[Viva] Fwd: CATIE News - Health-related issues for women living with and vulnerable to HIV in Ontario

[Tami Starlight]

---------- Forwarded message ----------
From: <mailing at mercury.catie.ca>
Date: Tue, Oct 4, 2011 at 11:20 AM
Subject: CATIE News - Health-related issues for women living with and
vulnerable to HIV in Ontario
To: cosmictami at shaw.ca


*CATIE News - Health-related issues for women living with and vulnerable to
HIV in Ontario*

The HIV epidemic has changed from the early years—from one that affected
mostly gay men and other men who have sex with men to one that increasingly
affects other groups, including people who use injection drugs and
heterosexual men and women.

As a result, the burden of HIV among women is increasing. Social and
economic conditions (such as poverty, gender inequalities and violence) that
fuel the HIV/AIDS epidemic may increase the vulnerability of women to HIV
infection and may make it more difficult for them to access care, treatment
and support. As a result, there may be important differences in how HIV
affects men and women. Recently, an Ontario-based study, called POWER
(Project for an Ontario Women’s Health Evidence-Based Report), released the
results of a gender-based analysis of health and access to healthcare for
women living with and vulnerable to HIV.
Study details

With the help of service providers and people living with HIV, researchers
selected a list of important HIV-related health outcomes. They then used
existing data sources (such as cohort studies and health services data) to
see what could be learned about gender differences in behavioural and health
outcomes.
Key findings *1. Women account for a rising number of new HIV infections in
Ontario*

Women accounted for 1,190 new HIV infections between 2006 and 2008,
representing one quarter of the 4,735 new HIV infections in Ontario
(incidence). The percentage of new infections among women has increased from
3% prior to 2001 to 25% from 2002 to 2008. Heterosexual contact accounted
for the vast majority of new infections (93%). The remaining 7% were in
women who inject drugs.
*2. Women account for 18% of all people living with HIV in Ontario*

An estimated 26,630 people were living with HIV in Ontario at the end of
2008 (prevalence). Women accounted for 4,750 (18%) of infections. In women,
87% of all infections were attributed to heterosexual sex and 13% attributed
to injection drug use. Women who came to Canada from a country where HIV is
endemic accounted for 58% of all new infections in women.
*3. Women, more so than men, report engaging in activities that place them
at risk for HIV infection*

Unprotected sex and sharing of needles and equipment used to prepare drugs
for injection place people at risk for HIV. Forty-seven percent of women
aged 15 to 49 who had multiple sex partners in the past 12 months did not
use a condom during their last sexual encounter, compared to only 35% of
men. Twenty-five percent of women who inject drugs reported injecting with
previously used needles and 44% reported using previously used equipment,
compared to only 14% and 30% of men respectively.
*4. Women who inject drugs and Aboriginal women have the lowest HIV
treatment rates during pregnancy  *

Ninety-five percent of pregnant women in Ontario who received prenatal care
were tested for HIV in 2009. Twenty-eight cases of HIV were identified.
Between 2005 and 2009, 91% of pregnant women who knew they were HIV-positive
took HIV medications, which prevent the vast majority of transmissions of
HIV from mother to child. Women whose HIV infection was attributable to
injection drug use had the lowest treatment rates during pregnancy at 75%.
Compared to other ethnocultural groups, Aboriginal women were less likely to
be on HIV medications during pregnancy.
*5. HIV-positive women who inject drugs report poorer mental health compared
to HIV-positive men who inject drugs*

In a standard survey used to assess quality of life (SF-12), HIV-positive
women who use injection drugs reported greater mental health issues compared
to HIV-positive men who use injection drugs.
*6. Women living with HIV report more bothersome symptoms of HIV than men
living with HIV*

In a standard survey used to assess symptom burden (ACTG symptom index),
women reported a greater symptom burden than men. On average, women reported
4.5 symptoms that bothered them compared to only 3.7 reported by men. The
most commonly reported issues were fatigue or loss of energy (34%);
nervousness or anxiety (25%); pain, numbness or tingling in the hands and
feet (21%); and feeling sad, down or depressed (34%). Women were more likely
than men to report feelings of sadness.
*7. HIV-positive women are less likely than HIV-positive men to consistently
have undetectable viral loads*

Of the HIV-positive people who underwent a viral load test in Ontario in
2008, 63% had an undetectable viral load. Fewer women had an undetectable
viral load than men (58% vs. 64%). It should be noted that this viral load
data included both people on treatment and those not on treatment. People
may not be on treatment for a variety of reasons, including personal
preference, access to care issues, the practice of their physician, etc.
Where to go from here?

The results of the POWER Study suggest that there are many areas for
improvement in HIV prevention, care, treatment and support for women in
Ontario. These include:

   - HIV prevention campaigns aimed specifically at women to promote safer
   sex and safer injection drug use
   - Programs to encourage HIV-positive women, particularly Aboriginal women
   and women who inject drugs, to consider HIV treatment during pregnancy
   - Screening for mental health issues of HIV-positive women who currently
   inject or who have injected drugs
   - HIV-positive women have a higher symptom burden which needs to be
   addressed within the healthcare environment
   - HIV-positive women who currently inject drugs and desire drug treatment
   should be referred to drug treatment programs
   - A multi-pronged approach to treatment and care, which could include
   such initiatives as treatment education for women and initiatives aimed
   at increasing women’s access to care

*—Laurel Challacombe*

REFERENCE:

Bayoumi AM, Degani N, Remis RS et al. HIV Infection. In: Bierman AS, editor.
*Project for an Ontario Women’s Health Evidence-Based Report*: *Volume
2*<http://www.powerstudy.ca/the-power-report/hiv-infection>:
Toronto; 2011.



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