From: repnomar@leland.Stanford.EDU (Janet M. Lafler)
Subject: Re: Feminis
Organization: DSG, Stanford University, CA 94305, USA
Date: Sun, 26 Jul 92 16:19:54 GMT


A number of people have pointed out, now, that HIV infection manifests itself
differently in men than in women, and that women's symptoms, which are often
gynecological, are often ignored and not recognized as manifestations of HIV.
I'd just like to point out that this is not only a matter of doctors ignoring
women's symptoms, it is part of the ways AIDS is legally defined by the CDC.
AID doesn't discriminate, but the CDC does. 

In order to be diagnosed with AIDS you have to a) test positive for HIV and
b) have contracted either one of several "AIDS-defining" infections (e.g.
pneumocystic pneumonia, non-pulmonary TB) or, with some types of infections, 
a combination of two.  The formula for diagnosing AIDS was developed, in the 
U.S., based on the manifestation of the disease in men, because far more men 
have been affected in the U.S. so far.  (This is changing, as more and more 
women are being infected.)  This means that the official definition of AIDS 
often excludes women.  For instance, Kaposi Sarcoma, which is relatively 
common among men (especially gay men) with HIV but rare among women with HIV, 
is an AIDS-defining disease, while cervical cancer, a common late manifesta-
tion of HIV in women, is not an AIDS-defining disease.  Oral Candidiasis 
(thrush) is part of an ARC (AIDS Related Complex) diagnosis, but Vaginal 
Candidiasis (the same infection in a different place) is not.  It's quite 
possible for a woman to die of HIV without ever having met the criteria for 
an AIDS diagnosis.  (It's also possible, though less likely, for a man to die 
of HIV without having met these criteria.  Doctors who work with people with 
HIV are very frustrated by the CDC definitions for AIDS and ARC, which do not 
reflect reality.  CDC is currently revising the definition, but the new def-
initions are not in place yet, and they may not be that much better.)

One of the reasons that this is important is that many government benefits 
are not extended to people with the virus unless they have an official AIDS 
diagnosis.  For instance, in California people with AIDS are automatically 
eligible for MediCal (state health plan), so it can be very important to get 
an AIDS diagnosis.  In San Francisco, there are so many people with HIV that
the people who run Project Open Hand (which delivers meals) have had to re-
strict their services to people with CDC-defined AIDS, because they just don't 
have the resources to serve everybody with HIV-disease.  Just about any ser-
vice for HIV-infected people is geared towards people with an AIDS or ARC 
diagnosis.  So it's a serious problem for women not to be able to be defined
as having AIDS as easily as men, even if they're really sick.

People have pointed out that women with AIDS have a shorter life expectancy
than men once they have been diagnosed.  The figure that I have seen is that
the average life expectancy for women is shorter by about 100 days.  (This
is out of an average life expectancy of 22 months for people diagnosed with
AIDS.)  Part of this discrepancy may be due to race and poverty; women with
AIDS are far more likely to be poor and black than men with AIDS.

I also want to reiterate the idea that forming programs or setting up public
education campaigns aimed at one demographic group doesn't mean that we're
telling everybody else to go to hell.  Different groups are affected by the
disease in varying ways.  Injection drug users need to be taught how to clean
needles, and to be urged not to share needles.  Women need to be told that 
certain gynecological problems may be symptoms of HIV disease.  We have to
take into account that in different cultural communities, the definition of
"homosexual" may be different.  Not everybody needs exactly the same informa-
tion, and we have to make an effort to reach out to people who think that
they aren't likely to get the disease.  

/Janet
-- 
Internet: repnomar@leland.stanford.edu // GEnie: J.LAFLER
"Turnips care deeply about many things," remarked Rush, appearing suddenly. 
"Turnips are strongly emotional vegetables...."