Public Health Faculty Publications School of

1992

Finding HIV-infected Women - The Clinician's Role

Mary Guinan University of Nevada, Las Vegas, [email protected]

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Repository Citation Guinan, M. (1992). Finding HIV-infected Women - The Clinician's Role. Journal of the American Medical Women’s Association, 47 92-93. Reston, VA: https://digitalscholarship.unlv.edu/community_health_sciences_fac_articles/71

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This Article has been accepted for inclusion in Public Health Faculty Publications by an authorized administrator of Digital Scholarship@UNLV. For more information, please contact [email protected]. WOMEN'S HEALTH Finding HIV-infected women- The clinician's role

Table 1-States with Highest Cumulative AIDS Incidence in Mary E. Guinan, MD, PhD Another consider­ Women and Highest Seroprevalence of HIY in Childbearing Women ation for screen­ An estimated HIV seroprevalence/ ing should be the I 00,000 women AIDS case rate/ 1,000 childbearing patient's state of State I 00,000 women women are currently in­ residence. The fected with the hu­ Puerto Rico 71.3 NA states with the man immunodefi­ New Jersey 62.9 4.9 highest inci­ ciency virus ( H IV) New York 61.0 5.8 dences of AIDS District of Columbia 59.8 5.5 10 the United Florida 34.7 4.5 in women are in States, 1 and a Connecticut 24.4 3.0 the Northeast great majority of them are unaware of Maryland 21.0 3.1 and along the At­ Delaware 15.2 2.6 lantic coast. 3 their condition. Approximately Massachusetts 13.6 2.5 20,000 HIV-infected women were Rhode Island 12.8 1.6 (Puerto Rico and identified through publicly funded Georgia 11.0 1.6 the District of HIV screening programs in I989 and South Carolina 9.4 1.5 Columbia are 2 I990, and an unknown number NA =not available considered to be through private screening. Because Cumulative incidence rates of cases of AIDS in women t,hrough Decem­ states in these most HIV-infected women are be­ ber 31, 1990, and seroprevalence of HIV in childbearing women, 1987 analyses.) The I2 lieved to be in the lower socioeco­ and 1988.2•3 states with the nomic strata, it is unlikely that a sig­ highest inci­ nificant number were identified in the dences were Pu­ Table 2-Age Groups of Women private sector. Therefore, up to 80% with AIDS (as of November JO, 199/f erto Rico, New ofHIV-positive women may not know Jersey , New Age at they are infected. diagnosis Number(%) York, the Dis­ Finding women with HIV infection trict of Colum­ is important for two major reasons: I) ::512 1533 (7) bia, Florida, 13-19 203 (1) Connecticut, early medical treatments, prophy­ 20-24 1365 (6) laxis, and a healthy life-style can 25-29 4030 (18) Maryland, Dela­ lengthen life and improve its quality 30-34 5481 (25) ware, Massachu­ by prolonging disease-free intervals 35-39 4223 (19) setts, Rhode Is­ 40-44 2196 (10) and delaying the onset of AIDS; and 45-49 1062 (5) land, Georgia, 2) patient counseling and education 50-54 669 (3) and South Caro­ can prevent further transmission of 55-59 483 (2) lina. In a study of HIV to sex (or drug-sharing) partners 60-64 354 (2) HIV seropreva­

