Women and HIV, IX International Conference on AIDS Highlights
The following are several summaries from three studies supported by the National Institute of Allergy and Infectious Diseases (NIAID): the Heterosexual HIV Transmission Study (HATS), the Women and Infants Transmission Study (WITS) and the Women's AIDS Cohort Study (WACS), which are scheduled for presentation at the IX Conference on AIDS in Berlin, Germany. All information from these summaries is embargoed until presentation time. To pursue these or related stories, call the NIAID Office of Communications at (301) 402-1663.
NIAID began HATS, in collaboration with the Centers for Disease Control and Prevention, in 1990 to examine risk factors influencing the transmission of HIV from men to women. NIAID established WITS in 1989, in conjunction with the National Institute of Child Health and Human Development, to address specific questions relating to the natural history of HIV infection in women, including gynecologic complications. In 1992, NIAID funded WACS at the State University of New York Health Science Center in Brooklyn to recruit and follow 450 HIV-infected women. WACS assesses the acquisition and natural history of selected sexually transmitted diseases to determine the effect of HIV infection on gynecologic health among injection and non-injection drug using women.
NIAID, a component of the National Institutes of Health (NIH), supports research on AIDS, tuberculosis, allergies, immunology and infectious diseases. NIH is an agency of the U.S. Public Health Service, part of the U.S. Department of Health and Human Services.
HIV-Infected Women More Likely To Use Condoms, Reduce Risk of Transmitting Virus Poster, Tuesday, June 8, 11:30 a.m. (5:30 a.m. EDT)
A study of women in Brooklyn, N.Y., infected with HIV found evidence that the women are leading safer and healthier lives. Jointly sponsored by NIAID and the Centers for Disease Control and Prevention, the study found that HIV-infected women had reduced their number of sex partners, increased their use of condoms and showed a trend toward stopping their use of illegal drugs.
For the WACS, scientists assessed the sexual behavior and drug use among 130 HIV-infected women who had not yet developed AIDS and 628 uninfected women from the same community. All of the women had a high risk for becoming HIV-infected based on their sexual history. The average number of sexual partners totaled 23.8 for the HIV-infected women, with most women reporting seven. Uninfected women averaged 29.9 total partners, with most women reporting five.
Of those with HIV, 35 percent said they had more than one sexual partner during the year before their infection was diagnosed, but this percent declined to 15 percent after diagnosis. Specifically, the HIV-infected women diagnosed most recently had the lowest levels of risk behavior. However, the percent reporting multiple sex partners changed from 10 to 19.9 to 18.1 percent respectively for women surveyed less than a year, within one to two years and more than two years since their diagnosis. The uninfected women had sexual risk behaviors similar to those of the women with HIV prior to their infection.
After a diagnosis of infection, women were more likely to use a condom with all partners than were the uninfected women. Likewise, infected women who had ever used drugs reduced such activity after diagnosis. For example, those using crack or cocaine declined from 69 to 28 percent and those taking heroin dropped from 56 to 39 percent.
Knowledge of Serostatus and Change in Risk Behavior Among HIV-Infected Women Without AIDS." H. Minkoff, S. Landesman, J. DeHovitz, P. Kelly, A. Duerr and J. Feldman of the State University of New York, Health Science Center at Brooklyn, N.Y., and the Centers for Disease Control and Prevention, Atlanta, Ga.
Couples Don't Always Agree on Whether or Not They Use Condoms Poster, Tuesday, June 8, 11:30 a.m. (5:30 a.m. EDT)
The longer a sexual relationship, the less likely are couples, in which at least one partner has HIV, to agree on whether or not they have used condoms in the last six months, report HATS investigators. Similarly, couples in which both partners are heavy illegal drug users are half as likely to agree about condom use in the last six months as other couples. Neither ethnicity nor age of the individuals, nor differences in ethnicity or age within couples predict who agrees. The duration of HIV infection also is not predictive of condom use.
