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HIV/AIDS in WomenIn early June of 2001, the Federal Centers for Disease Control marked the anniversary of a turning point in modern medicine, if not in modern history. Twenty years earlier, the CDC had issued its first report on the disease we now call AIDS.(1) That report described five cases of an unusual form of pneumonia, pneumocystis carinii pneumonia (PCP), in young homosexual men.
PCP is caused by a normally harmless organism that is widespread in the human body. Until then, it was known to cause disease only in people whose immune systems had been weakened, usually by cancer or cancer treatments. The men in the CDC report, however, did not have cancer or any other known health problem. CDC experts concluded they were seeing something new, which they called "cellular-immune dysfunction related to a common exposure," and characterized as "a disease acquired through sexual contact."
As other similar case reports came in, risk groups were defined: gay men, Haitians, IV drug users. Tests that measured victims' cellular immunity told the same story over and over again: loss of T-lymphocyte cells, which are important players in the human immune system, and poor lymphocyte response to infections. Soon afterward, other associated illnesses and conditions were identified, including lymphadenopathy, or swollen lymph nodes; Kaposi's sarcoma; and various fungal and parasitic diseases.
In January 1983, the CDC reported on two women with impaired immune systems who were sexual partners of men with AIDS.(2) One was a 37-year-old African American woman with thrush (oral candidiasis), lymphadenopathy (swollen glands) and PCP. Blood studies showed lymphopenia (low levels of lymphocytes in the blood) and undetectably low levels of T-helper cells, another sign of a severely impaired immune system. Her steady male sexual partner for the previous six years had been a man with a history of IV drug use who had died of AIDS in November of 1982. The second case was a 23-year-old Hispanic woman, also with lymphadenopathy, lymphopenia, and decreased T-helper cells. Her steady sexual partner was a bisexual male who had developed AIDS symptoms in June of 1982: lymphadenopathy, oral candidiasis, PCP, and Kaposi's sarcoma.
Twenty years later, these two women remain typical of the largest subgroup of women with HIV/AIDS in the U.S. today: members of a racial or ethnic minority who acquired the disease through heterosexual transmission from a bisexual or IV drug-using partner. Second in size to this group is the subgroup of women with HIV/AIDS who are themselves IV drug users.
A Virus That Does Not DiscriminateAIDS entered the United States primarily through the gay male population (the current scientific term is "men having sex with men," or MSM). In the beginning, some thought the disease affected only gay men. It did not take long for it to become clear that AIDS was caused by a nondiscriminating virus, first called human lymphotropic virus type III/lymphadenopathy associated virus (HTLVIII/LAV) and later renamed human immunodeficiency virus type 1 (HIV-1). This was a disease that would infect and kill anyone if the circumstances were favorable. One favorable circumstance was transmission from one IV drug user to another through a shared hypodermic needle. Another was transmission through heterosexual sex.
What Should We Call It?Before the virus causing AIDS was identified, the CDC created what is known as a "surveillance definition." This is a provisional definition made for the purpose of gathering information about a new disease. In the case of HIV/AIDS, the original surveillance definition included constitutional symptoms; neurologic conditions; opportunistic infections called by viruses, bacteria, fungi and parasites; and cancers. As with other surveillance definitions, it was revised as new data came in. In 1992, the 1987 definition was expanded. This led to a sharp peak in the incidence curve, as shown in Figure 1 below.
Estimated Incidence of AIDS and Deaths of Adults and Adolescents with AIDS*, 1985-2001, United States.
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