HAB Produces a Guide to the Clinical Care of Women With HIV/AIDS
More than 20 years of the epidemic has shown conclusively that the clinical care needs of women differ, sometimes radically, from those of men:
- Women are more biologically susceptible to HIV infection (e.g., male-to-female transmission is 2 to 4 times more efficient than female-to-male transmission).21,22
- Women with HIV/AIDS may have more difficulty than men accessing treatment and health care.23
- Women are often diagnosed later in their disease than men. Even when they know their status, approximately 1 in 4 women postpone medical care as a result of barriers ranging from unstable home life, intimate partner violence, caregiving responsibilities, and depression, among others.24
- In order to reduce mother-to-child transmission, women in pregnancy need access to and monitoring of antiretroviral medications.
- HIV-positive women are at higher risk for abnormal pap smears, human papillomavirus (HPV)—an STD that causes cervical cancer—and reproductive tract problems.25,26
In 2001, HRSA’s HIV/AIDS Bureau released A Guide to the Clinical Care of Women with HIV/AIDS, a manual to help the medical community understand the health issues that women who were infected with HIV/AIDS faced and how to best care for them. Anderson, the guide’s editor, says, “Even if doctors saw a large number of AIDS patients, it didn’t mean that they understood the unique health issues of an HIV-infected woman.” Anderson adds that even providers who worked with women were often at a loss for how to treat this population. She says that over time they learned that women with HIV experience more gynecological issues than otherwise healthy women.
A Guide to the Clinical Care of Women with HIV/AIDS is being updated for re-release in late 2011. It is the first publication to offer clinicians specific guidelines for treating women with HIV/AIDS and remains the preeminent textbook on the topic the world over.
SPNS Women's Initiative
To address the treatment, engagement, and retention needs of HIV-infected minority women, the Part F Special Projects of National Significance (SPNS) Program has funded the Enhancing Access to and Retention in Quality Care for Women of Color Initiative. Launched in 2010, this project funds 11 sites (five urban and six rural) to develop improved outreach and intervention strategies to better care for HIV-positive women of color.
Women of color account for one-third of the female population but approximately 84 percent of the estimated number of women living with AIDS.27 Many of the factors that render women of color especially vulnerable to HIV infection, such as higher rates of poverty and lack of health insurance, also serve as barriers to effective linkage to and retention in care. Moreover, lower retention and adherence rates for women of color translate to lower rates of response to treatment and survival.28
Reflecting HRSA’s commitment to involving people living with HIV disease in program planning, many of the Quality Care for Women of Color Initiative sites are developing innovative community-based strategies, including training peers to serve as positive role models and encourage women to improve medication adherence and medical follow-up. Other interventions include community-based outreach, patient education, intensive case management, and patient navigation strategies to improve health outcomes.
The initiative will last 5 years, so grantees are still in the early stages of implementation. Outcomes will be published in 2014. Preliminary efforts have given grantees valuable insight into the unique barriers facing women of color in various communities as well as a greater understanding of potential strategies for overcoming these obstacles.
Albert Einstein College of Medicine in Bronx, New York, the evaluation and support center for this initiative, will provide technical assistance to the demonstration sites and assess the effectiveness of the selected models.