View the presentations: Sharon L Hillier | Dázon Dixon Diallo | Tonya Poteat | Monica Ghandi | Q&A
Men who have sex with men (MSM) have been in the spotlight of the HIV and AIDS epidemic since the 1980s but as Dazon Dixon Diallo (founder of SisterLove Inc. and advocate for PLWHIV) says, women make up 50 percent of all HIV infected people worldwide, and the fight for recognition still continues.
Diallo discussed that women have had to study HIV and advocate for their own inclusion in the conversation and policy-making, becoming activists in the process. "Women don't get AIDS, we just die from it," she remembers women saying in the '80s and '90s.
Dr Monica Gandhi discusses that traditionally, women have been under-represented in clinical trials for HIV treatment, stating that less than 50 percent of participants for Elvitegravir were women. If that doesn't sound too bad, cure studies have an average of 8.3 percent female participants. Given women may have biological and sociological experiences that are drastically different to their male counterparts, this seems an oversight.
Dr Gandhi goes on to discuss that the lack of representation in the academic sphere is similar, with female representation diminishing as rank escalates. This, she says, hasn't improved significantly in the last 12 years. Less than 8 percent of scientific research is authored by women.
Why is this? Dr Gandhi feels some of the barriers to the inclusion of women in academic research is a perceived lack of parity to their male colleagues, a lack of retention in the workforce and a lack of equal compensation. Some of the ways this can be countered is largely through holistic mentoring and attacking the unconscious bias against women, and this assertion is supported by research published by the National Academy of Science in 2006.
What does this mean for the average clinician? That unconscious bias may be being extended to our female patients through the filters of our guidelines and the very science they are based off, particularly when it comes to HIV? None of us ever likes to think our patients fall through the cracks, but the reality is that they can and do. We do well to remember that the guidelines are there to provide a structure to clinical decision-making where those decisions can be difficult to make, however we must also adopt a holistic approach in all aspects of our practice.
Our clinical guidelines allow us the flexibility to place real-world patients into a mould and have them break it. We must let them. This can mean screening women for HIV more frequently, or at intervals that are not described in the clinical guidelines, but it could also mean diagnosing a case of HIV that otherwise would have surfaced as a late presentation.
The Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) recognises those at risk of late presentation (and significant sequelae) as women, older people, heterosexual men, and culturally and linguistically diverse people. If women have had to educate themselves and push for their inclusion, why not take up the baton and start including more of our female patients in this discussion?
