National Women’s Health Report
PUBLISHED BY THE NATIONAL WOMEN’S HEALTH RESOURCE CENTER
continued on page 2
Volume 28
Number 2
Published six times a year by
the National Women’s Health
Resource Center
157 Broad Street, Suite 315
Red Bank, NJ 07701
1-877-986-9472 (toll-free)
www.healthywomen.org
INSIDE
4 The Women’s Interagency
HIV Study
5 Of Microbicides & Vaccines
6 Ages & Stages:
HIV & Pregnancy
7 Ask the Expert: 
Commonly Asked 
Questions About HIV/AIDS
8 Lifestyle Corner: 
Living with HIV: 
How to Make it Easier
fter 11 years in an abusive marriage to an alcoholic, Diane Schuster, * a
44-year-old mother of two from Norwich, NY, did something she would
come to regret for the rest of her life. She had an affair with a man from
work. Within a few months, Ms. Schuster became ill with flu-like symptoms.
After searching on the Internet, she realized her symptoms resembled those of
acute retroviral syndrome—
ing showed she was HIV positive. 
A
Within days, Ms. Schuster’s world flipped upside down. Priorities went from figuring out
what’s for dinner, checking her daughters’ homework and rebuilding her relationship with
her husband to worrying about viral loads, CD4 counts and T cells. 
She’s learned a lot about her disease since her diagnosis on March 14, 2006, but the
biggest lesson she learned has nothing to do with the immune system: “I learned that HIV
is not a disease of homosexual men and IV drug users,” she says.
Indeed. Today, the face of the HIV/AIDS epidemic is increasingly feminine. Worldwide,
nearly half of all AIDS cases occur in women,1 while in the United States, 27 percent of
those with AIDS today are women, compared to just seven percent in 1985.2 Additionally,
the annual number of estimated AIDS cases increased 15 percent among women but just
one percent among men between 1999 and 2003.3
Most infected women are young and black: AIDS is the leading cause of death for
African-American women ages 25 to 34 in the U.S. Overall, African Americans make up
nearly 60 percent of all AIDS cases in women in the U.S. with a diagnosis rate 25 times
that of white women and about four times that of Hispanic women.22 Hispanic women
come next, making up about 20 percent of women with AIDS, while white women account
for 16.8 percent.2
And, as many people are aware, the epidemic is much worse in other countries. In sub-
Saharan Africa, for instance, women now outnumber men as victims of the epidemic, making
up almost 60 percent of adults living with HIV and 75 percent of those between the ages
of 15 and 24.1
The reason? “It goes back to literally centuries of unequal treatment of women,” says
Karina Danvers, director of the Connecticut AIDS Education and Training Center at the
Yale School of Nursing in New Haven, who is HIV positive herself. 
“I think HIV/AIDS is one of the many symptoms that come from inequality and society’s
concept of where women belong.” That’s one reason she sees for the higher rates of the
disease in African-American and Hispanic women in this country: “They’ve been taught 
to be even more submissive.”
“Submissive” means that many women feel powerless to insist that men use condoms
during intercourse; that they can be sexually abused and raped; that they may turn to
&Women     HIV
*Not her real name.
drugs or prostitution to cope with 
sexual abuse, poverty and hopelessness.4
In fact, the majority of infections in
women in the U.S. are due to hetero-
sexual transmission (80 percent) or
injecting drug use (19 percent).2
The Virus in Women
Although AIDS began as a gay men’s
disease, the virus seems to infect women
more easily. In fact, studies find that
the virus is two to four times more
transmissible to women than to men.4
Other gender-related findings on the
disease:  
a71 Having another sexually transmitted
infection (STI), such as genital herpes,
increases the risk of HIV infection
up to tenfold, and women are more
likely to have an STI than men.4
a71 Using hormonal contraceptives such
as injectable progesterone or birth
control pills may increase a woman’s
susceptibility to infection.5 However,
most of the studies of hormonal
contraceptives and HIV have been
conducted among women at high
risk of HIV infection, including sex
workers in Africa. It remains unclear
whether hormonal contraception
increases the risk of acquiring HIV
in other populations. Condoms are
the only method proved to prevent
HIV transmission.
a71 Adolescent girls are particularly 
vulnerable to HIV infection. Among
the possible reasons: sexual inter-
course often results in tiny tears in
the genital tract, allowing the virus
to enter;4 their immature genital
tracts provide more exposure for 
the virus; and they’re more likely to
engage in high-risk activities such as
having unprotected sex and multiple
sexual partners. They are also less
likely to negotiate condom use.22
a71 The risk of HIV infection doubles
during and immediately after preg-
nancy. This may be due to high levels
of progesterone, which has been
shown to increase susceptibility to
infection in primates.6
a71 Women tend to be poorer than men,
and HIV infection is linked to
poverty. One reason: Women of high-
er economic status know more about
HIV prevention than poorer women.
In fact, women without a high
school education are 50 percent
more likely to be infected with HIV
than women who graduated high
school, says Ms. Danvers.
Once infected with the virus, women
are affected differently than men. For
instance, women appear to have lower
levels of the virus present in the first
several years of infection.7 No one knows
why this is, says Stephen J. Gange, PhD,
associate professor in the department
of epidemiology at Johns Hopkins
Bloomberg School of Public Health.
But researchers are actively searching
for answers. Women also have more
difficulties accessing care, usually
because of economic issues. Plus, they
often don’t have the time or make the
effort to take care of themselves before
taking care of others.4
“The social and medical aspects of
HIV are tied together,” says Ms. Danvers.
“If you have to take care of the children,
the household and everything else,
you’re going to put yourself last on 
the list. If you do that, you’re not
going to do as well.” 
That could be one reason studies
show that just one in four women 
eligible for the antiretroviral therapy
known as HAART—highly active anti-
retroviral therapy—are on the regimen.8
“If their kids have HIV, women will
make sure their kids take their medi-
cines, but not themselves,” says Ms.
Danvers. One woman she knows sent
her kids to summer camp instead of
using the money to buy a refrigerator
WOMEN & HIV   continued from page 1
2 National Women’s Health Report   June 2006
EXECUTIVE DIRECTOR
Elizabeth Battaglino Cahill, RN
EDITORIAL DIRECTOR & MANAGING EDITOR
Heidi Rosvold-Brenholtz
DIRECTOR OF COMMUNICATIONS
Amber McCracken
WRITER
Debra L. Gordon
NWHRC MEDICAL ADVISOR
Pamela Peeke, MD, MPH
Bethesda, MD
EDITORIAL ADVISORS
Susan R. Barringer, RN, MPH
Consultant for the Connecticut AIDS Education 
and Training Center 
Yale School of Nursing 
New Haven, CT 
Karina Andrea Danvers, BS, MA 
Director, Connecticut AIDS Education 
and Training Center 
Yale School of Nursing 
New Haven, CT
Stephen J. Gange, PhD
Associate Professor
Department of Epidemiology
Johns Hopkins Bloomberg School of Public Health
Baltimore, MD
Betsy C. Herold, MD
Chief, Division of Pediatric Infectious Diseases 
Professor of Pediatrics 
Mount Sinai School of Medicine 
New York, NY
Gina Wingood, ScD, MPH
Associate Professor of Public Health
Agnes Moore Endowed Faculty in HIV/AIDS Research
Director, Social and Behavioral Science Core, 
Center for AIDS Research
Emory University
Rollins School of Public Health
Atlanta, GA
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The National Women’s Health Report provides health
information for women interested in making informed
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suggest individual diagnosis or treatment. This publication
is not a substitute for medical attention. The publisher
cannot accept responsibility for application of the
information herein to individual medical conditions. The
National Women’s Health Resource Center does not
endorse or promote any medical therapy or device.
Opinions expressed by individuals consulted for this issue
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to address above or call toll-free number.
for her medications. “She felt her
kids’ needs came first.”
