Dr. Donald Sodora (right) and Jeff Milush

(WOMENSENEWS)–The virus that causes AIDS spreads surprisingly fast throughout the head and neck after oral exposure–either through breastfeeding or semen–and may result in a greater number of infections than previously believed, according to new research.

The findings–preliminary until confirmed by other investigators–could have major health implications for women and girls worldwide. Many women have no other choice but to breastfeed their babies (and breastfeeding is the best method in most cases to maximize the women’s and the infants’ health) and many may not have sexual partners willing to wear protection against the virus, such as condoms, during oral sex.

For the study published earlier this month, researchers led by Donald Sodora, Ph.D., an assistant professor of internal medicine and infectious diseases at the University of Texas Southwestern Medical Center at Dallas, tracked the simian version of HIV, known as SIV, throughout the oral cavities and digestive tracts of monkeys.

The animals were infected in their cheeks pouches. One day after exposure, scientists found lymph nodes–tissue that serves as filters for the immune system–in the head and neck had been infected. They also found the virus had infected much of the soft tissue in the mouth, including the gums, and also the esophagus and tonsils. Four days after infection, the AIDS virus was found in nearly all head and neck tissue. However, researchers did not find evidence AIDS had infected any of the digestive tract, leading scientists to suspect stomach acids may contain substances that ward off the virus.

Risk Level Questioned

“The level of risk involved in oral transmission (of HIV) has been questioned,” Sodora told Women’s eNews. “We wanted to see the virus, where it is, how it’s spreading and how the immune system is responding. We didn’t have a preconceived idea of what we would find. But we never expected the virus to spread as rapidly as it did. That was probably the biggest surprise.” Sodora and his team reported their study results in the Dec. 3 issue of the medical journal AIDS.

“It looks like a well-done study,” says Charles Hicks, M.D., associate professor of medicine at Duke University’s Division of Infectious Diseases in Durham, N.C. “This isn’t very well known among the general public. Oral exposure can be an important mechanism by which people get infected. There are a lot of misconceptions about what really is a potential risk behavior.”

The risks of contracting HIV through sexual contact have been well-established, but the understanding of how the virus spreads through oral exposure is murkier.

Sodora said the virus was not found in saliva during his study, suggesting saliva may contain substances, such as enzymes, which may destroy the AIDS virus. However, these protective substances do not appear to also exist in breast milk and semen.

Disproportionate Effect on Women

The Geneva-based World Health Organization reports that AIDS is beginning to disproportionately affect women. Of the 37.2 million adults living with HIV/AIDS worldwide, almost half are women. In the region hardest hit by AIDS, sub-Saharan Africa, 60 percent of the adults living with HIV are women. In this area alone, women are 1.3 times more likely to become HIV infected than men.

WHO statistics also indicate that in the past two years AIDS has steadily increased among women in every region. The largest spike was observed in East Asia, which saw a 56 percent increase, followed by a 46 percent increase in Eastern Europe and Central Asia. WHO states girls and young women ages 15 to 24 are three to four times more likely to become HIV positive compared to boys and men of the same age.

“Most women contract HIV/AIDS through unprotected heterosexual intercourse,” says Dr. Florence Tumasang, an obstetrician-gynecologist in Yaounde, Cameroon, who is affiliated with the International Women’s Health Coalition. “More often than not they contract HIV from their regular sexual partners, people they have known for some time and have become less cautious with to the extent that they stop using condoms.”

If these new findings are confirmed by additional studies, it could “explain the already high rates of infection in (breastfed) babies born in Africa,” says Tumasang. “If the risk of infection through oral exposure is much higher than previously believed, those responsible for health education should get out that information. This is something that had been refuted for such a long time. It is important to let the world know that there is a real risk of infection through oral exposure.”

Epidemic Spreading in U.S.

The epidemic is not confined to underdeveloped areas.

In the United States, women, particularly minority women, constitute a growing number of HIV infections. Data from 2001 shows HIV infection was the leading cause of death for African American women ages 25 to 34 and was one of the top four leading causes of death for Hispanic women ages 35 to 44, according to the Centers for Disease Control and Prevention in Atlanta.

In addition, HIV infection was the sixth-leading cause of death among all women ages 25 to 34 and the fourth leading cause of death among all women ages 35 to 44. CDC data show that in 1992, women with AIDS only accounted for 14 percent of the adolescent and adult population living with the disease. By the end of 2003, the number had jumped to 22 percent.

“The face of HIV is changing,” says Dr. Theresa Mack, an AIDS specialist and associate medical director at St. Luke’s-Roosevelt Hospital Center in New York.

There’s a widespread misconception among women of color that AIDS is still just a white, gay man’s disease, says Mack. “I think that image has stuck, unfortunately. And now you have a population of people who don’t know they’re HIV positive.”

Many women today still fail to understand AIDS can be contracted through heterosexual sex. If the virus is spreading through oral exposure as quickly as this new research might indicate, Mack adds, then “it has grave implications” for women’s health.

Katrina Woznicki is a freelance writer based in Edgewater, N.J.

For more information:

University of Texas Southwestern Medical Center at Dallas–
UT Southwestern researchers trace how virus that causes AIDS spreads following oral exposure: