December 1 is World AIDS Day, an opportunity to bring awareness to the fight against HIV and AIDS. This year, the focus of the UN AIDS campaign is “closing the gap,” which means providing prevention, treatment, care, and support services to all people.
Women, particularly young women and pregnant women, are often more at risk for and more affected by HIV. Most cases of HIV infection in women are diagnosed in the reproductive years. According to UN AIDS, in 2013, almost 60% of all new HIV infections among people aged 15–24 occurred among adolescent girls and young women.
This past Sunday marked World AIDS Day. The truth is every day is a good day for us to encourage our patients to know their HIV status and to educate women on ways to reduce their risk of infection.
Some facts: According to the Centers for Disease Control and Prevention, women account for 20% of all new HIV infections each year. Most women with HIV (84%) are infected through heterosexual sex. The remaining women acquire HIV through intravenous drug use. Of the more than 1.1 million Americans living with HIV today, almost 24% of them are women. Unfortunately, women of color, particularly African-American women, continue to be disproportionately impacted by HIV and AIDS. Even though black women make up only 13% of the total US population, they account for 64% of all new infections each year.
A few years ago, many physicians probably screened patients for HIV only if they were high risk, were pregnant, or requested the test. Today, I believe that is changing. ACOG’s guidelines issued in 2008 recommend that ob-gyns routinely screen all our patients between the ages of 19 and 64 for HIV, regardless of their individual risk factors. Sexually active women younger than age 19 and women older than 64 who have had multiple partners in recent years should also be tested.
A lot of progress has been made in the fight against HIV/AIDS, but we haven’t won the war yet. Approximately one-quarter of Americans who have HIV don’t know it. The best defense our patients have is knowing their HIV status. Women who know that they are HIV-positive can take steps to reduce HIV-related illnesses, avoid unintended pregnancy, and protect their sexual partners from infection. Another benefit is that pregnant women who know their status can greatly reduce the risk of mother-to-child transmission of HIV (to less than 2%) by taking antiretroviral therapy.
My hope is that as more women gain health insurance coverage under the Affordable Care Act, more of them will get tested for HIV and receive appropriate health care. Getting more people tested and receiving treatment for HIV will go a long way in preventing new infections. As ob-gyns, we must increase our efforts to routinely screen all our patients for HIV, particularly in areas where HIV infection rates are highest.
Earlier this week it was reported that a Mississippi toddler born with human immunodeficiency virus (HIV) apparently cleared her HIV infection and is now disease-free. The story of her innovative medical treatment and remarkable results is truly exciting. However, as an ob-gyn, I can’t help but think that this entire situation could have been avoided.
Today in the US, mother-to-child transmission of HIV is a rare occurrence. HIV-positive women have roughly a 2% chance of passing along the virus to their babies. This is due in large part to increased HIV screening among pregnant women. Those who test positive for HIV during pregnancy can begin treatment with antiretroviral medications before they give birth. These medications significantly reduce the risk that a child will be born with HIV. The earlier the medication is given during pregnancy, the better, but it can still have a positive effect when administered just 24–48 hours before delivery and/or to the newborn within the first two days of life.
ACOG recommends that all pregnant women be screened for HIV as a part of routine prenatal care. Repeat third-trimester testing is also recommended for pregnant women in areas with high HIV prevalence. Not all women receive prenatal care, and it’s not uncommon for ob-gyns to see women for the first time when they come to the hospital to deliver. In this case, rapid HIV testing can confirm a woman’s HIV status. If she tests positive, she may still be able to receive medication in time to protect her baby from infection.
I cannot stress enough the importance of knowing your HIV status. Screening is the best method we have to both head off HIV transmission to infants and stop the spread of the disease to people of all ages. In addition to the screening recommendations for pregnant women, ACOG also recommends that all women ages 19–64 be routinely screened for HIV, regardless of individual risk factors.
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For the first time in more than two decades, HIV/AIDS researchers and activists are convening in the US for this week’s International AIDS Conference. American attitudes toward HIV/AIDS have changed significantly since this conference was last held on our soil. Fortunately, education and awareness efforts have helped tame fear and misconceptions about the disease. However, the growing number of people with HIV/AIDS who go on to live long and healthy lives has given way to complacency as many people start to assume the worst is over.
Make no mistake, HIV/AIDS still takes a great toll on Americans. More than 1.2 million people in the US are living with HIV, with approximately 50,000 new HIV infections occurring each year. Women account for more than 25% of new infections, mostly as a result of heterosexual contact. Women of color are particularly hard hit.
Screening is key to prevent the spread of HIV. ACOG recommends that all women age 19–64 be regularly screened for HIV. HIV screening is especially important for pregnant women and those planning pregnancy. Increased prenatal testing, treatment of HIV+ pregnant women and their newborns with antiretroviral medications, and avoidance of breastfeeding have helped drastically reduce transmission of the virus to newborns to less than 1%. Additionally, researchers continue to make advances with medical therapies to suppress and prevent HIV.
Though the pandemic continues, the feeling in the lead-up to the International AIDS Conference is one of hope that a cure is within reach. I share the optimism and hope that the conference will remind Americans that prevention, screening, and early treatment are vital to beating HIV/AIDS and that, most importantly, the battle is not yet won.
Today—World AIDS Day—we celebrate the great strides we’ve made in the treatment of HIV/AIDS. But we also recognize that over one-fifth of the estimated 1.1 million people in the US living with HIV don’t know they have the disease, which means they are missing vital opportunities to receive life-prolonging treatment and protect their sexual partners.
Approximately 25% of people with HIV are female, and the majority of them were infected through heterosexual contact. However, many sexually active women have never been tested, whether because of stereotypes about who’s at risk, stigma and fear of knowing their status, or because they’ve never been offered an HIV test.
ACOG recommends that all women ages 19–64, regardless of risk status, be routinely offered HIV screening. It is so important for women to know their HIV status, especially if they are planning a pregnancy or become unexpectedly pregnant. One of the HIV success stories is that with proper treatment, the risk of a mother passing along HIV to her baby is less than 1%.
Americans who are HIV positive are living longer and healthier lives thanks to antiretroviral medications. But you must know your status first. Ask your doctor today about getting an HIV test.