Other issues that may predict
why women don’t take HAART
include a history of sexual abuse,
illegal drug use and race, with
white women being twice as likely
to be on HAART as African-
American or Hispanic women.
One reason may be that women
who have been sexually abused
find it difficult to have trusting
relationships with their health care
professionals, preventing them
from sharing personal information.
Additionally, a damaged self-image
can lead women to ignore their
own care.8
When researchers in the Women’s
Interagency HIV Study (WIHS)
asked eligible women why they
weren’t taking HAART, 15 percent
said their health care professionals
hadn’t prescribed it. The rest said
they felt “too healthy, wanted to
wait, were afraid of side effects or
had difficulty taking the medicine.”8
Breakthrough Medical Therapies:
Women’s Mixed Blessing 
The introduction of the anti-
retroviral drugs in the mid 1990s
changed the outcome of AIDS like
nothing else. “We have witnessed
one of the most remarkable rever-
sals of fortune in any disease in
the history of medicine,” noted an
editorial in one medical journal in
2004. In 1984, the median survival
for someone just diagnosed with
AIDS was six months. Today, it 
is at least 10 years.
“We no longer talk about the
pure natural history of HIV/AIDS,”
says Dr. Gange. “We talk about the
treated history of HIV infection.”
The therapies have been a mixed
blessing for women, however. While
they work just as well in women
as in men, they seem to cause
more frequent and more severe
side effects than in men, including
diarrhea, nausea, nerve damage,
kidney stones and pancreatitis.
Ms. Danvers, who was infected
by her ex-husband in 1984 and
diagnosed five years later, can 
definitely relate. “I have diarrhea
six times a day, I’m constantly
nauseous, and a terrible headache
has become part of the back-
ground every day. It’s not life-
threatening, but it’s life-affecting.”
Stigma Remains
Even though the AIDS pandemic
is more than 20 years old, the
stigma attached to the infection
remains, particularly for women,
says Gina Wingood, ScD, MPH,
associate professor of behavioral
science and health education at
Emory University in Atlanta. 
“The stigma that is directed
toward women with HIV is differ-
ent and more damaging than the
stigma for men,” she says. “When
you talk about women living with
HIV, you’re raising issues of her
having had sex with a drug user,
being unfaithful to a partner….
We don’t have these social gender-
stigmatizing issues toward men, even
heterosexuals.” This, in turn, affects
women’s self-esteem and makes
them less likely to seek HIV testing
because of their fears of stigma.
“A lot of people are ignorant
about AIDS,” says 45-year-old
Sharon,* who has been HIV 
positive since 1994 when she 
was infected while she worked in
a health care facility. “They don’t
understand it, and they still don’t
know that this is not a disease
where if you hug someone you’re
going to get infected.”
The stigma can be especially
strong in certain cultures, like the
Hispanic culture. That’s one reason
for a grassroots social marketing 
effort called “HIV Stops with
Me” (www.HIVstopswithme.org).
It aims to reduce the stigma asso-
ciated with HIV and acknowledge
the powerful role HIV-positive
people have in ending the epidemic. 
3
Women make up 
27 percent of those
living with AIDS in the
U.S. today, compared 
to about seven percent
in 1985.
National Women’s Health Report 
continued on page 4
*Not her real name.
Resources 
AIDS Vaccine Clearinghouse
www.aidsvaccineclearinghouse.org
Launched by the AIDS Vaccine Advocacy
Coalition (AVAC), a nonprofit community
and consumer-based organization, the
clearinghouse is a comprehensive and
interactive source of AIDS vaccine
advocacy information. 
The Body.com
www.thebody.com
Offers bulletin boards, breaking news,
research information and other content on
HIV and AIDS. Its mission is to demystify
HIV/AIDS and its treatment, improve
patients’ quality of life and foster
community through human connection.
U.S. Centers for Disease Control 
1-800-232-4636
www.cdc.gov/hiv
The CDC provides information about the
prevalence of HIV and AIDS as well as
consumer information on the disease 
and treatment.
