The Context of HIV Risk Among Drug Users and Their Sexual Partners

Factors Associated With Sexual
Risk of AIDS in Women
Ann O’Leary
INTRODUCTION
Women are increasingly represented among U.S. acquired
immunodeficiency syndrome (AIDS) cases. As of December 1992,
almost 28,000 cases of AIDS in women had been reported to the Centers
for Disease Control and Prevention (CDC) (Centers for Disease Control
and Prevention 1993b). However, nearly half of these (44 percent) were
reported during 1991 and 1992 alone, reflecting a dramatic increase in the
rate of female infection (Centers for Disease Control and Prevention
1993a). The number of cases of AIDS in women has been projected to
become between 55,000 and 75,000 by the end of 1994 (Centers for
Disease Control and Prevention, 1992). As the number of women with
human immunodeficiency virus (HIV) infection and AIDS has grown,
numerous considerations specific to women have arisen. These concern
differences in disease course and treatment, issues in the prevention of
infection, and effects of stigmatization (Ickovics and Rodin 1992;
O’Leary et al. 1993b). This chapter describes the extant research
concerning the structural and personal factors related to sexual risk for
HIV infection in women, with special reference to female partners of
drug users. Following is a brief description of prevention programs that
have been evaluated, a discussion of female-centered prevention
strategies, and recommendations for future research and intervention.
WOMEN AND AIDS: WHO IS AT RISK?
Within the United States, women are a rapidly growing segment of the
population infected with HIV, the cause of AIDS. Their representation
among persons with AIDS, expressed as a percentage of the total AIDS
cases reported, increased from about 3 percent in 1981, when the first
cases were reported to the CDC, to 12 percent in 1990 (Ellerbrock et al.
1991). AIDS is now the leading cause of death among African-American
women of reproductive age (ages 15 to 44) in New York and New Jersey
(Chu et al. 1990). Heterosexual transmission, which appears to be more
efficient when the infected partner is male (Padian et al. 1991), also has
64