Women and AIDS in the United States: epidemiology, natural history, and mediating mechanisms.

The number and proportion of women with the human immunodeficiency virus (HIV)1 and acquired immunodeficiency syndrome (AIDS) have increased rapidly throughout the past decade. Despite these increases, research attention on women with AIDS has been relatively scarce until recently. It is likely that there are important sex differences at all phases of the disease process-from prevention, through viral exposure, diagnosis, and living with HIV, to treatment for AIDS. Therefore, research findings from studies of men may not all be extended reliably to women with HIV and AIDS. In this article, we review the literature on U.S. women in particular and discuss what differentiates these women from their male counterparts with the disease. We begin with an epidemiologic review and description of the natural history of the disease to lay the foundation for a more complete understanding of the biological and psychosocial factors relevant to AIDS in women. The association between psychosocial mechanisms--including stress, control, and social support--and immune-mediated disease outcomes is discussed in detail. Implications for research, prevention, and treatment also are considered.