National Association on HIV Over Fifty
617-262-5657
www.hivoverfifty.org
Provides educational, prevention, service 
and health care programs.
National Institute of Allergies 
and Infectious Diseases
301-496-5717
www.niaid.nih.gov 
Part of the government-funded National
Institutes of Health. Provides consumer
information on the virus, treatment, 
research and clinical trials.
*Not her real name.
National Women’s Health Report
The majority of
infections in women 
in the U.S. are due 
to heterosexual
transmission 
(80 percent) or
injecting drug use 
(19 percent).
WOMEN & HIV   continued from page 3
The Women’s Interagency HIV Study 
t the start of the AIDS epidemic in 1983, the National Institutes of Health began a large, multicenter study
designed to collect information on the disease, its treatment and its victims—in men. It would be another 10 
years, however, before it funded a similar study for women—the Women’s Interagency HIV Study (WIHS).
But the researchers in the WIHS have more than made up for lost time. Since it began, it has enrolled more than
2,800 HIV-infected and 950 HIV-uninfected women in six sites around the country, making it the largest study in
the United States to focus on HIV infection in women. 
One critical finding: The virus has no sex bias. Overall, says Stephen J. Gange, PhD, associate professor in the
department of epidemiology at Johns Hopkins Bloomberg School of Public Health and principal investigator of the
study, “the general pattern that predicts the occurrence of opportunistic infections and death is pretty similar in men
and women.” In other words, women get sick and die at the same rate and in the same timeframe as men. 
Over the years, the study has shaped the way HIV/AIDS is treated in women. It identified the best time to begin
HAART in women, evaluated women’s satisfaction with their medical care and discovered that HIV-infected women
have increased rates of infection with HPV, the virus that causes cervical cancer. Researchers also learned that hor-
monal contraceptives have no impact on the effectiveness of HAART, a study responding to concerns raised by a
participant of the study’s community advisory board. 
Ongoing studies are examining the impact of menopause on retroviral therapy and HIV-infected women; the
long-term effect of retroviral therapy as women live longer with the disease; changes in blood fats and glucose levels
from HIV therapies; and how the virus and treatment impacts women’s cardiovascular health. 
One of the most impressive aspects of the study, says Dr. Gange, is the long-term commitment of its participants,
most of whom are inner-city, low-income, minority women. More than 80 percent have participated more than five
years.
One reason for their commitment, he says, is the respect and caring shown by the study’s health care professionals.
“They’ve formed a strong link,” he notes. “We’re saying that we don’t view you as research subjects; you are partic-
ipants in a study, and hopefully we’ll be able to show that this research is relevant to your own lives.”
To learn more about the WIHS, go to https://www.statepiaps.jhsph.edu/wihs/. 
A
One of those people is
Maricela Berumen, a 29-year-old
Hispanic woman who posted her
story on the campaign’s Oregon
Web site. “At first I kept my
HIV status a secret,” she wrote.
“I didn’t want anyone to find
out, not even my family. I was
afraid of their reaction, afraid of
being rejected and feared the 
indignation if people found out 
I was infected with the virus
(HIV).” She eventually went
public, she wrote, because
“HIV/AIDS is real and affects 
all races, ages and genders.”
Another major issue for HIV-
infected women is whether to tell
their children. Sharon still hasn’t
told her 21- and 17-year-olds. “I’m
not sick as long as I keep taking
my meds,” she says. “I just don’t
feel my children need to know.”
Meanwhile, Karen,* 43, has
told three of her five children,
ages 29 to 16. “They didn’t
understand at first,” she says,
but some family and individual
counseling helped. “Now they
understand, and they know that
I’m not going to die.” 
She gave birth to two of her
children after her diagnosis in
1983, but thanks to the drugs
she took during pregnancy and
labor (see HIV & Pregnancy on
page 6), neither has the virus. 
Ask these women what mes-
sage they’d like to pass on to
other women with the virus, and
they don’t hesitate: “Don’t put
yourself down. Learn and under-
stand about the disease, find a
support group and know that
you’re not alone.”a24
*Not her real name.
