Women and HIV

According to the World Health Organisation, women are more vulnerable to AIDS infection.

• The Biological Reasons
• The Economic Factors
• Socially and culturally
• HIV & Pregnancy
• Protecting the Foetus
• Breast Feeding & HIV
• Immunisation for children at risk of having HIV

The Biological Reasons

• Women have a larger mucosal surface and microlesions, which can occur during intercourse and can be entry points for the virus. Very young women may be even more vulnerable in this respect.

• There are more viruses in sperm than in vaginal secretions.

• The presence of sexually transmitted diseases increases the chance of contracting HIV. Women are at least four times more vulnerable to infection, as a higher rate of untreated STIs.

• In the lower socio economic strata women are coerced/forced into having sex. This increases risk of microlesions.

The Economic Factors

• Financial or material dependence on men means that women cannot control when, with whom and in what circumstances they have sex. They cannot demand the use of condoms. They cannot restrict the sexual partners their husbands/male friends take.

• Many women have to exchange sex for material favours, for daily survival. There is formal sex work but there is also this exchange, which in many poor settings, is many women’s only way of providing for themselves and their children.

Socially and culturally

• Women are not expected to discuss or make decisions about sexuality.

• They cannot request, let alone insist, on using a condom or any form of protection.

• If they refuse sex or request condom use, they often risk abuse, as there is a suspicion of infidelity.

• The many forms of violence against women mean that sex is often coerced which is itself a risk factor for HIV infection.

• For married and unmarried men, multiple partners (including sex workers) are culturally accepted.

• Women are expected to have relations with or marry older men, who are more experienced, and more likely to be infected. Men are seeking younger and younger partners in order to avoid infection and in the belief that sex with a virgin cures AIDS and other diseases.

All these factors impact women adversely. Women carry the burden of AIDS. As AIDS patients they get very little support from their parents’ families or their husbands’ families.

Though many women AIDS patients are monogamous, they contract HIV because their partners have multiple sexual partners. Yet, the women bear the brunt of the stigma. They are treated as adulteresses. They are denied respect, support and quite often given less opportunity for treatment.

HIV & Pregnancy

There is a one in three (30-35%) chance that a baby born to a mother who has HIV will become infected. The infant can become infected in the womb, during delivery or while being breastfed.

It is observed that of the infants infected, a few may become ill early in life whereas others survive for several years, even up to 15 years or longer, with proper management.

Becoming pregnant is a personal choice that should be made by the women after discussing with her husband and obstetrician.

The couple must be apprised of:

• The risks of infecting the child.

• The medication that may be required during pregnancy.

• Safer delivery and feeding alternatives that may be required to reduce risk of infection.

• The possibility of adopting a child.

• The possibility of Artificial Insemination (AI) if the woman is negative and the husband is HIV positive.

Protecting the Foetus

In some developed countries, washing of sperms free of HIV is being tried.

Pregnant women should opt for the HIV test to make decisions about continuing the pregnancy.

Those who go through with the pregnancy may opt for ACTG 076 regime to reduce the risk of HIV transmission to the baby to 5%. (Ask your doctor about this). Breast-feeding increases the chance of HIV transmission to the baby. But this should be discussed in individual cases depending on affordability of artificial feed, and also the capability of the mother to handle these feeds (in terms of hygiene and familiarity.)

Breast Feeding & HIV

The W.H.O emphasizes that breast feeding should continue to be promoted, supported and protected in all countries, irrespective of the prevalence of HIV infection in the country because of the overall immunologic, nutritional, psychological & child spacing benefits. In individual situations where mother is known to be HIV infected, the additional risk of the infant dying with malnutrition if not breast fed should be compared with the risk of infant become HIV infected. If the former is the likely outcome, the infant should be breast-fed irrespective of the HIV status of the mother.

Immunisation for children at risk of having HIV

• Children should receive immunisation as per the Extended Programme Of Immunisation (EPI).

• BCG does not confer 100% protection against TB but it surely protects the child against serious types of YN affecting the Central Nervous System, bones and joints.

• DPT 2,3,4 months and booster doses as for all children.

• Measles 9 months (95% protection) live vaccine to be avoided in children with disorders of the immune system.

• Polio-inactivated may be advised. (Live Polio virus may be shed for months and may cause complications to others who are HIV in the family and previously not vaccinated against polio).

• Typhoid Vaccine +18 -24 months.

• HBV 0,1 month 6 months.

• If the child has mild cough cold or diarrhoea there is not need to postpone immunisation.