The majority of the people infected with HIV have contracted it through sexual intercourse with an infected person (5). Bodily fluids such as blood, semen, and vaginal secretions all may contain the virus. Using a condom can decrease the risk of contacting the HIV virus during intercourse with an infected partner. Another method of infection is through blood transfusion during surgery. A person may receive untested, infected blood, therefore containing the disease. Through mid 1992, 2% of HIV infected adults and 12% of HIV infected children were infected with HIV via blood transfusion (15).

However, the ELISA (enzyme linked immunosorbent assay) test was developed to screen the nations blood supply before used during transfusion procedures (15). Sharing needles during IV drug use is yet another method of contracting HIV. Infected users pass the needle back and forth increasing the risk of spreading HIV. Finally, another method of transmitting this disease is from mother to infant during pregnancy. Infants may be infected with HIV while in the womb or possibly at birth if the mother is infected (5).

WOMEN AND THE HIV ILLNESS: HIV/AIDS was first identified in the United States among gay and bisexual men, and for the first decade of the epidemic, the disease was primarily associated with homosexuality and intravenous drug use in men (6). In recent years, there has been a growing realization that HIV/AIDS is spreading rapidly among women, and rates of HIV infection in women may eventually mirror those in the global epidemic (6). Approximately 61, 4000 women had been diagnosed with AIDS in the United States as of December 1994 (7). In the last decade, the proportion of AIDS cases in women has nearly tripled (7). In 1985, there was a 7%increase of AIDS cases among women, which grew to almost 20% in 1996 (8). Of that total number of cases reported among women, the proportion attributable to heterosexual contact also increased (9).

In 1994, AIDS cases in women attributable to transmission via heterosexual contact surpassed the number attributable to transmission via injection drug use; however, sexual contact with a man who injects drugs accounts for the majority of heterosexual acquired AIDS cases (9). AIDS is the fourth leading cause of death in women ages 25-44 years in the United States (9), and is the leading cause of death among African-American women in the same age group (10). Yet women remain understudied and overlooked. The lack of research specific to women leaves health care providers unprepared to recognized and respond to womens symptoms or experiences and uninformed about their health needs (11). As a result, women are diagnosed at later stages of clinical deterioration and receive fewer health care services to help them survive the illnesses associated with AIDS (11). Therefore, women die sooner from AIDS than men do.

Clinical Manifestations: A recent surveillance study has indicated that from 1995 to 1996 there has been a 23% decrease in the number of deaths from AIDS (6). There has also been a 6% decrease in the number of HIV-infected individuals diagnosed with AIDS (6). The decrease in AIDS-related morbidity and mortality are attributed to the improvements in the medical care, as well as the increased availability of therapies. However, these decreasing trends do not concern women infected with HIV and AIDS. During this same time, women with AIDS-related illnesses increased by 2% with only a 10% decrease in the numbers of AIDS related death (6). The differences reported for women are due to the increasing AIDS cases in women and the lack of drug therapies specific to women (6).

In 1982, the Center for Disease Control and Prevention (CDC) developed a case definition of AIDS based on a list of related diseases and lab evidence for or against HIV infection (12). Over the years, this definition has been modified and used for epidemiological studies and clinical assessments, which frequently tied it to the provisions of certain health and social services (12). In 1993, the CDC expanded the case definition for AIDS in adolescents and adults when they added invasive cervical cancer to the list of AIDS-related diseases (6 12). Although women develop recurrent and resistant gynecological problems as a consequence of HIV infection, they do not meet the CDC criteria for an AIDS diagnosis (12)..