As medical conferences go, it wasn't exactly traditional.
Women physicians greatly outnumbered the men at the weekend gathering in Huntington Beach. The gender imbalance (about 120 to 5) was somewhat understandable since the meeting--"Current Issues in Women's Health Care"--was sponsored by the American Medical Women's Assn., a Virginia-based organization of 11,000 women physicians and medical students.
And while the program included topics of traditional concern to women--treatment of rape survivors and use of estrogen for menopausal symptoms--the gloomiest and most startling talks centered on issues often but mistakenly viewed as mainly men's problems: AIDS, cocaine and heart disease.
Welcome to the front lines of reality medicine, where an infectious disease specialist from the federal Centers for Disease Control fired the first round, claiming many heterosexual women have a false sense of immunity about AIDS.
Women are four times as likely as men to acquire AIDS through heterosexual intercourse, said Dr. Mary E. Guinan, CDC assistant director for science and a visiting professor of medicine at Emory University, Atlanta. But many women are lulled into thinking otherwise, she charged, partly due to women's magazine articles that reassure readers there's little risk of them contracting the disease.
CDC statistics suggest otherwise. As of July, 1988, 339 men and 1,223 women in the United States have acquired the disease through heterosexual intercourse, Guinan said. Last year, 10.7% of all reported AIDS cases were women, she said. "By 1992, we expect women will account for 13%-15% of all AIDS cases," she said, acknowledging that "i.v. drug use is still the most important transmission category for women" but far from the only category.
Although the number of women who acquire AIDS through heterosexual intercourse is still relatively small, Guinan reasons that any number is cause for concern.
"The risk of sexually transmitted disease (STD) does not depend on socioeconomic group, personal hygiene, education, income, race or sex," she added. And the risk of contracting any sexually transmitted disease increases, she added, as the number of lifetime sex partners increases.
Generally speaking, she added, "one lifetime sexual partner is a thing of the past. I would say less than 15% of our population is in that category."
Acknowledging that the route to preventing AIDS and other STDs is not an easy one, Guinan suggested that condom use somehow be made more appealing. "What we need is something like 'The Joy of Sex With Condoms,' " she said.
Stemming the use of crack--a cocaine derivative that's smoked in a pipe or in cigarettes--is also vital to stemming AIDS, according to Guinan and another speaker, Dr. Mindy Fullilove, director of Multicultural Inquiry and Research on AIDS at the Bayview-Hunter's Point Foundation in San Francisco.
Fullilove, an assistant clinical professor of psychiatry at UC San Francisco, elaborated on the crack-AIDS connection. "Crack gives an intense high," she said. Crack "turns people on" and "a woman at the mercy of crack is totally unable to say, 'Oh, stop, let's use a condom.' "
"There is no rational sexual behavior where crack is involved," Guinan said. "If we don't get to the crack house, the spread of AIDS and other STDs is just going to escalate beyond belief. . . . Until we eliminate crack in our communities, we're not going to prevent AIDS in women."
In Fullilove's pilot study of 23 crack users, ages 13-19, 40% had suffered from at least one STD, according to their self-reports. And 30% admitted having had more than five sexual partners in the last year. "In the general population, surveys show, (only) about 6% of those age 18-29 have more than five partners a year," Fullilove said.
She calls crack "a manufacturer's dream and a physician's nightmare." Addiction can occur quickly and supplies are cheap, Fullilove explained. "In our area, you can get a hit on a crack pipe for $1. For a few dollars, you can get a cigarette (with crack) . . . and we don't know how to treat the addiction." Under study, she said, is the use of antidepressants and acupuncture.
Another killer, heart disease, has typically been considered more a man's problem than a woman's. But research and clinical observation suggest that's not entirely accurate, said Dr. Nanette Wenger, a professor of medicine at Emory University School of Medicine and director of the Cardiac Clinic at Grady Memorial Hospital.
Women are more likely to have heart attacks that are not diagnosed as such, she said. And although women often develop heart disease later in life than men do, "once it occurs, the outcome is more serious." And an initial heart attack is more likely to kill women than men, she added.
Other studies show that women suffer more anxiety and depression than men following heart attacks and have less relief of symptoms after undergoing coronary artery bypass graft surgery, she said.
Despite the sobering statistics and predictions, the weekend conference did have its lighter moments. During Guinan's talk on rational sexual behavior, she cited a survey that found men didn't always tell the truth about their sexual histories, explaining, "This survey shows that men lie."
"No-o-o," the audience shot back in mock disbelief.
"\o7 Some\f7 men lie," Guinan rephrased. "And those of us with a prolonged single life are more apt to meet up with them."