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Women now represent the fastest growing segment of the AIDS epidemic. Heterosexual transmission is the most common mode of HIV transmission for women. Male-tofemale transmission is 1.9 times more effective than female-to-male transmission. Women who engage in anal intercourse are at increased risk of transmission, and some data suggest that oral contraceptives, which can cause cervical ectopy, also increase the risk of HIV transmission. An estimated 42% of HIV-infected women have gynecologic diseases, including vaginal candidiasis, pelvic inflammatory disease, anogenital warts (condylomata acuminata) caused by human papillomavirus, and cervical dysplasia. Some data suggest that esophageal candidiasis, HIV wasting syndrome, disseminated Mycobacterium avium-intracellulare complex (MAI), and recurrent herpes simplex virus may be more common AIDS-defining conditions in women than in men. Early reports of HIV in women suggested that women suffer a more rapid progression of disease and that their survival is lower than that of men. Further analyses, however, have revealed that the poorer outcomes of HIV-infected women are more likely due to poor access to appropriate health care for HIV infection.
