You gotta have HAART. (FYI).
Before highly active antiretroviral therapy (HAART) became available for the treatment of HIV in 1996, women's likelihood of using antiretroviral therapy was influenced mainly by clinical and behavioral factors; use of HAART, however, is affected by additional factors, some of which reflect possible differentials in access to therapy. (1) Among 1,690 women participating in a multisite longitudinal study, those with low CD4 counts, those with clinical symptoms of HIV or AIDS, and those who had participated in clinical trials had elevated odds of using antiretroviral therapy before HAART was available (odds ratios, 1.4-5.2); recent substance users had reduced odds (0.6). Once HAART became available, its use was predicted by the same factors. In addition, the odds of HAART use were elevated among women with a high CD4 count and a high viral load, some college education or private insurance (1.2-2.4). The odds were reduced among black women and women who had ever injected drugs (0.8 for each). "Given the complexity of these regimens, their expense, and their reliance on near-perfect adherence for efficacy," the researchers comment, these differentials may not be surprising. "The challenge," they conclude, is to ensure that HAART is not restricted to particular subgroups of women.
(1.) Cook JA et al., Use of highly active antiretroviral therapy in a cohort of HIV-seropositive women, American Journal of Public Health, 2002, 92(1): 82-87.
FYI is compiled and written by Dore Hollander, executive editor of Perspectives on Sexual and Reproductive Health.