Author Affiliations: Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention (Drs Hader, Smith, Moore, and Holmberg); and the Epidemic Intelligence Service, Epidemiology Program Office (Dr Hader); Centers for Disease Control and Prevention, Atlanta, Ga.
Context During the past decade, knowledge of human immunodeficiency virus (HIV)
infection in women has expanded considerably but may not be easily accessible
for use in understanding and prioritizing the clinical needs of HIV-infected
Objectives To perform a comprehensive review of epidemiologic, clinical, psychosocial,
and behavioral information about HIV in women, and to recommend an agenda
for future activities.
Data Sources A computerized search, using MEDLINE and AIDSline, of published literature
was conducted; journal articles from January 1981 through July 2000 and scientific
conference presentations from January 1999 through July 2000 were retrieved
and reviewed for content; article reference lists were used to identify additional
articles and presentations of interest.
Study Selection Data from surveillance and prospective cohort studies with at least
20 HIV-infected women and appropriate comparison groups were preferentially
Data Extraction Included studies of historical importance and subsequent refined analyses
of topics covered therein; these and studies with more current data were given
preference. Four studies involving fewer than 20 women were included; 2 studies
were of men only.
Data Synthesis Women account for an increasing percentage of all acquired immunodeficiency
syndrome (AIDS) cases, from 6.7% (1819/27 140 cases) in 1986 to 18% (119 810/724 656
cases) in 1999. By the end of 1998, of all newly reported AIDS cases among
women, proportionally more were in the South (41%), among black women (61%),
and from heterosexual transmission (38%). Of note, increasingly more women
have no identified or reported risk, about half or more of whom are estimated
to be infected heterosexually. It is estimated that a total of at least 54%
of women newly reported with AIDS in 1998 acquired HIV through heterosexual
sex, including women in the no identified or reported risk category estimated
to have been infected heterosexually, meeting the surveillance heterosexual
risk definition. Natural history, progression, survival, and HIV-associated
illnesses—except for those of the reproductive tract—thus far
appear to be similar in HIV-infected women and men. Although antiretroviral
therapy has proven to be highly effective in improving HIV-related morbidity
and mortality rates, women may be less likely than men to use these therapies.
Drug use, high-risk sex behaviors, depression, and unmet social needs interfere
with women's use of available HIV prevention and treatment resources.
Conclusions Continued research on HIV pathogenesis and treatment is needed; however,
emphasis should also be placed on using existing knowledge to improve the
clinical care of women by enhancing use of available services and including
greater use of antiretroviral therapy options, treating depression and drug
use, facilitating educational efforts, and providing social support for HIV-infected
Hader SL, Smith DK, Moore JS, Holmberg SD. HIV Infection in Women in the United States: Status at the Millennium. JAMA. 2001;285(9):1186–1192. doi:10.1001/jama.285.9.1186
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