Rural Center for AIDS/STD Prevention
RCAP

Fact Sheets

Fact Sheet: Number 9 (1997)

HIV Prevention for Women

As of June 30, 1997, the Centers for Disease Control and Prevention (CDC) had recorded 32,242 cases of AIDS among women greater than 13 years of age living in the United States. Of 604,176 adult/adolescent AIDS cases diagnosed by mid-year 1997, 15% were women. Of these cases, nearly 40% were attributed to heterosexual contact. Since 1991, there has been a 495% increase in the total number of AIDS cases among U.S. women. (1,2)

Figure 1 illustrates that women are comprising a progressively larger portion of yearly AIDS cases over the past 10 years. During this time, there has been a sustained increase in the proportion of AIDS cases among women attributed to heterosexual contact in rural and urban areas. (3)

In a recent study of U.S. AIDS cases among women: (3)

  • The rate of infection (cases per 100,000 population) among black women was more than twice as high as the rate for Hispanic women and nearly 17 times greater than the rate for white women.
  • Six percent of the cases were diagnosed among rural women.
  • Heterosexual contact accounted for 52% of the cases.
  • Heterosexual HIV infection was more common in women under the age of 25 than women older than 25.
  • Fifty three percent of the heterosexually transmitted cases were attributed to sex with a male partner of unreported risk, 38% to sex with a male partner who injected drugs, 7% to sex with a bisexual male partner, and 2% to sex with a hemophiliac.

The study also found that the greatest increases in yearly AIDS rates occurred in heterosexually infected women born between 1970 and 1974. The report concluded that prevention behaviors of women remain critically important and that, for example, poverty, substance abuse, sexual power imbalances, and women's financial dependence on men inhibit HIV prevention behaviors.

Rural Women and HIV Infection
CDC recently reported results from interviews of 222 HIV-positive women living in small cities/rural areas of the South. Sixty-six percent and 17% of the cases were attributed to heterosexual contact and injecting drug use, respectively. (1) In contrast, 1996/1997 HIV/AIDS surveillance data from the CDC indicated that 40% and 33% of incidence cases were attributed to heterosexual contact and injecting drug use, respectively.' Hence, HIV transmission by heterosexual contact may be more common and transmission by injecting drug use may be less common in rural areas.

Fifty seven per cent of the rural South sample reported having an STD within the last 10 years and 26% had used crack (cocaine) in the past 6 months. The study concluded that prevention efforts in rural areas should focus on preventing substance abuse, and treatment of STDs. (4) A 1997 study of HIV positive women in rural Virginia indicated that 32 of 33 women had reported heterosexual activity as their only risk behavior for HIV infection. (6)

Women Who Have Sex with Women
Of the 85,500 AIDS cases among women reported to CDC at the end of 1996, 1,648 (about 2%) of the women reported sexual contact with other women. Of these cases, none were confirmed to be a result of female-to-female sexual transmission. Nevertheless, CDC has recommended that women who have sex with women:

  • Use condoms if they also have sex with a male or insert a sex toy into the body.
  • Use dental dams, cut-open condoms, or plastic wrap as a barrier between female partners during oral sex.
  • Should be aware that vagina secretions and menstrual blood of an HIV positive woman are particularly infectious during early and late stage HIV infection. (7)

Prevention Needs of Women
Risk of male-to-female transmission of HIV infection can be reduced by the consistent and correct use of a latex condom or a female condom. Studies determining the protective value of diaphragms, spermacides, and vagina agents are presently being conducted. Nonoxynol-9 provides no added protection against gonorrhea, Chlamydia, or HIV infection. (4)

In general, HIV prevention behaviors of many women are partly determined by:

  • Choice of contraceptive method. Women using hormonal contraceptives are less likely to be condom users than those not using hormonal contraceptives.
  • Age of the male sex partner. A young woman having sex with a man who is several years older than her is less likely to use condoms.(8)
  • The sexual desires of her male partner. In a recent study, males were more likely than females to report that sex felt better without a condom. (9)
  • Perception of risk. Studies have suggested that some women have a psychological need to believe their partner is HIV negative, does not inject drugs, and is monogamous.