5
hile condoms are
excellent (at prevent-
ing the virus from
infecting another
person), it’s often difficult for
women to negotiate the use of
condoms,” says Betsy C. Herold,
MD, professor of pediatrics and
microbiology at Mount Sinai
School of Medicine in New York
and a leading researcher on the
use of microbicides to prevent
HIV. “It’s imperative that there
be alternative strategies available
to women for their own health.” 
Enter microbicides. The micro-
bicide is a substance that will
either kill or reduce the infectivity
of the virus. Microbicides could
be infused into sponges, formed
into time-release suppositories or
developed as intravaginal rings
that work for weeks or months.
Microbicides come with an
added bonus: Many are also
effective against other sexually
transmitted infections, including
herpes, chlamydia and gonorrhea.11
Today, five microbicides are
being tested in six late-stage 
clinical trials involving tens of
thousands of women in the 
United States and developing
countries. Some work by disrupt-
ing the viral envelope, blocking
the virus’s entry into cells or
making the vagina itself hostile
to the virus, while others disrupt
the virus’s life cycle.
The trials are expected to wrap
up in 2007 at the earliest, says
Dr. Herold, at which time the U.S.
Food and Drug Administration
will consider their approval.
While microbicides show great
promise, safety is a major concern.
Studies found that one microbicide
thought to protect against HIV—
nonoxynol-9—actually increased
the risk of transmission, because
it irritated the lining of the vagina.
Once one or more microbicides
are approved, Dr. Herold predicts
that future research will focus on
developing combination microbi-
cides, “so we can hit the virus at
several different steps.” This
would also help prevent the virus
from becoming drug resistant.
“The concept of vaccines is
very exciting, and they are our
greatest hope for HIV prevention
in the long term, but they have a
long way to go in their develop-
ment,” Dr. Herold says. One
challenge is that the virus attacks
the immune response, yet vaccines
rely on a strong immune response
to prevent infection—a kind of
medical catch-22. Another chal-
lenge is that the virus is constantly
changing. Developing a vaccine
that will work long term is like
trying to hit a moving target.
Nonetheless, the National
Institutes of Health has initiated
or conducted more than 75 clinical
trials of more than 35 vaccines.
Ten new vaccines entered clinical
trials in the past two years and
six to eight are expected to begin
testing within the next 18 months.12
However, despite almost twenty
years of research and more than
$500 million spent in recent years
on vaccine research (compared
to about $52 million a year for
microbicidal research),13 a safe
and effective vaccine is not likely
to be available for at least anoth-
er five to 10 years, she predicts.a24
Of Microbicides & Vaccines 
The more you read about women and HIV, the more depressing it
can get. But there is hope on the horizon—closer than you might
expect. While HIV vaccines have garnered most of the attention
and funding, a more realistic preventive approach for women is
microbicides, “chemical condoms” that sabotage the virus. W
Since the beginning 
of the epidemic 
in the U.S., 176,190
women and female
adolescents have been
diagnosed with AIDS.
“
HIV/AIDS Glossary  
a71 Antiretroviral: A drug that suppresses the activity or
replication of retroviruses such as HIV by interfering
with various stages of the viral life cycle.  
a71 Acquired Immunodeficiency Syndrome (AIDS): A 
disease of the body’s immune system caused by the
human immunodeficiency virus (HIV). AIDS is char-
acterized by the death of CD4 cells (an important
part of the body’s immune system), which leaves the
body vulnerable to life-threatening conditions such
as infections and cancers.
a71 AZT (zidovudine): Sold under the brand name 
Retrovir, a drug approved for use as part of combi-
nation antiretroviral therapy to treat HIV disease.
a71 HAART: Highly active antiretroviral therapy. 