92 JAMWA Vol. 47, No. 3 before they are diagnosed, we can Current and Future Dimensions ofthe p/oyee Responsibilities and Rights best detect early infection by screen­ HIV/AIDS . WHO/GPA/ Journa/1990;3:153-163. ing appropriate women aged 15 SFI/90.2, September 1990. 2. CDC: Characteristics of, and HIV in­ through 44. Since these are the child­ f~ction among women served by pub­ TESTIMONY, continued bearing years, the question of whether hcly funded HIV counseling and test­ all pregnant women should be ing services-United States, 1989- of women in biomedical careers. Our screened has been raised. After an 1990. MMWR 1991;40:195-197. organization has a vital interest in this extensive review, an expert group has 3. Ellerbrock TV, Bush TJ, Chamber­ land ME, et al: of women subject; the following are the top pri­ a~vised against mandatory testing of with AIDS in the United States, 1981 orities we would like the OR WH to pregnant women,7 but has advocated through 1990. JAMA 1991;265: 2971- address. a policy of voluntary screening, ie, 2975. Sexual Harassment. Today's advising all pregnant women of the 4. Gwinn M, Pappaioanou M, George woman physician struggles with sub­ HIV epidemic and offering testing. JR, et al: Prevalence of HIV infection in childbearing women in the United tle discrimination that undermines The presence of a sexually trans­ States: Surveillance using newborn morale and productivity and de­ mitted disease is an indicator of in­ blood samples. JAMA 1991 ;265: creases opportunities for career ad­ creased risk of HIV infection; there­ 1704-1708. vancement. The ORWH could con­ fore, all women with newly diagnosed 5. Department of Defense: Prevalence of duct national surveys to document gonorrhea, syphilis, pelvic inflamma­ H/V-1 Antibody in Civilian Appli­ cants for Military Service, October sexual harassment and publicize tory disease, chancroid, chlamydia, or 1985-September 1990. Atlanta GA model policies developed for dealing infection should be Centers for Disease Control, 1990. ' with it. strongly encouraged to be screened 6. CDC: HIV/AIDS Surveillance Re­ Lack of Mentors. Women physi­ for HIV. In addition, two questions in port. Atlanta, GA, Centers for Disease cians' lack of access to important the sexual history are useful for as­ Control, December 1991, p 12. 7. Working Group 'on HIV Testing of mentor relationships early in their sessing risk of HIV infection: How Pregnant Women and Newborns: HIV careers can handicap them for the rest many sex partners have you had in infection, pregnant women, and new­ of their professional lives. The the past year? Did you use condoms borns: A policy for information and ORWH needs to examine ways not with every sexual encounter? I advise testing. JAMA 1990;264:2416-2420. only to increase the number of female all women who have had more than role models, but also to review the one sex partner in the past year and PHYSICIAN MOTHERS, continued persistent reluctance of senior male who have not used condoms with ev­ professionals to mentor women phy­ ery encounter to be tested for HIV. References sicians. No woman should be tested with­ l. Sayres M, Wyshak GF, Denterlein G, Dependent Care. The medical out her consent. Mandatory testing et al: Pregnancy during residency. N structure fails to recognize the paren­ cannot be justified on public health Eng/ J Med 1986;314:418-423. tal responsibilities of women in such a grounds.7 Before embarking on a 2. Feminist Majority Foundation: Em­ profound way that we are at danger­ screening program for women, the powering Women in Medicine. Wash­ ous risk of creating a permanent clinician must ensure that appropri­ ington, 1991. 3. American Co/lege ofObstetricians and "mommy track" or underclass of fe­ ate counseling and testing is avail­ Gynecologists' Guidelines on Preg­ male practitioners. AMWA strongly able, as well as access to treatment nancy, Work, and Disability. Wash­ recommends a minimum of 12 weeks and prevention services. State and lo­ ington, ACOG, 1982. family /medical leave for women in cal health departments have informa­ 4. Harris D, Osborn L, et al: Effects of medicine and elsewhere. All hospitals tion on the availability of publicly pregnancy on work performance. JAMA 1985;25:1995-1997. need child care facilities. funded HIV testing. Further infor­ 5. Bernstein AE: Maternity and medi­ Research Credit for Women. An­ mation on HIV testing, AIDS ser­ cine. Resid Staff Physician 1991; ecdotal reports about the poor treat­ vices, educational resources, women 37:67-74. ment of women researchers in bio­ and HIV, and clinical trials for which 6. Brazelton TB: Issues for working par­ medicine-plagiarism, stealing wom­ women are eligible is available from ents. Am J Orthopsychiatry 1986; 56:14-25. en's research, failure to credit women the Centers for Disease Control's Na­ 7. Sinal S, Weavil P, Conys G: Child care subordinates-should be examined. tional AIDS Clearinghouse, 800-458- choices of women physicians. J Am Mechanisms must be developed to 5231. Med Worn Assoc 1989;44:183-184. 8. Rowe M: Barriers to equality: The assure proper credit for contributions References power of subtle discrimination to main­ to research, including a fair hearings l. WHO Global Programme on AIDS: tain unequal opportunity. The Em- appeal process."

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