Women at risk Women now contracting AIDS at a faster rate than men

THE BALTIMORE SUN

You're not a gay man. You're not an intravenous drug abuser. You're a woman who doesn't sleep around or do drugs. Why should you worry about getting AIDS?

"The first teen-ager I had with AIDS was a delightful girl. You'd never think she was at risk. She was from a stable family. She had one sexual partner," said Gale Cromwell, a nurse practitioner with the University of Maryland's Adult AIDS Clinic.

"At the beginning of the epidemic, it was mainly drug users and gay men -- if you were involved with them, you were within the circle of risk. Now, the virus has clearly moved into the general population. We have lawyers, nurses, a Getty heiress even," said Denise Rouse, director of D.C. Women's Council on AIDS, referring to Aileen Getty, a granddaughter of Jean Paul Getty. "Now we're talking, we're all at risk."

The growing number of women infected with HIV, the AIDS virus, was dramatically illustrated recently at both political conventions, when Mary Fisher and Elizabeth Glaser took to the stage, respectively, in Houston and New York as personal witnesses to how HIV crosses all gender, sexual, racial and socio-economic boundaries.

Ms. Fisher and Ms. Glaser are not entirely representative of women with AIDS because the largest group, half of them, contracted the virus through intravenous drug use. Yet their speeches served to highlight what many health professionals see as a long-ignored subset of the HIV-positive population.

"Women still are not getting the attention they deserve," said Dr. Helen Rodriguez-Trias, a California-based physician and president-elect of American Public Health Association. "But it's become evident in the past two, three years that women are the fastest growing group."

While men with AIDS still greatly outnumber women with AIDS, female AIDS cases are growing at a higher percentage than male AIDS cases. For example, the number of women with AIDS jumped 15 percent from 1990 to 1991; in the same time period, the number of men with AIDs increased less than 4 percent.

That is linked in part to a shift in how people are contracting HIV: Although the largest transmission category remains male homosexual or bisexual contact, heterosexual transmission in recent years has shown the fastest increase. Last year, for example, the number of men contracting the virus from homosexual or bisexual sex actually dropped from the year before, while the number of people who contracted the disease from heterosexual sex went up 21 percent.

And that is particularly bad news for women because they more often contract the virus through sex with men than the other way around, according to statistics.

Additionally, AIDS statistics are worrisome because of the time lapse involved, researchers say.

"When you're looking at AIDS statistics, you're looking at something that happened five years ago," said Liza Solomon, a Johns Hopkins School of Public Health researcher who recently launched one of the first major studies on women and HIV infection. "For an epidemic that's only 11 years old, five years ago is another era."

Luana Clark of Baltimore is perhaps among the most typical of the women currently infected with the virus.

"I was 11 years old when I first stuck a needle in my arm," said Ms. Clark, who is now 40 and recently celebrated her seventh "anniversary" of recovery from drug use. More than half of the 717 Maryland women who have contracted AIDS since 1981 were intravenous drug users.

But despite her years of intravenous drug abuse, she never gave a thought about contracting HIV -- "Addicts don't think like that; they only think about how they're going to get the money for the next time" -- and only discovered she was infected after her boyfriend died of AIDS about five years ago. She said her infection has not yet developed into AIDS.

As an educator for the Health Education Resource Center (HERO), an AIDS resource center in Baltimore, and a volunteer active in several support groups, Ms. Clark has devoted much of her energy to helping other women who are HIV-infected.

L In part, the work is "my defense mechanism," Ms. Clark said.

"I have a personal life only sporadically. If I see a relationship developing into something where I'll have to disclose [my HIV status], where I would have to accept whatever reaction comes from that, I cut it off," said Ms. Clark, who is the mother of two grown children and currently is caring for a 14-year-old whose mother died of AIDS. "Right now, it's hard for me to accept I'm a time bomb waiting to go off. I've accepted it, but for the people who love me and who I'll have to leave behind -- my son, my daughter, a lover -- I haven't accepted that for them yet."

She advocates greater attention to the different medical and social problems women experience when it comes to AIDS.

"What happened to Joe doesn't mean it will happen to Mary," Ms. Clark said.

"A lot of the studies of HIV have been with gay men," Dr. Solomon said. "But HIV has really moved into the women's community in recent years, and women are clearly different from men. The research from men doesn't tell us what HIV will be like in women."

Doctors have anecdotal evidence, for example, that women with HIV tend to suffer repeated genital tract infections, such as yeast infections, she said. Additionally, there are indications that various cervical diseases, including cancer and precancerous changes in the cells, may be more prevalent in HIV-positive women.

"AIDS is a different disease in women," said Dr. Rodriguez-Trias, a former medical director of the New York state AIDS agency and a board member of the National Women's Health Network.

She cites a paper presented earlier this summer at the international AIDS conference in Amsterdam that showed that less than half of women who were HIV-infected and died fit the current diagnostic profile of AIDS -- which is based largely on how the disease affects men.

The Centers for Disease Control is also looking at the issue: At a conference next month in Atlanta, AIDS professionals discuss the current "case definition" of AIDS and whether it needs to be altered to reflect the different symptoms women may experience.

In the past, the interest in women when it came to AIDS generally fell into two categories, both of which focused on women as transmitters of the virus rather that recipients of it, Dr. Rodriguez-Trias said.

"Because HIV is transmitted mother to child, most of the interest in women when it came to policy and programs was on the child. Women themselves weren't the focus," she said. "The other group of women that got attention were sex workers, because they were giving it to men."

That focus has ignored the larger reality, AIDS professionals said.

"Women are predominantly acquiring this infection from either drug abuse on their own or their partners' drug abuse," Ms. Cromwell said. "It's not from multiple sex partners. Until we're able to control drug abuse, we're not going to be able to control HIV."

The women who have "come out" as HIV-infected tend not to reflect this: Ms. Glaser, the wife of "Starsky and Hutch" actor Paul Michael Glaser, for example, and Ms. Getty contracted the virus from blood transfusions; Ms. Fisher, a wealthy Florida woman whose family has contributed to Republican campaigns, from her husband; Tina Chow, the late style-setter and jewelry designer, from a heterosexual affair; and Kimberly Bergalis, the young Floridawoman, during a dental procedure.

"I do have to commend those women for coming forward. They are affecting the consciousness," Ms. Rouse said.

"I think each woman who comes forward does an enormous service," Dr. Solomon said. "But we as a society need to be as compassionate to the drug user who gets this virus as to women who get it through a transfusion or from their husbands."

Women, however, are less likely to be open about their HIV status because the stigma is perhaps greater for them than men, she and others said. As tennis star Martina Navratilova noted when Magic Johnson, who attributed his contraction of HIV to a promiscuous heterosexual lifestyle, received an outpouring of sympathy, how would the public have felt about a woman who got the virus that way?

"Many of the women I care for have children, and they want to protect them from the stigma," Ms. Cromwell said. "They worry, 'Is it going to get out in the neighborhood that I have AIDS?' "

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