In the study of 235 sexually active couples, 28 percent disagreed on the frequency of using condoms during the last six months before the survey. No systematic reporting differences were found between men and women: in 13 percent of the couples, the woman reported greater frequency of condom use than the man, while in 15 percent, the man reported greater use. In contrast, among 59 percent of the couples, both partners agreed that they always used condoms and among five percent, both agreed that they never used condoms.
When all 278 study couples are considered, investigators found that men were significantly more likely than women to report abstinence from sexual activity in the last six months.
These results lead the researchers to conclude that responses from both partners should be assessed when studying factors associated with condom use to more accurately estimate the frequency of condom use.
"Within Couple Disagreement on Condom Use: A Report From the Heterosexual HIV transmission Study." Judith Bromberg, Julie Maher, Whedy Wang, Katherine Grijalva at the University of Michigan, Ann Arbor and Janice Cordell of NIAID.
Mom's Use of Cocaine Is More Harmful to Baby Than Her HIV Infection Poster, Tuesday, June 8, 11:30 a.m. (5:30 a.m. EDT)
Children born to HIV-infected mothers who use cocaine are more likely to suffer adverse outcomes at birth from the drug than from the virus, report NIH-supported investigators. Such information is important for scientists examining the effects of HIV infection during pregnancy.
In an analysis of 148 births to mothers participating in WITS, researchers found that regardless of the babies' HIV status, those whose mothers used cocaine during pregnancy had shorter gestations by one to two weeks, birth weights lower by 233 grams, were shorter in length by 1.7 centimeters (cm.) and had smaller heads by 0.7 cm. in circumference.
The investigators used urine toxicology screening tests and the mothers' reports to determine their use of cocaine or crack, heroin, methadone or marijuana when smoking. Investigators assessed tobacco smoking and alcohol use during pregnancy using the women's self reports. Among the 148 mothers, 35 percent used cocaine; 34 percent, other drugs; 43 percent, alcohol; and 53 percent, tobacco. Urine toxicology tests are essential to pediatric HIV studies in the United States, the scientists conclude.
"Maternal Cocaine Use Predicts Adverse Neonatal Outcome More Strongly Than Does Infant HIV Infection: The Women and Infants Transmission Study." Evelyn M. Rodriguez, Kenneth Rich, Lynne Mofenson, Hermann Mendez, Clemente Diaz, Harold Fox, Karen Green, Donald Brambilla from NIAID and the National Institute of Child Health and Development.
Efforts to Boost Women's Enrollment in Clinical Trials Meet With Success Poster, Tuesday, June 8, 11:30 a.m. (5:30 a.m. EDT)
The rate at which women are being accrued into NIAID's clinical trials of HIV therapies has increased greatly since 1986, reflecting specific efforts to encourage them to enroll. Having women participate in the trials is particularly important as the HIV epidemic expands in this population.
Women accounted for 23 percent of adult participants in 1992 in NIAID's AIDS Clinical Trials Group (ACTG), its largest clinical trials network. The investigators found that the percent of women had increased from 6.7 percent in the years 1986 through 1990 to 14 percent in 1991.
Among the ACTG's efforts to encourage women to enroll have been the addition of obstetric and gynecology expertise into the design and conduct of the trials, child care on site, transportation to and from clinical research visits, meals during clinic visits and assistance in accessing social service organizations as well as including social workers, case managers and community outreach workers as staff.
Also, women of color are represented in the ACTG in similar proportion to women with AIDS in the U.S. population, about 74 percent. Investigators also noted that women with a history of drug use are still under-represented in the ACTG, accounting for approximately 26 percent.
Data from two large trials with significant numbers of women, ACTG 076 and 175, will provide answers to important questions concerning treatment of HIV-infected women and the transmission of HIV infection to their children during pregnancy.
"Women's Participation in AIDS Clinical Trials Group (ACTG) -- Enough or Still Too Few?" Joyce A. Korvick, P. Stratton, K. Spino, Constance Wofsy of NIAID and NICHD, Bethesda, Md.; Statistical and Data Analysis Center, Boston, MA; University of California, San Francisco, Calif.