The Changing Presentation of HIV Disease in Women in Rhode Island*

Abstract

The purpose of this study was to evaluate temporal changes in the ethnicity, mode of transmission, reasons for HIV testing, and initial CD4 counts among HIV-positive women in our region between 1985 and 1992. Between 1985 and 1992, 290 consecutive HIV-seropositive women were evaluated at five primary care sites associated with the Brown University AIDS Program. Dividing our population according to the date of entry into the primary care medical system into two time periods (time period 1, before January 1, 1990, time period 2, January 1, 1990–December 31, 1991), women were more likely to be Latina (OR 2.1, 95% CI 1.1–3.9) and heterosexually infected (OR 2.5, 95% CI 1.5–4.1) in time period 2. African Americans and Latina constituted 58% of cases in time period 2 despite representing only 10% of our region's population. In time period 2, a higher percentage of women presented at an asymptomatic stage; 70% of injection drug-using (IDU) women and 50% of nondrug-using women with heterosexually transmitted HIV (compared to 45% and 40%, respectively, in time period 1). The principal reason for HIV testing in both time periods was that women perceived themselves or their partner(s) as at risk for HIV infection. Nearly one quarter of IDUs were first tested in prison in both time periods. In time period 2, a greater number of women were tested due to pregnancy and fewer were tested because of HIV-related symptoms. A growing proportion of known HIV-seropositive women in our region are Latina and African American. Heterosexuals make up a growing proportion of known seropositive women. The number of seropositive female IDUs entering the medical system annually is falling, but they are coming for treatment earlier in the course of HIV disease, which may be due to education programs, particularly in drug treatment centers, as well as mandatory testing in prison. These results suggest future HIV educational/preventive strategies for women should target self-assessment of risk and improved risk assessment by health care workers, particularly in minority communities.