Public Health Faculty Publications School of Public Health 1992 Finding HIV-infected Women - The Clinician's Role Mary Guinan University of Nevada, Las Vegas, [email protected] Follow this and additional works at: https://digitalscholarship.unlv.edu/ community_health_sciences_fac_articles Part of the Immune System Diseases Commons, Obstetrics and Gynecology Commons, Virus Diseases Commons, and the Women's Health Commons 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 This Article is protected by copyright and/or related rights. It has been brought to you by Digital Scholarship@UNLV with permission from the rights-holder(s). You are free to use this Article in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s) directly, unless additional rights are indicated by a Creative Commons license in the record and/ or on the work itself. 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 <!::65 673 (3) and will allow for informed choices Total 22,312 (100) lence in child­ about behavior, especially with re­ bearing women,4 gard to childbearing. Screening de­ the highest rates signed to find women with HIV in­ were found in the fection must be linked to treatment, Saharan African countries, or HIV same I2 states (see Table I). Like­ counseling, education, prevention, positive; 3) had a transfusion of blood wise, the highest rate of HIV infec­ and social services. or blood products between I978 and tion in female applicants for military Clinicians must become aware that I985; or 4) are natives of Caribbean service were found in New Jersey, women are at risk for HIV infection or sub-Saharan African countries. Puerto Rico, New York, the District and offer HIV testing to appropriate These criteria alone, however, are of Columbia, and Maryland.5 Clini­ patients. How can we decide who insufficient. Of women found through cians in these I2 states should be es­ should be screened? First of all, screening to be seropositive, 28% re­ pecially aware of the need to screen women with known risk factors should ported none of the above risks. 2 These women for HIV and refer them to be offered testing. All women who I) women either did not know or were appropriate services. are or were injecting-drug users unwilling to report their risk and, The highest AIDS case rates in (IDU); 2) have or have had sex part­ therefore, would have been missed if women6 are in the 25 to 44 age group ners who are known to be IDU, bi­ only these criteria were used for (see Table 2). Assuming that women sexual, natives of Caribbean or sub- screening. are infected an average of I 0 years 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 Pandemic. 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: Epidemiology 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 genital herpes 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.