Women particularly vulnerable by HIV, its treatment and its social consequences

Women are particularly vulnerable to HIV, drug complications and the social consequences of the disease, considered a stakeholder conference on the epidemic among women.
AIDS in women
This conference "Women and HIV", which was held in Paris, was organized at the initiative of the French Family Planning Movement (MFPF), Act Up-Paris and Sida Info Service. His first day was to end inter-association on a walk from the Porte Saint-Denis to Bastille, with the slogan "AIDS: when to parity."

According to data from the Institute of Health Surveillance (VS), 36% of 6300 seropositivities discoveries in 2006 were women. They remain, however, the majority (58%) of the cases related to heterosexual intercourse. More than half of them (56%) are foreign, mostly in sub-Saharan Africa.

But the vulnerability of women to HIV, in France as elsewhere, all aspects of the disease, whether clinical, therapeutic and social.

In France, the situation is particularly acute among African, less well informed about prevention methods and more at risk of sexual violence, said Dr. Florence Lot InVS. Among HIV-positive migrants are only 17% to gainful employment, against 45% of French women, showed the VESPA study.

As for prostitutes, "particularly hidden and vulnerable population," the study dating back to 1995, showed a prevalence of 2% in those who were not addicts, against 31% otherwise.

According Florence Lot, a study of prostitutes with a health component would be in preparation for the National Federation of Home and reintegration associations (FNARS).

The most common side effects
The fragility of women is also reflected in their increased risk of drug toxicity. Among other effects, several studies have shown an increased incidence of gastrointestinal, liver, skin and lipodystrophy effects, said Dr. Laurence Weiss, Immunology of the Georges Pompidou European Hospital AP-HP (HEGP, , Paris).

In terms of mitochondrial toxicity, they are six times more at risk of lactic acidosis, a rare but severe complication of some nucleoside analogues, according to a study.

There is also the problem of the interaction of HIV with contraceptives and a particularly high risk of osteoporosis, a result both of antiretroviral as menopause, said Dr. Sophie Matheron, infectious disease hospital Bichat (AP-HP, Paris).

Yet despite the many problems that are specific to them, only 12.25% of patients included in the trials of antiretroviral 1990s were women, she recalled, referring to a meta-analysis conducted on 49 studies. The main reason is the possibility of pregnancy, with the risk of pharmacological alterations.

"There was an under-representation of women in research on infection in the 1980s and 1990s," admitted Christine Rouzioux, a virologist at the Necker Children's Hospital (AP-HP, Paris).

However, their role in clinical research is higher in France than in the United States, she tempered. According to her, most national cohorts and include between 25% and 30% of women, a proportion very similar to that which they occupy in the French HIV population.

The virologist, who participated in the expert recommendations or 2006 "Yeni report" indicates that the 2008 edition, featured a "Women and HIV" chapter.

Difficult access to the female condom
Invited to give the opening speech of the conference, the Minister of Health Roselyne Bachelot, hosted by signs "Franchises [medical]: guilty of being sick," lamented that "prevention is based predominantly female still on the condom and on the willingness of the partner to use. "

"The female condom just to win as a prevention tool," noted the minister, who wishes to facilitate access to the second-generation model, including pricing. However, this would cause "difficulties" because there are still "too few manufacturers to really get to put it in competition," she acknowledged.

As for male condoms, Roselyne Bachelot reaffirmed have established "a true partnership with retailers" so they will also be available at 20 euro cents. This is the price as its predecessor Xavier Bertrand had launched at tobacconists and pharmacies.

Also announced by Xavier Bertrand, the presence of condom vending machines in schools, however, seems far from certain. "I note too often a number of boards oppose the effective implementation of these distributors," lamented the minister.