Women and children: increasingly targeted by HIV.

• Position: Includes one AIDS patient's description of his illness - Fight AIDS Worldwide - Cover Story

A young woman sat in a crowded clinic with a small baby, waiting patiently to see a nurse. The child, resting limply in his mother's arms, had not eaten for days and suffered from persistent diarrhoea. While anxious over her baby's health, the mother assumed these were normal, early childhood illnesses.

Instead, she soon discovered that both she and the child were infected by HIV Many women, especially in Africa, find out that they are HIV-positive in this way, said Dr. Sandra Anderson of the Health Care Support Unit of WHO's Global Programme on AIDS (GPA).

"They may test the baby for HIV without asking for consent, and then they test the mother--and the results come back", explained Dr. Anderson. "Women often find out that they're HIV-positive in a very shocking way."

Increasingly targeted by HIV, women may suffer the consequences of the disease more than most. An HIV-positive woman not only lives under her own death sentence, but has to endure damage to her childbearing and nurturing role. She has a 25 to 40 per cent chance of passing HIV to a child in the womb or at birth.

"I think women with AIDS are much more likely to be rejected than men", added Dr. Anderson. "They often end up being blamed."

WHO estimates that by the year 2000, more than 13 million women will have been infected by HIV, the virus leading to AIDS, and about 4 million will have died. In sub-Saharan Africa, women infected with HIV now outnumber men by six to five. In Malawi, infection rates among women attending prenatal clinics increased from about 3 per cent in 1985 to more than 30 per cent in 1993.

Even in industrialized countries, where transmission is most often through homosexual contact or by injecting drugs, there has been an ominous rise in heterosexual transmission, WHO reports. In the United States, AIDS cases in women were 10 per cent higher in 1993 than in 1992.

"A decade ago, women and children seemed to be on the periphery of the AIDS epidemic", Dr. Michael Merson, Executive Director of the GPA told the Second International Conference on HIV in Children and Mothers (7-10 September 1993, Edinburgh, Scotland). "Today, . . . women and children are at the centre of our concern."

What makes women susceptible to HIV?

There are three main reasons, according to WHO, for the growing rate of HIV infections in women:

* Women are biologically more vulnerable, since they have a larger mucosal surface exposed during sexual intercourse. Also, semen contains far higher...