Facts and Figures for HIV and AIDS
By the end of 2002, 159,271 adolescent
and adult women in the United States were reported as having AIDS. Based
on cases reported to the Centers for Disease Control and Prevention
(CDC) through December 2002, more than 57,376 women have been infected
with HIV. Among adolescent and adult women, the proportion of AIDS cases
more than tripled from 7 percent in 1985 to 26 percent in 2002.
Worldwide, more than 90 percent
of all adolescent and adult HIV infections have resulted from heterosexual
intercourse. Women are particularly vulnerable to heterosexual transmission
of HIV. This biological fact amplifies the risk of HIV transmission
when coupled with the high prevalence of non-consensual sex, sex without
condom use, and the unknown and/or high-risk behaviors of their partners.
Younger women are also increasingly
being diagnosed with HIV infection, particularly among African-Americans
and Hispanics. Through December 2002, women aged 25 and younger accounted
for 9.8 percent of the female AIDS cases reported to CDC. HIV disproportionately
affects African-American and Hispanic women. Together they represent
less than 25 percent of all U.S. women, yet they account for more than
82 percent of AIDS cases in women.
Women suffer from the same complications
of AIDS that afflict men but also suffer gender-specific manifestations
of HIV disease, such as recurrent vaginal yeast infections and severe
pelvic inflammatory disease, which increase their risk of cervical cancer.
Women also exhibit different characteristics from men for many of the
same complications of antiretroviral therapy, such as metabolic abnormalities.
Frequently, women with HIV infection
have great difficulty accessing health care, and carry a heavy burden
of caring for children and other family members who may also be HIV-infected.
They often lack social support and face other challenges that may interfere
with their ability to adhere to treatment regimens.
The Nature of
Addiction
Addiction is a progressive,
chronic, primary, relapsing disorder. It generally involves compulsion,
loss of control, and continued use of alcohol and other drugs despite
adverse consequences.
Addiction, treatment, recovery, and relapse
are all dynamic biopsychosocial processes. That is, they are processes
influenced by biological, medical, psychological, emotional, social
and environmental factors. In turn, these factors are influenced by
addiction, treatment, recovery, and relapse.
The primary goal of addiction treatment
is to meet the treatment needs of clients. These needs are biological,
psychological, and social in nature. Accordingly, the effectiveness
of treatment can be measured in terms of the overall biopsychosocial
health of clients, including such factors as decreases in substance
use, improvements in medical and physical health, improvements in psychosocial
functioning, greater employment stability, decreases in criminal justice
system involvement, and relapse prevention preparedness.
(Overview of Addiction
Treatment Effectiveness, U. S. Department of Health and Human Services,
Substance Abuse and Mental Health Services Administration, Office of
Applied Studies, February 2002).
Treatment Effectiveness: Does
Treatment Work?
First, research to date has conclusively
established that treatment can be effective, but there are only preliminary
indications at this time as to why treatment is effective or what it
is within treatment that makes it effective.
Second, some clients have better prognoses
at the start of treatment than others. The variables that suggest better
prognosis include:
§ low severity of dependence and
psychiatric symptoms at admission;
§ motivation beyond the pre-contemplation stage of change;
§ being employed or self supporting; and
§ having family and social supports for sobriety.
Third, some treatment variables have been
reliably shown to produce better and more enduring outcomes. The treatment
variables associated with better outcome in rehabilitation include:
§ staying in treatment (at least
outpatient treatment) longer and being more compliant with treatment;
§ having an individual counselor or therapist and more counseling
sessions during treatment;
§ participating in voucher-based behavioral reinforcement interventions;
§ participating in AA, CA or NA following treatment; and
§ having supplemental social services provided for adjunctive
medical, psychiatric, and/or family problems.
Cost Effectiveness
Drug addiction treatment is cost-effective
in reducing drug use and its associated health and social costs.
§ Treatment is less expensive than
alternatives, such as not treating addicts or simply incarcerating
addicts.
§ For example, the average cost for 1 full year of methadone
maintenance treatment is approximately $4,700 per client, whereas
1 full year of imprisonment costs approximately $18,400 per person.
§ According to several conservative estimates, every $1 invested
in addiction treatment programs yields a return of between $4 and
$7 in reduced drug-related crime, criminal justice costs, and theft
alone.
§ When savings related to health care are included, total savings
can exceed costs by a ratio of 12 to 1.
§ Major savings to the individual and society also come from
significant drops in interpersonal conflicts, improvements in workplace
productivity, and reductions in drug-related accidents.
(Principles
of Drug Addiction Treatment: A Research-Based Guide, National Institute
on Drug Abuse, National Institutes of Health, NIH Publication No. 99-4180,
October 2001).
Women and Substance
Abuse
Information on the natural history, clinical
presentation, physiology, and treatment of substance use disorders in
women is limited. Although women are estimated to comprise 42% of all
persons with substance use disorders in the United States psychosocial
and financial barriers(e.g., lack of child care) prevent many women
from seeking treatment. Other explanations for women’s underuse
of alcohol and drug treatment services may include women’s perception
of greater social stigma associated with their abuse of drugs and alcohol.
Once in treatment, women have been found
to have a higher prevalence of primary comorbidity. Many women with
substance use disorders have a history of physical and/or sexual abuse
(both as children and as adults), which may also influence treatment
planning, participation, and outcome.
Women also tend to have more family responsibilities
and may need more help with family-related problems. There is evidence
that increasing the focus of treatment on concerns specific to women,
such as adding treatment components that specifically address women’s
issues and increasing female staff, improves treatment outcomes for
women.
(Practice Guideline
for Treatment of Patients with Substance Use Disorders: Alcohol, Cocaine,
Opioids, American Psychiatric Association, Am J Psychiatry 152:11, November
2000).
Pregnancy and Substance Abuse
Substance use during pregnancy has the
following implications for both the mother the developing fetus:
§ the health of the pregnant woman;
§ the course of the pregnancy;
§ fetal development;
§ child development; and
§ parenting behavior.
(Practice Guideline for Treatment of Patients
with Substance Use Disorders: Alcohol, Cocaine, Opioids, American Psychiatric
Association, Am J Psychiatry 152:11, November 2000.)
The most well established effect of in
utero substance exposure is fetal alcohol syndrome. Reported effects
of fetal alcohol syndrome in children exposed to high doses of alcohol
in utero include:
§ low birth weight;
§ poor coordination;
§ neonatal irritability;
§ retarded growth and development;
§ craniofacial abnormalities (including microcephaly);
§ cardiovascular defects;
§ mild to moderate retardation;
§ childhood hyperactivity; and
§ impaired school performance.
(Practice Guideline for Treatment of Patients
with Substance Use Disorders: Alcohol, Cocaine, Opioids, American Psychiatric
Association, Am J Psychiatry 152:11, November 2000).
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