Women and AIDS Conference Report

The first National Conference on Women and HIV Infection was held December 13-14, 1990, in Washington, DC. It marked the first time that so many women with HIV, care providers, and activists had met specifically to talk about women and AIDS. The main issues discussed at the conference were the need for adequate health care for women with HIV infection, the lack of knowledge about the progression of disease in women, the problems of women and clinical trials, and the difficulties of doing education and prevention for women. This is a preliminary report of some of the information from the conference.

Some of the most interesting statistics presented proved conclusively what we already knew: health care makes a difference. Pat Kloser, M. D., from the Newark Women's AIDS Clinic, showed that the women who were cared for in her clinic averaged 70.4 weeks between AIDS diagnosis and death, as compared to the women who went through the emergency room and hospital system there, who averaged only 27.5 weeks.

The clearest recommendation for care was that women with symptomatic HIV disease should get cervical and anal Pap smears every six months, followed up by colposcopies if necessary. Pap smears are recommended for all women once a year, and men with HIV may be interested in having anal Pap smears done, as well. A Pap smear is a test for unusual, possibly pre-cancerous cells. Women with suppressed immune systems are especially vulnerable to infection with HPV (human papilloma virus) which causes cervical and other anogenital cancers. While there are not yet any truly effective treatments for cervical cancer or HPV infection in people with HIV, early detection and treatment offers the best hope of keeping it under control. Pap smears should become part of every woman's health care regimen, and we have heard that they are now going to be included in the standard of care for participants in AIDS Clinical Trials Group clinical trials.

There seems to be some evidence that the antimicrobial action of the PCP prophylaxis TMP-SMX (Bactrim or Septra) is causing vaginal candidiasis, or yeast infections, in women. It is well known that antibiotics such as penicillin can cause such infections, which many women have self-treated with acidophilus or yogurt, although we have not heard of any women on Septra taking acidophilus to counter the candidiasis. Vaginal candidiasis is also very common in women with HIV, so it may be hard to tell whether it is caused by Septra or not. TMP-SMX may also be preventing some of the HIV-related bacterial pneumonias that many women and injection drug users are getting.

Conflicting data was presented on the interaction of methadone and AZT. One clinician stated that methadone lowered levels of AZT in the blood, and another said that it nearly doubled AZT levels. Many recovering injection drug users are on methadone, so this will be an important drug interaction to study. As a group, injection drug users in clinical trials showed the same compliance rates as gay men did, debunking the myth of IDUs as irresponsible people. In fact, the most important predictor of compliance in a Boston trial of AZT was the belief in the efficacy of AZT, not the participant's drug using status or transmission route.

One woman with AIDS described her frustration at being unable to find a doctor who was willing to operate on her cervical cancer. Doctors discussed their difficulties in getting and keeping good nurses. Many women talked about the need for substance abuse treatment, and made it clear that they could not take care of their HIV infection without taking care of their substance use, and vice versa. We were encouraged to hear of community-based clinics for women with HIV; but speakers noted that women enter the health care system everywhere, and there are few obstretics and gynecology physicians, or emergency room personnel, who are trained to care for women with HIV.