Combinations of drugs people with HIV take to 
control the virus.
a71 Human Immunodeficiency Virus (HIV): The virus that
causes Acquired Immunodeficiency Syndrome (AIDS).
a71 Microbicide: An agent that inactivates, kills or
destroys microbes like viruses. 
a71 T cell: A disease-fighting white blood cell, including
CD4 and CD8 cells. HIV infects and kills CD4 cells,
weakening the immune system. The number of CD4
cells in a blood sample indicates the health of the
immune system. 
a71 Viral load: The amount of viral genetic material 
in the blood or other tissues, often expressed as
number of copies per milliliter (mL).  
oday that’s all changed.
Given the appropriate
treatment, the transmis-
sion rate from mother to
infant is as low as two percent,
with some studies showing a
zero transmission rate, says
Susan R. Barringer, RN, MPH, 
a consultant for the Connecticut
AIDS Education and Training
Center at the Yale School of
Nursing in New Haven. Without
treatment, however, women have
a one in four chance of passing
the virus on to their babies.
Those figures are important,
since between 6,000 and 7,000
HIV-infected women give birth
every year in the U.S.14 It’s a 
figure likely to increase as the
virus becomes more prevalent 
in women and as more HIV-
positive women, optimistic
about their future because of 
the newer therapies, choose to
have babies.
As one HIV-infected woman
wrote on an Internet bulletin
board for women with the dis-
ease: “Having a child is, in my
book, the one thing I don’t think
I could live without … I think it
is time for (HIV) positive women
to recognize the possibilities for
them of childbirth.”
Still, about 90 percent of
pregnancies in HIV-infected
women are unplanned.15
The good news is that infected
women who become pregnant
do not have higher rates of mis-
carriage, ectopic pregnancy and
stillbirth than women not infect-
ed with the virus, indicating that
HIV-positive status does not 
necessarily affect the pregnancy
itself.15
The first step to preventing
transmission between mother
and baby is identifying HIV-
positive pregnant women. Yet 
in 2000, 29 percent of HIV-
infected infants (between 80 
and 110) were born to mothers
who either didn’t know or didn’t
tell anyone they had HIV infec-
tion prior to the birth.16
One reason pregnant women
don’t get tested is because their
health care provider doesn’t rec-
ommend it or doesn’t send the
message that it’s important. If
they do, Ms. Barringer says,
“women are very, very open to
testing,” particularly if they trust
their provider and the issue is
framed as a way of maintaining
good health for mom and baby.
To that end, Ms. Barringer
has a message for women’s
health care professionals who
don’t recommend screening:
“Make no assumptions about
your patients’ risk or apparent
lack of risk.” 
As soon as an HIV-positive
woman finds herself pregnant,
or a pregnant woman tests HIV-
positive, she should discuss
treatment during pregnancy with
her health care professional. If
she has a low viral load and a
high CD4 count, and she hasn’t
started retroviral therapy yet,
she may only need to take AZT
(zidovudine), the first drug ever
approved for the treatment of
AIDS, during pregnancy. Most
women, however, will likely
need a combination of drugs.
Another way to reduce the
risk of transmission to the baby,
says Ms. Barringer, is to have an
elective caesarian. This avoids
the trauma of a vaginal birth,
during which tiny tears and
scrapes in the baby’s skin could
provide access to the virus.
After birth, babies born to
HIV-infected women test posi-
tive for the virus, because they
have their mother’s antibodies
(HIV tests measure antibodies to
the virus). The infants’ true sta-
tus, however, won’t be known
for another three to six months.
Nonetheless, all of the babies
receive treatment just in case,
until their HIV status is verified.
After the birth, HIV-infected
women should not breastfeed,
said Ms. Barringer, because
breastfeeding increases the risk
of transmission by 15 percent.
The only exception is if women
live in areas with unsafe water,
are unable to provide formula
for their babies or face stigma
associated with not breastfeeding
that could threaten their safety.
In the end, she says, the message
she’d like to get to pregnant
women or women planning a
pregnancy is that testing for 
HIV not only benefits their own
health, but their babies’, too. 
