At the end of 2001, UNAIDS estimated that there were 37.1 million adults living with HIV/AIDS. Of those, 18.5 million or about 50% were women. In sub-Saharan Africa, more women than men are infected. Epidemiological studies indicate that women can and do become infected with HIV through sexual transmission more easily and at higher rates than men. For biological, psychological, and/or social reasons, the course of HIV disease may differ in women (Kilian et al., 1999), and the mental health impact of infection has its own place in the study of women.
While women represent a significant and growing part of the pandemic, knowledge and services specific to women continue to lag behind those specific to other HIV-infected populations (Gorna, 1995). For many years, papers on HIV and women were the exception rather than the norm (Sherr, 1996), and women were rarely included in clinical trials. In the late 1990s, research tended to focus on the role of women in vertical (i.e., mother to child) transmission (Mofenson, 1999; Shafer et al., 1999; Wiktor et al., 1999; McIntyre and Gray, 2002) and on child outcomes, rather than addressing women's issues (Pinch, 1994) or tracking maternal outcomes.
This chapter discusses the mental health implications for women living with HIV, which are often inextricably bound with their physical health concerns. It discusses a number of factors to consider in caring for women with HIV, including relationships, sexual behavior, parenting, pregnancy, treatment and adherence, and emotional impact (such as anxiety, depression, grief, bereavement, and coping).