Study Attempts to Track HIV Transmission in Women

Out In the Mountains Magazine (April 2000)

Researchers at the Centers for Disease Control and Yale University have launched a three-year study of HIV/AIDS transmission between women.

Scientists will conduct interviews with women in San Francisco, Los Angeles, New York, Washington DC, and Baltimore in hopes of clarifying the risks involved in female-to-female sexual contact.

The confidential interviews will probe the sexual practices and possible risky behaviors of HIV-positive lesbians and women with female partners, not all of whom may identify themselves as lesbians.

When possible, they hope to interview past partners and take viral DNA samples; if all goes well, this will allow them to map transmissions from one woman to another.

Earlier samplings have shown that this may be the medical equivalent of looking for a twig in a haystack.

In a 1998 CDC survey of 109,311 women, 2,220 reported at least one female partner, along with other risk factors. Of these, 347 reported only female partners, but 98 percent of this group also had other risk factors, generally IV drug use. Similarly, in a 1993 University of Texas study of 168 women reporting only female partners, all of them had other risk factors.

To date, there have been only 5 cases where no other risk factor was found.

“Because of the scarcity of data, we can’t say with absolute certainty that female-to-female sexual transmission does not occur,” said Dr Helene Gayle, director of the National Center for HIV, AIDS and TB Prevention, in an interview with WebMD.

Researchers believe such transmission is theoretically possible. The virus is present in vaginal secretions and menstrual blood, so it could ostensibly pass through cuts in the linings of the mouth or vagina.

Most feel that the risk is low, but present. If it can be proven, it will allow public health officials to better educate gay women about those risks.

The CDC has urged women to be aware of their partners’ HIV status, regardless of gender. They have also suggested that partners not share sex toys, and that they use condoms or dental dams during oral sex.

Women with HIV have long been overlooked by medical science.

This neglect arose in part because of the way the AIDS crisis developed. Attention naturally focused on gay men, then IV drug users, then the rest of the population. Coupled with a cultural discomfort with female sexuality, it’s no wonder that women were not established as a risk group until the epidemic was well underway.

By then, the virus had become entrenched. In 1985, women accounted for 7 percent of all AIDS cases; in 1998, the figure stood at 23 percent and climbing. Now HIV is growing faster among women than men.

So why don’t they figure prominently in research and drug trials? It’s actually part of a larger “institutional sexism” in medicine.

Historically, the female body has been viewed as unsuited to research because of hormonal fluctuations or fear of reproductive damage. The male is seen as the norm, with the assumption that what works in one gender will work in the other.

But there’s plenty of anecdotal evidence that HIV/AIDS doesn’t work the same in women. They seem to become sicker with a lower viral load and a higher T-cell count than men, and their survival time is much shorter. And despite the fact that everyone is taking the same drug protocols, the decline in mortality has been nowhere near as sharp for women.

With only 17 percent of federal funding going to woman-targeted research, and even less to studies of lesbians, it may be years before scientists can unravel the different pathways of HIV in the female population.