“I think that’s a really important
message for women to share
with others they know.” a24
National Women’s Health Report 
HIV & Pregnancy 
When the AIDS epidemic began, its most
innocent victims were the babies. Infected 
in utero or via breastfeeding, most died before
they were old enough for kindergarten. 
&AGESSTAGES
T
6
Yes, you can. While the 
likelihood of the virus’s
transmission isn’t as high during
oral sex as during vaginal or
anal sex, there are cases in which
the virus has been transmitted
this way. For instance, you may
have sores or cuts in your mouth
through which the virus could
enter. And, of course, semen and
vaginal fluid may contain the
virus, which could enter your
body through cells lining your
mouth.
If you choose to perform oral
sex, make sure your male partner
uses a condom. Female partners
should use a dental dam or a
cut-open condom in their mouth
to create a barrier. You can even
use plastic food wrap as a barri-
er during oral sex with a woman
or as an added protection during
oral sex with a man.
——Beryl A. Koblin, PhD
Head, Laboratory of Infectious Disease Prevention
Member, Lindsley F. Kimball Research Institute
The New York Blood Center
New York, NY
I’ve just been diagnosed with
HIV. I’m so confused and
upset I don’t know what do.
Where do I start? 
The first step, if you haven’t
already, is to find a physician
who specializes in HIV/AIDS.
This disease and its treatment are
so complicated that a general
practitioner will not be able to
take care of you as well. 
Ask what your viral load is
(how much virus is in your sys-
tem) and get your T-cell count,
which tells you how well your
immune system is doing. These
numbers provide a picture of
your medical status.
Then identify a support sys-
tem. Your support system doesn’t
have to be large; just one or two
people you trust and feel com-
fortable with. In fact, it’s a good
idea to let them know you’re
going to be tested and have one
of them with you when you get
the results.
If you need to start on anti-
retrovirals, decide if you want 
to go through your insurance
company—which alerts them to
your HIV status—or pay for it
yourself to protect your privacy.
I also recommend you have a
support system in place when
you start taking the drugs and
take some time off from work,
because the initial side effects
can be harsh. 
You also need to learn to
incorporate the virus into your
life, particularly your sex life.
That means practicing safe sex.
If you don’t know how to use
condoms, or how to negotiate
their use with your partner, talk
to a social worker or counselor
who specializes in HIV/AIDS.   
Then there’s the issue of when
to disclose your status. When 
to tell can be very tricky. Some
people might treat you well, but
others may start seeing you as a
dying person. Ditch the latter—
you don’t need that type of 
person around.
——Karina Danvers
Director of the Connecticut AIDS Education 
and Training Center 
Yale School of Nursing 
New Haven, CT
7
Commonly Asked Questions about HIV/AIDS
Can I get HIV through oral sex? 
National Women’s Health Report 
ASK THE
EXPERT
Q
References
1 The Global Coalition on Women and AIDS. World
Health Organization. www.unaids.org. 
2 Centers for Disease Control. HIV/AIDS Surveil-
lance Report, 2004 (Vol 16). Atlanta: US Depart-
ment of health and Human Services, CDC; 2005:
1–46. www.cdc.gov/hiv/topics.
3 Centers for Disease Control. HIV/AIDS Surveil-
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ment of health and Human Services, CDC; 2005:
1–46. www.cdc.gov/hiv/topics/
4 Turmen T. Gender and HIV/AIDS. Int J Gynaecol
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5 Lavreys L, Baeten JM, Martin HL Jr, et al. Hor-
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tion: results of a 10-year prospective study.
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a prospective study. Lancet. 2005 Oct
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7 Anastos K, Gange SJ, Lau B, et al. Association of
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8 Cohen MH, Cook JA, Grey D, Medically eligible
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9 Schooley RT. Starting highly active antiretroviral
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TF. Sex differences in pharmacokinetics and
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11 Madan RP, Keller MJ, Herold BC. Prioritizing
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infections: first-generation vaginal microbi-
cides. Curr Opin Infect Dis. 2006
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http://www.nih.gov/od.
