International Conference on Women and Infectious Diseases

On February 27–28, 2004, scientists, clinicians, researchers, women's health advocates, educators, policymakers, and representatives from nongovernmental organizations and community-based organizations gathered in Atlanta for the first International Conference on Women and Infectious Diseases (ICWID): From Science to Action. The Office of Minority and Women's Health of the National Center for Infectious Diseases, Centers for Disease Control and Prevention (CDC), spearheaded the conference. It was cosponsored by the World Health Organization, the Pan American Health Organization, the Department of Health and Human Services (DHHS), and the American Society for Microbiology. 
 
The broad ICWID steering committee included representatives from the DHHS Office on Women's Health, the National Institutes of Health Office for Research on Women's Health, the National Institute of Allergies and Infectious Diseases, the National Institute for Child Health and Human Development, the Fogarty Center, and the Office of Women's Health of the Health Resources and Services Administration. Academic, community-based, and philanthropic organizations as well as numerous CDC entities were involved. The conference's goal was to enhance prevention and control of infectious diseases among women worldwide. The conference's 400 attendees from 25 countries (both industrialized and developing nations) and 30 U.S. states recognized the need for a forum to address the complex set of concerns and issues surrounding women and infectious diseases. 
 
Julie Gerberding, director of CDC and administrator of the Agency for Toxic Substances and Disease Registry, opened the conference with an overview of the impact of infectious diseases on women. The address reminded listeners of the female face of infectious diseases: women may be biologically more susceptible to certain infections and suffer more severe complications. Other keynote speakers included Paul DeLay of the Joint United Nations Programme on HIV/AIDS, Carol Bellamy of the United Nations Children's Fund, and Mirta Roses Periago of the Pan American Health Organization. 
 
The theme of the conference was "From Science to Action." In 35 sessions, attendees discussed practical application of scientific knowledge in areas such as HIV, infectious causes of chronic diseases and other infectious disease–chronic disease relationships, gender roles in infectious disease transmission and prevention, sexual coercion and its effect on infectious diseases in women, sexually transmitted diseases, health disparities, healthcare workers and caregivers, immunization, effective community-based strategies, the role of cultural competence in women's health, and more. 
 
The Bill and Melinda Gates Foundation sponsored 26 ICWID scholarships, which allowed persons from nongovernmental organizations and community-based organizations from 10 countries and four continents to attend who otherwise would not have had the opportunity. These ICWID scholars will amplify the conference's impact by taking the knowledge and insights gained back to their home countries and organizations. 
 
The conference successfully illuminated the female face of infectious diseases. While celebrating successes in the prevention and control of prenatal and neonatal Group B Streptococcus infections and achievements in other arenas, participants emphasized the many challenges remaining for the future. With the continuation of such efforts, the newly spotlighted female face of infectious diseases can also be the face of hope and progress.


Impact of HIV on Women Internationally
Women bear about half of the HIV infections worldwide.In sub-Saharan Africa, 58% of those infected are women; in Asia this figure is 30%.While the epidemic occurs in varied geographic regions, all women are biologically and socioculturally vulnerable.
Our common prevention options fail to take into account women's realities: being in, or wanting to be in, a union; wanting to have children; the imbalance of power in male/female relationships; inaccessibility of education; the threat of sexual violence; and the economic vulnerability that leads to engaging in sexual activity for survival.Female-controlled methods, including female condoms and microbicides, are essential and must take into account these realities.The prevention needs of women already infected with HIV must be addressed by supporting disclosure, fighting stigma, and being sensitive to the threat of violence and disinheritance.
The burden of care for those living with HIV/AIDS most often falls to women and girls.Recognition of the value of this work is vital, as is addressing practical issues that can help alleviate this burden of care.

