With the advent of highly active antiretroviral agents, women with HIV infection can expect to live longer than ever before. This increased survival has led to concerns about the long-term implications of HIV disease and its treatment. Women with HIV infection appear to lose ovarian function earlier in life than women without HIV infection. They also have evidence of reduced bone mineral density and increased cardiovascular risk. Moreover, many of these increases in risk factors are present even prior to the menopausal transition. All of these risks, present at mid-life, augur poorly for future health and describe a substantially increased burden of disease likely to accrue to HIV infected women as they enter older age groups. Further compounding the adversity faced by the HIV infected, the demographics of women most vulnerable to this disease include adverse social and economic influences, both of which worsen their long term prognosis. For example, drug use and poverty are related to more severe menopausal symptoms and chronic stress is related to worse psychological and cardiovascular risk. An understanding of how menopause interacts with HIV infection is therefore most important to alert the clinician to perform surveillance for common health problems in postmenopausal women, and to address directly and appropriately symptomatology during the menopausal transition.

Dramatic improvement in the survival of the HIV population has occurred with the ascendance of highly active antiretroviral therapy (HAART). In the foreseeable future, HIV-infected women who acquired disease during the peak years of the epidemic are expected to survive to experience menopause and even years beyond. The HIV epidemic may be viewed as 'mature', as its earlier victims become part of the geriatric population. Research about the process of menopause in HIV-infected women and, conversely, about HIV infection in women undergoing menopause is currently limited. Existing research suggests that the process of menopause is affected by HIV infection, inasmuch as infected women appear to experience menopause at an earlier age, with greater symptomatology, and with different reproductive hormone profiles compared with HIV-uninfected women. HIV infection also appears to affect bone mineral density, cardiovascular disease and cognition, with some age-related interactions. Lifestyle and demographic factors have pervasive importance for both HIV infection and the menopause in women. This article reviews the current state of knowledge about the menopausal process in HIV-infected women, and the common conditions in postmenopausal women that are likely to be affected by HIV infection. Clinicians should appreciate the potential role of HIV infection in caring for menopause-aged women.

Unprotected heterosexual intercourse is the leading cause of HIV acquisition in women. Due to the complex nature of correct and consistent condom use by both men and women, developing alternative female-controlled HIV prevention options is a global health priority. Vaginal films containing antiretroviral drugs are a potential delivery system for the prevention of HIV acquisition through sexual contact. In this study, we explored women’s preferences regarding physical characteristics of microbicide vaginal films through questionnaires and focus groups. Eighty-four sexually active, ethnically diverse women 18 to 30 years of age from Pittsburgh, Pennsylvania, participated in the study. Women visually and manually examined a variety of vaginal films, as well as three other vaginal products undergoing evaluation for HIV prevention: tablet, ring, and gel. Means and standard deviations or frequencies and 95% confidence intervals were calculated for questionnaire data. Focus groups were audio-recorded, transcribed verbatim, and coded for content analysis. Women most frequently preferred vaginal films to be smooth and thin (63%), translucent (48%), and 2"×2" square size (36%). Driving these preferences were five major themes: ease and accuracy of use, desire for efficacy, discretion, intravaginal comfort and minimal impact, and minimizing disruption of sexual mood/activities. Women’s preferences for various microbicide vaginal film physical attributes represented a balance of multiple values. In general, women desired a comfortable, efficacious, easy-to-use, and minimally intrusive product.

Background Quick-dissolve films hold promise for HIV microbicide formulation with regards to low cost and scalable manufacture. Consideration of women's preferences enhances probable use of promising microbicides. This study examined preferred physical characteristics of quick-dissolve vaginal films for HIV prevention and factors that influenced valuation of HIV prevention. Methods We conducted a cross-sectional mixed methods study of women aged 18-30 years from two counties in southwestern Pennsylvania to qualitatively and quantitatively assess preferences. During focus groups women handled and evaluated films of varying texture, thickness, size, shape, and appearance. A prefocus group survey collected demographics, sexual history, and valuation of vaginal product characteristics. A post-focus group survey collected attitudes towards vaginal microbicides. We carried out thematic analysis of focus group transcripts using modified grounded theory. We examined relationships between participant characteristics and valuing HIV prevention using Fisher's exact test. Results Eighty-four women participated, with a mean age of 23 years and largely white (54%) and black (43%). Only three reported previous use of a vaginal film. Participants preferred films to be smooth and thin (63%), translucent (48%), and 232" square size (36%). Translucent and smooth, thin films were perceived as likely to disintegrate rapidly. Smooth, thin films were perceived as more comfortable and less irritating than textured, thick films. Translucent films were thought to represent a balance between discretion and visual discernibility. Easy, accurate insertion, uniform coverage, and adequate HIV prevention efficacy were viewed as advantages of 2"32" square size films. Engaging in at least one episode of binge drinking in the past year was associated with rating HIV prevention as important (p¼0.048). Participants expressed concern regarding sexual intercourse in the context of alcohol intoxication. Factors associated with ranking HIV prevention as the most important characteristic of a vaginal product included higher number of lifetime vaginal sex partners (p¼0.001) and black race (p¼0.011). Conclusions Smooth, thin, translucent, and 2"32" square films were perceived to offer features valued by women in our sample. Women were concerned with issues of use, including insertion, disintegration, and comfort, as well as issues of discretion and efficacy.