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A Q
A
or example, you need 
to know how to manage
your disease beyond 
medication. As with 
any chronic health condition,
lifestyle choices can make a
huge difference in your health.
They can work with medica-
tion to strengthen your immune
system and reduce side effects. 
Specifically:
1. Quit smoking. Maybe you
think that since you’re sick
anyway, it doesn’t matter if you
smoke. Well, it does. A study
on men (there’s one on the way
about women) found that HIV-
positive people who smoked
were more likely to develop
respiratory symptoms, chronic
obstructive pulmonary disease
and bacterial pneumonia than
HIV-positive men who didn’t.17
Doesn’t your body have
enough to deal with without
adding tobacco to the mix? 
2. Talk to someone. There’s a
misconception out there that
just because we now have fairly
effective therapies for HIV/AIDS,
those living with the disease have
an easier time of it emotionally.
One of the few studies to look
at the psychological state of
HIV-infected women taking
retroviral therapies, however,
found most were still very dis-
tressed and having significant
difficulties adjusting. I urge
you to find a therapist, support
group, a friend, a spiritual
leader—anyone—who will 
listen to your concerns with
empathy. Many clinics offer
such counseling for HIV-
infected people on a sliding-
scale or free basis.18
3. Seek help for depression. In
a woman with HIV, one study
suggests that the worse the
depression, the higher the
amount of virus in your blood
and the less likely you are to
take your medications.19 If you’re
feeling depressed, talk to your
health care professional. A com-
bination of counseling and/or
antidepressant medications
may help.
4. Try to see an HIV or infec-
tious disease specialist. Studies
show that women are more likely
to receive recommended anti-
retroviral therapy from these
specialists than from other
doctors.20
5. Get regular Pap tests. If you
have HIV, you’re more likely
to develop cervical lesions that
could lead to cervical cancer.
In fact, the development of
cervical cancer is now considered
a sign of AIDS for women with
HIV. The U.S. Centers for 
Disease Control recommends
a Pap smear upon diagnosis
and six months later. If neither
show any problems, you
should have one every year
thereafter if you don’t have
symptoms, every six months if
you have HIV symptoms, prior
abnormal Pap smears or signs of
HIV infection.
6. Follow a low-fat, high-fiber
diet. You have a higher risk of
developing high cholesterol,
most likely because of the anti-
retroviral therapy. Saturated fat
—found in whole-fat dairy and
other animal products—is one
of the major culprits when it
comes to high cholesterol levels.
Meanwhile, fiber is impor-
tant, because people taking
certain antiretroviral medica-
tions tend to develop lipodys-
trophy, a condition in which
fat accumulates in the back
of the neck and around the
abdomen. These medications
may also increase your risk of
diabetes. There’s some evidence,
however, that a high-fiber diet
can reduce some of this fat
accumulation and the risk of
diabetes. Try a Mediterranean
diet, which includes lots of
whole grains, vegetables, fruits
and healthy oils, like olive and
fish oil, and small amounts of
animal protein.21
7. Hit the weight room a couple
of times a week. Building muscle
is important in this disease, in
which “muscle wasting” may
occur. It can also help prevent
insulin resistance, reduce tri-
glycerides and shrink abdominal
fat if you have lipodystrophy.
And don’t forget regular aerobic
exercise, like walking, running
on a treadmill, riding a bike or
swimming. Talk to your health
care professional before begin-
ning any exercise program.a24
LIFESTYLE
CORNER
By Pamela Peeke, MD, MPH
NWHRC Medical Advisor
Dr. Peeke is a Pew 
Foundation Scholar in
Nutrition and Metabolism, 
and Assistant Clinical 
Professor of Medicine at the
University of Maryland in
Baltimore. She writes about
health and lifestyle issues
important to all women.
Living with HIV: How to Make it Easier 
HIV: yet another health issue we now know has unique
effects on women. But thanks to intense research over the
last 10 years, our understanding of this dreadful disease
has grown significantly. However, if you’re living with HIV,
you may feel there’s so much more you need to learn. F
National Women’s Health Report  8