By Warren King
Seattle Times medical reporter
Over the past 20 years, HIV and AIDS have sickened more women worldwide than any other life-threatening infection, and it's now affecting American women like never before, researchers in Seattle and Baltimore report in a major new overview of the disease in women.
While cases in men increased only 1 percent from 1999 to 2003, estimated AIDS cases in U.S. women increased 15 percent, with younger women and women of color especially hard hit, the scientists wrote in Friday's edition of the journal Science.
Newly diagnosed men still far outnumber women each year in the U.S. About 31,600 men were diagnosed in 2003, compared with about 11,500 women. But the researchers emphasize that the disease is expanding in women worldwide.
"There is no sign that it's going anywhere but up," said Dr. Julie Overbaugh, a Fred Hutchinson Cancer Research Center expert in HIV transmission and co-author of the report.
"I think young women are at high risk because of predisposing [physical] factors and because in some situations they have limited abilities to negotiate the terms of sex with their partners."
In King County, the number of newly diagnosed HIV cases in women has remained fairly constant through the years. But women now make up a higher percentage of the total number of new cases ? 12 percent today compared with 4 percent in the 1980s ? because male cases have decreased.
"The bad news is that we haven't gotten the number of [female] cases down," said Dr. Gary Goldbaum, senior medical epidemiologist for Public Health ? Seattle & King County.
HIV infections nationwide are difficult to calculate because not all states require them to be reported. Thus, the Science article focuses on cases of full-blown AIDS while King County can measure HIV diagnoses.
Nationally, African-American women have been especially affected in recent years. The rate of AIDS diagnoses in African-American women was 25 times the rate for white women, and four times the rate for Hispanic women in 2003, reported Overbaugh and Dr. Thomas Quinn, of Johns Hopkins University.
What began mainly as a disease among gay men in the United States is becoming more like it has always been in Africa ? one that is transmitted heterosexually. More than a third of the people living with HIV/AIDS in the U.S. acquired the virus heterosexually, and about one-fourth are women. In sub-Saharan Africa, about 60 percent of the infections are in women.
The so-called "bridge" to women in the U.S. initially was mainly injection-drug use, Quinn said. Bisexual men shared needles with other men or women, and the virus spread through both semen and blood.
"In the U.S., the spread [to women] was a function of time," said Quinn, a specialist in international health.
Women also are more physically vulnerable to HIV infection than men, the scientists said.
During the teen years, the cervix is still developing, and exposes more mucosal cells that are vulnerable to infection. Young women also have higher rates of sexually transmitted diseases, such as gonorrhea and genital herpes, that make them more susceptible to HIV because those diseases cause lesions that make for easy HIV entry. And the diseases cause increases in the body's immune cells that are targets for the virus.
Hormonal contraceptives, such as the pill, also may play a role in the infections, because the hormones may increase the number of immune cells targeted by the virus, and accelerate progression of the disease once infection occurs, studies show.
In the developing world, where heterosexual transmission is responsible for nearly all infections in women, societal factors are especially important, the researchers said.
Many women have little power in sexual relationships, are impoverished, have little education and live where violence against them is tolerated, the report said.
In the U.S., the increased infections in African-American women were from both heterosexual transmission [80 percent] and injection-drug use [about 20 percent], the researchers reported.
In King County, the proportion of recent infections in African-American women has increased to about 6 percent of the total of all people infected since 1999. Madeline Brooks of Renton knows all too well how HIV infection can turn life in a different direction.
Brooks, now 47, was infected by her husband 14 years ago after he began injecting drugs. She said she was overwhelmed when she learned of her diagnosis.
"I can't say I didn't think about killing myself, but I wanted to stay alive for my kids," said Brooks, an African American and mother of six.
Brooks left her husband and supported her family working part time as an auto mechanic and as a patient advocate for the People of Color Against AIDS Network, an advocacy and HIV-prevention program. With the help of medication, she has remained relatively healthy.
"My kids stay on me 24/7 about taking my meds," she laughed. "They'll stand there until I take them."
Brooks also speaks widely to groups that want to learn about HIV and how to protect against it.
"Too many young women get infected because they are afraid of being alone," she said. "I tell them to learn to be independent and not dependent on a man."
Christina DeNully, 26, of Lynnwood, also was infected by a former partner and has struggled with the disease since she was 15. She tried working for a law firm, but had to quit because of her illness. She now lives on Social Security. Like Brooks, she also speaks to groups about AIDS, especially youth organizations.
"I tell them that anyone can get [HIV], that it's a difficult journey when you do, and that they need to protect themselves or don't have sex," said DeNully.
"I tell young women that if their partner won't use condoms, to tell him 'bye.' "
In their report, scientists Overbaugh and Quinn call for a variety of ways to curb the increasing rate of infections in women.
Researchers must design trials of HIV vaccines to consider gender differences, they said. One recent major trial recently indicated that women produced more antibodies than men, showing that men and women may have reacted differently to the vaccine.
More effort also must be made to make condoms accessible, Overbaugh and Quinn said. And research should be stepped up to develop effective microbicides, anti-HIV creams and gels for women to insert before intercourse.
"These are all rather grand ideas about what needs to be done," Overbaugh said. "And we're not saying they're going to be easy to do."
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