HIV-Positive Women's Perspective, Advocacy, Sexual and Reproductive Rights
Biomedical, social, and human rights factors are compelling reasons for giving particular attention to women and HIV.However, research on women and HIV/AIDS in terms of treatment, adherence, and opportunistic infections is deficient.Women lack access to treatment, and women's representation in treatment advocacy initiatives remains wanting.
In terms of sexual and reproductive health, women face barriers in accessing treatment for sexually transmitted infections and have inadequate access to prophylactic treatments such as Pap smears and sexual health screenings.Female condoms are often unobtainable, and accelerated research on woman-controlled barriers is needed.Many programs for HIV-positive women lack services to support safe conception, frequently consider women only or primarily in terms of reproduction, and can unethically deny HIV-positive women reproductive health services.
Scientific research, programs, and initiatives should focus on HIV-positive women and their interrelation with treatment, adherence, opportunistic infections, female-controlled prevention methods, and reproductive health.These findings must then be translated into ethical policy and practice.

HIV among Young Women in Developing Countries
Youths (persons 15-24 years of age) are a major part of the HIV epidemic around the world, making up an estimated half of new HIV infections, and young women are typically infected earlier than are men.Young women have both biological and social vulnerabilities.They can be susceptible to "sugar daddy" relationships, they are vulnerable to sex trafficking or coercion, and they have less education, including HIV prevention education, than their male counterparts.Some countries have had success in reducing HIV among young women; however, many program challenges remain: lack of evaluation, limited resources, the unique vulnerabilities of youth ignored, and the lack of influence by young persons.
Fifteen million children 15 years of age and younger have lost one or both parents to AIDS, and this situation also presents challenges, including increased risk of sexual exploitation, the loss of educational opportunities as young people are forced to leave school because they lack school funds or must work to support remaining family members, and the need for HIV prevention education that addresses orphans' special needs.Some promising youth programs have been initiated, among them curriculum-based programs, peer education, and voluntary counseling and testing; however, more resources and evaluation must be devoted to youth programs, and these programs should view youth as assets, not as problems.

Hepatitis B in Women: Domestically and Internationally
Globally, hepatitis B virus (HBV) infection is a major cause of infectious disease-related death, causing approximately 620,000 deaths annually.Without hepatitis B vaccination, an estimated 1.4 million HBV-related deaths would occur in the 2000 birth cohort over the lifetime of the cohort.HBV infections acquired in the perinatal and early childhood periods account for 21% and 48%, respectively, of HBV-related deaths worldwide.Thus, routine vaccination of infants and children serves as the basis for a global hepatitis B prevention program.
In 1992, the World Health Organization recommended that hepatitis B vaccine be included in childhood immunization programs in all countries, but because of financial constraints, many countries were unable to initially implement this recommendation.In 1999, a global initiative began to make hepatitis B vaccine available to children living in 69 of the world's poorest countries, and by the end of 2003, routine childhood hepatitis B vaccination was included in national immunization programs in >151 countries.However, many countries, mainly in sub-Saharan Africa, have not yet introduced the vaccine, and coverage with the three-dose vaccination series remains low in many countries that have introduced the vaccine.When all countries have introduced the vaccine and coverage with the three-dose vaccination series reaches 90%, up to 84% of global HBV-related deaths will be prevented.

Hepatitis B in the United States
In the United States, an estimated 5% of the civilian, noninstitutionalized population has serologic evidence of past or present HBV infection, and 0.4%-0.5% have chronic infection and are the primary source of infection for others.From 1990 through 2002, the incidence of reported acute hepatitis B declined 67%.The incidence of acute hepatitis B among men has been consistently higher than among women.In 1990, the incidence among men and women was 9.8 and 6.3 per 100,000, respectively; in 2002, the incidence was 3.7 and 2.2 per 100,000, respectively.Overall, incidence among women has declined more than among men.Trends in acute hepatitis B reflect poor vaccination coverage among persons who engage in high-risk behavior.
Persons at high risk for HBV infection often seek health care in settings in which vaccination services could be provided.During 1996-1998, approximately half of persons with reported acute hepatitis B previously had been treated for a sexually transmitted disease (STD) or incarcerated: 89% of injection drug users, 35% of men who have sex