best, says Dr. Wasserheit, because they prevent transmission of HIV and STDs. condoms should be worn during vaginal and anal intercourse and oral sex.

Female condoms are also an option, says Dr. Wasserheit. This type of condom, which resembles a clear plastic bread wrapper with a ring at one end to anchor it around the cervix, has been on the market since 1992. They haven't been popular, but they're the one condom that's under a woman's control.

Weigh nonoxynol-9's risks. Some years ago, the spermicide nonoxynol-9, found in contraceptive jellies, creams and foams, was touted as a means to prevent HIV transmission when used in conjunction with a condom. But a debate is raging about it. Some studies indicate that frequent use of nonoxynol-9 may actually cause inflammation that aids in HIV transmission, while at least one study indicates that nonoxynol-9 does in fact reduce the risk of transmission by 70 to 80 percent. "We currently don't know precisely where the cut-off is for safe and effective use of nonoxynol-9," says Dr. Wasserheit. Talk it over with your doctor.

Limit your partners. "A woman should also give herself a chance to know her partner and his sexual behavior well before engaging in sex," says Dr. Wasserheit. Is he or was he a drug user? Is he bisexual? Will he use a condom? If not, rethink whether you want to have sex with him. (See page 472 for advice on how to raise these subjects with your partner.)

Get an STD checkup. Treating STDs can reduce your vulnerability to HIV, says Dr. Wasserheit. But since half of all STDs are without symptoms, it's important that you get checked for them by your health-care provider after having sex with any new partner. Even if you're in a long-term relationship, have your doctor test for STDs regularly, even in the absence of symptoms.

Test before pregnancy. If you're thinking of getting pregnant, have your doctor check for HIV, suggests Dr. Carpenter. If the test is positive, discuss the situation with your family and health care providers to decide what to do.