Anger at Women's History Study Delay

Doctors, researchers and activists say a two-year delay of a
study that could help understand the progression of HIV disease
in women is hampering efforts to prolong the lives of women with
AIDS.

A natural history study of women with HIV was promised by
the National Institutes of Health during the December 1990 Women
and HIV Conference in Washington D. C. But the Request for
Applications (RFA), the governmental process that allows
researchers to apply for funding and participation in the study,
has not yet been released.

"We could have good answers by now," said Dr. Judith Cohen,
an epidemiologist who studies HIV in women at the University of
California, San Francisco. "While we waited the last year,
10,000 more women were diagnosed."

A similar study of men, the Multicenter AIDS Cohort Study
(MACS), has been following the progress of more than 5,000 gay
and bisexual men since 1984, and has spent $100.3 million.

The National Institute of Allergies and Infectious Disease
(NIAID) is coordinating the women's study, called the Women's
Interagency HIV Study, and has allocated $5 million for 1993. A
nurse in the epidemiology branch said that the RFA was just
approved by the head office at the NIH and that it should be
published by mid-November at the earliest.

"It just takes a long time for RFA to go through the
approval process," said Miriam Galbraith, a nurse consultant for
NIAID who is the deputy project officer for the study. "The idea
has to be approved before writing the RFA itself."

In San Francisco, Dr. Cohen is waiting for the RFA so that
she can apply for funds for the study. She is working with Bay
Area Research Consortium on Women and AIDS (BARCWA), which is
ready with 450 HIV-positive women to begin the natural history
study.

Once approved, the study would continue to enroll women as
soon as they know they are HIV-positive and monitor their health
for four years. "We just don't have much research on women," Dr.
Cohen said. "It is particularly important (to look at) women
(because) we have a whole set of indirect evidence that something
else is going on ...women have body parts that men do not."

The current standard of care for women with HIV does not
include information about gynecological problems, Dr. Cohen said.

The Centers for Disease Control announced on October 27 that
it would expand the definition of AIDS illnesses to include
invasive cervical cancer, pulmonary tuberculosis and recurrent
pneumonia, after a two year battle by women activists. This
decision, while it does not go far enough, is expected to improve
the standard of care for women, activists said. Earlier this
year, the CDC announced plans to expand the AIDS definition to
include people whose T-cell count is below 200, but criticism
that the change still did not address women's needs stalled
implementation.

Women continue to have shorter survival rates than men,
although the gap has narrowed. Dr. Cohen published research in
the July 1992 Journal of Infectious Diseases that showed that men
in San Francisco survive four to five months longer than women in
San Francisco. The study examined men and women with comparable
opportunistic infections.