HIV Prevention Education for Women
A study of 1173 women whc*ed a 23% increase in encourage condom use show1 13% to 35%). Seventy five consistent condom use (froncported hormonal percent ofthe women who r( contraceptive use upon study'enrollment continued to use the same contraceptive at the end of the study. Researchers concluded that condoms and hormonal contraception may be acceptable for dual use by women. (10)

In a study of 128 women, those randomly assigned to a five session skills-based HIV intervention program were more than twice as likely as control women to be consistent condom users three months after the program.(11) In another study of 197 women, those randomly assigned to a five session skills-based HIV intervention program reported a 30% increase in condom use (from 26% to 56% of all intercourse occasions) three months after the program. (12)

In a recent interview of HIV prevention interventions for women, several components of effective programs were identified:

  • Interventions specifically constructed for women were more effective than those designed for men and women.
  • Interventions focusing on relational skills were more effective than those including information only or information plus practice with using condoms.
  • Interventions of 4 to 5 sessions in duration were more effective than those lasting only one session.

Authors also noted that education programs must seek to increase women's economic independence, decrease physical violence from men, and change sexual norms related to male dominance. (13)

Conclusion
For sexually active women whose partner's HIV and STD status is unknown, CDC recommends consistent and correct use of male latex condoms, with or without the use of spermicide. If male condoms are not used, CDC suggests female condoms. Using spermicide alone for HIV prevention is not recommended. (4)

Sources of Information

  1. Centers for Disease Control and Prevention. (1997). HIV/AIDS Surveillance Report. Midyear Edition, 9(1).
  2. Centers for Disease Control and Prevention. (1992). HIV/AIDS Surveillance Report. Year-End Edition.
  3. Wortley, P.M., & Flemmming, P.L. (1997). AIDS in women in the United States: Recent trends. Journal of the American Medical Association, 278, 911-916.
  4. Centers for Disease Control and Prevention. (1997) HIV/AIDS Prevention. July.
  5. A. Lansky (personal communication, September 22, 1997).
  6. Roberts, N.E., Collmer, J.E., Wispelwey, B. & Farr, B.M. (1997). Urbs in rure redux: Changing risk factors for rural HIV infection. The American Journal of the Medical Sciences, 314, 3-10.
  7. Centers for Disease Control and Prevention. (1997). HIV/AIDS and women who have sex with women (WSW) in the United States. Facts. July.
  8. Miller, R.A., Clark, L.F., & Moore, J.S., (1997). Sexual initiation with older male partners and subsequent HIV risk behaviors among female adolescents. Family Planning Perspectives, 29, 212-214.
  9. Jadak, R.A., Fesia, A., Rompalo, A.M., & Zenilman, J. (1997). Reasons for not using condoms of clients at urban sexually transmitted diseases clinics. Sexually Transmitted Diseases, 24, 402-408.
  10. Centers for Disease Control and Prevention. (1997). Contraceptive practices before and after an intervention promoting condom use to prevent HIV infection and other sexually transmitted diseases among women-- selected U.S. sites 1993-1995. Morbidity and Mortality Weekly Review, 46(17), 4-7.
  11. DiClemente, R.J., & Wingood, G. (1995). A randomized controlled trial of an HIV sexual risk-reduction intervention for young African-American women. Journal of the American Medical Association, 270, 1105-1112.
  12. Kelly, J.A., Murphy, D.A., Washington, C.D., Wilson, T.S., Koob, J.J., Davis, D.R., Ledzema, G., & Davantes, B. (1994). The effects of HIV/AIDS intervention groups for high-risk women in urban clinics. American Journal of Public Health, 84, 1918-1922.
  13. Exner, T.M., Seal, D.W., & Ehrhardt, A.A. (1997). A review of HIV interventions for at risk women. AIDS and Behavior, 1, 93-124.

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