PERSPECTIVE ON AIDS : How Do You Know You’re Safe? : Women must get serious about protecting themselves, for the epidemic is spreading, especially among teens.

As the nation’s first female surgeon general, I’d like to speak to women in this country about a health problem that makes me fear for all of us: the alarming spread of AIDS among sexually active women.

In the second decade of this epidemic, the female face of AIDS is still largely unfamiliar. We do not yet see ourselves from this new and unsettling vantage point, and we are letting this killer claim more and more of us and our children.

We cannot expect to have any real power over our health and well-being until we are empowered with knowledge. If we have learned anything from the solidarity of the women’s movement, it is this: To know is to care, and to care is to act.

Let me share with you some facts about women and AIDS, so that you begin to see the problem as it really is.

The Centers for Disease Control estimates that 111,000 women can be counted among the 1 million Americans who are infected with the virus but do not yet show major symptoms. Although men still account for most of the reported cases of AIDS in the United States, women and perinatally infected children are the fastest-growing groups of people reported. Out of more than 214,000 reported cases, roughly 22,000 have been reported in women, almost half of them in the past two years.

HIV infection and AIDS are now among the five leading causes of death for women 25 to 44, an age group that accounts for nearly half of all the women in this country. In New York City and New Jersey, AIDS is already the leading cause of death in women of childbearing age.

About half of the women now sick with AIDS acquired the virus by injecting drugs, but at least 34% got AIDS through heterosexual sex, and it is this risky behavior that endangers the greatest number of women. If we compare the first half of the epidemic to the second half, heterosexual transmission has jumped by 44%. Among teen-age women, the situation is even more pronounced: 50% of adolescent females diagnosed with AIDS in 1990 reported contracting the virus through heterosexual contact.

Although the data on transmission through vaginal intercourse are still limited, a number of studies have suggested that an infected man may be 2 to 5 times more likely to pass the virus to a woman than a woman is likely to pass it to a man; one study estimated a 20 times higher risk.

Any woman who risks having unprotected sex with just one man is taking the incredible risk of exposure to all of his partners. Remember the partners you have had in the last 10 years; now think about what that means to you and your children, even those yet unborn.

It is widely assumed that women who get AIDS through sex are part of the drug culture. Indeed, 62% of women who acquire the virus heterosexually report that their partners injected drugs. But an increasing proportion of AIDS cases is being attributed to sexual contact with a man whose risk factors were unknown to the woman. This category has increased from 6% in 1985 to about 15% in 1991. Also increasing is the number of cases among women who report sexual contact with bisexual men; 9% fall into this category, and they tend to be older women, between 30 and 49.

I cannot stress enough the far-reaching, deadly consequences of drug abuse. Drug injection transmits HIV through blood in and on shared needles and syringes. This practice involves a two-fold risk: direct transmission through shared needles and sexual transmission from men who inject drugs. Alcohol, crack cocaine and other drugs alter judgment about sexual contact and may put users of these drugs at higher risk for infection.

We must stop taking chances and begin to take greater charge of our lives. We must take the initiative to protect our health, to shield ourselves and our children from all sexually transmitted diseases, including HIV.

The first step in prevention is being aware of the risks; then the challenge is to change behavior. This means refraining from sex altogether, or demanding and maintaining a truly monogamous relationship, or negotiating for safer sex through the use of condoms.

Taking such action can be very hard for some women. We have been telling sexually active women that abstinence works, and that those who cannot abstain should “change the rules” and insist that their partners wear condoms. But for women in some communities, this can seem impossible. We have also been telling women that monogamous sex with one uninfected partner is safe--but realistically speaking, can every woman be sure that she is in a truly monogamous relationship? Because of social, cultural and religious beliefs in some communities, women who insist on bargaining for their protection may be abandoned, abused or thrown out on the streets.

Of equal concern is the fact that many women, especially those associated with the drug culture, are not inclined to seek health services. In many cases, women’s inbred role of caretaker leads them to put others first. They may be diagnosed too late and thus appear to die faster.

AIDS diagnoses may also be complicated by the fact that women with HIV often present slightly different symptoms than men. Like their male counterparts, they suffer from diarrhea, weight loss and pneumocystis carinii pneumonia. In addition to these well-known AIDS manifestations, women with the virus are prone to gynecological disorders such as cervical dysplasia (abnormal cells of the cervix) and severe, difficult-to-treat yeast infections. Owing to these gender differences in the manifestation of the disease, I urge women to consult thoroughly with their health-care providers.

Woman to woman, I urge each of you, in all sincerity, that if you have any reason to believe that you may have contracted HIV, the time to act is now: Contact your doctor or visit a public health clinic or testing site right away for counseling and testing.

And don’t panic. Remember, you are not alone. AIDS has become a women’s disease. Until there is a cure, we must encourage one another to do what is necessary to take care of ourselves. It is not egotistical to give our own health priority; it is life-affirming. In the face of AIDS, for once, put your own health first. Your family will have a lifetime to be glad you did.

For more information, call the Centers for Disease Control National AIDS Hotline: 1-800-342-AIDS, or 1-800-344-SIDA (Spanish).