Help female patients guard against HIV/AIDS

Women now represent nearly 20% of all adult AIDS patients in the United States, and the greatest increase is in heterosexual transmission. How can you help your female patients understand and take action against HIV risks?

1. Help patients negotiate — and sustain — condom use. How many of your patients start a new sexual relationship using condoms, only to drop condom use after just a few weeks? asks Linda Dominguez, OGNP, family planning clinician and consultant in Albuquerque, NM. If you discover that your patient has stopped using condoms, get her to tell you the reason.

It’s important for women to hear themselves say the reasons behind such an important decision, Dominguez notes. Whether it stems from "he took me to a nice restaurant" or "he threatened to beat me if we continued to use the condom," help your patient to see the events taking place that may place her at risk. Offer her some strategies to keep condom use consistent and fun, such as putting the condom on with her mouth or trying a variety of condoms and water-based lubricants. (Contraceptive Technology Update offers information on helping patients use condoms in its January 1997 issue. See pp. 6-8.)

2. Look at the role of drug and alcohol use in initiating and maintaining condom use. Women may plan to use condoms for protection. They may even carry condoms in their purses. But good intentions about condom use may go out the window when drugs and alcohol enter the picture, Dominguez says. By identifying a primary risk behavior, such as drug and alcohol abuse, you then can move to a secondary risk behavior, inconsistent use of condoms.

Identify the use of drugs and alcohol in your patient history forms. By doing this, you can say, "How can we help you negotiate your use of drugs and alcohol?" before you talk about condom use. Be prepared to refer patients to local services if drugs or alcohol present a problem.

3. Keep fingertip references for high school equivalency diploma courses, job assistance programs, and other empowerment programs. A woman’s financial vulnerability can make her willing to accept less than a full measure from a relationship, she says, and she may drop condom use if it threatens the relationship. Some-times just offering the use of the office phone can help a patient make a call about a training program, which can be a first step to a less risky lifestyle.

4. Help teen-agers learn skills for consistent condom use. A 32-year-old divorcee, while unaware of the rise of heterosexual HIV transmission, probably has the basic skills to talk frankly with her partner about condom use, Dominguez says. An adolescent needs help to learn how to initiate and maintain condom use.

A female adolescent’s views about what constitutes a lengthy relationship may differ from that of an older woman. A month may be long-term for a teen and signal the clinician to ask about continued condom use. If your patients are having multiple relationships apart from a steady boyfriend, they may choose to use condoms with the new partners but not with the boyfriend, Dominguez says. Help patients understand the serious repercussions involved if the boyfriend also is choosing to have multiple relationships.

5. If a patient does test positive for HIV, be prepared to help her get the care she needs. Women with HIV have special medical needs, so be ready to offer care or have referral information available, says Felicia Guest, MPH, CHES, director of training at Southeast AIDS Training and Education Center at Emory University in Atlanta.

Whether it is contraceptive counseling, prenatal care, or gynecological concerns, there is no lack of resources, so be proactive, Guest urges. Get the proper training in your field and have the name of an experienced caregiver in your Rolodex in case you need a consultation.

The National HIV Telephone Consultation Service at San Francisco General Hospital is an excellent resource for HIV treatment information, Guest says. A joint project with the University of California at San Francisco and the San Francisco Department of Public Health, the service features a toll-free "warmline" providers can call for next-day answers. The number, for health care providers, is (800) 933-3413. A free service, it is operated Monday through Friday, 7:30 a.m. to 5:30 p.m. PST, with voice mail available around the clock.