Women and AIDS Conference Report by Laura Thomas

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.