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US Women With HIV Get Too Little Support
on STIs and HIV Transmission, CDC Says
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4th International Workshop on HIV & Women, January 13-14, 2014, Washington DC
Mark Mascolini
Only 55% of sexually active HIV-positive women in care in the United States receive clinician counseling about transmission of HIV, according to a CDC survey of a nationally representative sample of women with HIV [1]. Fewer than half of these women got screened for three key sexually transmitted infections (STIs): syphilis, gonorrhea, or chlamydia.
Women account for an estimated 25% of HIV infections in the United States, but research has provided no recent nationally representative estimate of what kind of care they receive. To address that need, Centers for Disease Control and Prevention (CDC) investigators analyzed 1139 women in care for HIV who are part of the Medical Monitoring Project. That program aims to create nationally representative samples of HIV-positive adults in care across the United States and Puerto Rico.
This analysis involved women in care in 2009 who completed an in-person interview and had clinical data available from their medical records. CDC investigators estimated that they represent 114,527 HIV-positive women in care across the country in the study period. (UNAIDS calculates that the United States has 180,000 to 370,000 women with HIV infection.)
While 31% of women were 50 or older, 38% were 40 to 49, 21% were 30 to 39, and 9% were 18 to 29. Black women made up the largest proportion of the study group, 61.5%, while 18% were white and 17% Hispanic. Nearly one quarter of women, 23.5%, reported a lapse in health insurance at some point, and 77% had an annual household income below $20,000.
Most women in the CDC sample, 83%, reported taking antiretroviral therapy, but only 66% had a viral load below 200 copies/mL on their most recent assay. A large majority of women, 87%, had at least two CD4 counts on record, most had received prophylaxis for Pneumocystis pneumonia, if appropriate (82%), most had Pap testing for abnormalities that could presage cervical cancer (77%), and most had influenza vaccination (76%).
But fewer than half of all women had received recommended screening for syphilis (49%), chlamydia (30%), or gonorrhea (28%). Only 50% of all women and 55% of sexually active women said their clinician counseled them on how to prevent transmission of their HIV. Among sexually active women, this rate dwindled with age, with 67% of 18-to-29-year-olds reporting counseling, 61% of 30-to-39-year-olds, 47% of 40-to-49-year-olds, and 53% of women 50 or older.
The CDC team hopes their findings will provide a national benchmark "to characterize patterns of HIV care and monitor changes in care over time among HIV-infected women." They proposed that "efforts to improve adherence to clinical guidelines may help improve treatment of HIV-infected women in the United States."
Reference
1. Short W, Beer L, Do A, et al. Clinical characteristics and quality of HIV care for women in the United States: Data from the Medical Monitoring Project, 2009. 4th International Workshop on HIV & Women, January 13-14, 2014, Washington DC. Abstract 4.
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