The Impact of HIV/AIDS on Women

Vulnerabilites Increase Both the Risk and Outcomes of HIV Infection in Women

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While HIV does not discriminate between women and men, there are considerable differences in both the presentation and incidence of HIV between gender groups. According to the Centers for Disease Control and Prevention (CDC), women account for 23% of the HIV population in the U.S. Of those diagnosed with HIV, less than half are linked to care, while fewer than one in three is able to maintain an undetectable viral load (the measure for treatment success).

The figures become even more concerning when comparing women by ethnic groups. African American women, for example, are today the fourth highest risk group overall, with nearly five time the infection rate of their African American male counterparts. Moreover women of color account for 50% of all new infections in people between the ages of 13 to 19 years of age, meaning that they're being infected at a far younger age and rate than the men who infect them.

As such, HIV is today the seventh leading causes of death for Latino and African American women aged 25 to 44.

Identifying the Vulnerabilities Unique to Women

There are vulnerabilities to HIV that are entirely unique to women and account for the many of the differences in infection rates between men and women worldwide. They include:

  • Biological vulnerabilities wherein the female body is generally more susceptible to HIV as result of the larger surface are of the vagina and cervix. This alone provides easier access for HIV through delicate mucosal tissues that line the female genital tract. As a result, women are twice as like to acquire HIV from sexual intercourse than their heterosexual male partner.
     
  • Gender inequities that can place men in a position of power over women, minimizing the sexual consent of many, at-risk women. Inequity in employment and education further exacerbate these issues, making women more reliant on financial support from men who may be abusive or even violent.
     
  • Racial disparities further compounds the issue, with high rates of poverty, incarceration and injecting drug use fueling the epidemic, particularly in African American communities where the prevalence of HIV is high. Failures in public healthcare delivery and/or a lack of integrated HIV services also drive many accessing or remaining in care.
     
  • Women who have been sexually abused are more likely to engage in risky sexual behaviors, including multiple sex partners, condomless sex, or exchanging sex for drugs.
     
  • Women are more likely to postpone or avoid healthcare due to financial constraints, while sacrificing their own medical needs in favor of those of their children.
     
  • Sexually transmitted diseases such as syphilis and gonorrhea are often more difficult to diagnose in women than in men, placing women at far higher risk of getting HIV.
     
  • Even with the availability of the HIV prevention pill (known as pre-exposure prophylaxis, or PrEP), research has suggested that it works nowhere near as effectively in women as it appears to do in gay men due to varying levels of drug concentration in vaginal and rectal tissues.

What Can Be Done?

A number of initiatives have been put into place to address the vulnerabilities that can place a women at higher risk of HIV. Among them, awareness campaigns are being increasingly developed to target specific population of women with an aim to communicating in a culturally and age appropriate voice.

From the biomedical standpoint, millions of dollars have been spent to research and develop topical microbicides and intravaginal microbicidal rings, which may "invisibly" prevent the spread of HIV from men who refuse condoms. While struggling, efforts are also being made to revive interest in the female condom by providing enhancements for easier insertion and comfort.

For women diagnosed with HIV, integrating healthcare to link reproductive services with HIV-specific services (including testing and treatment) may improve retention rates—which, in turn, improves drug adherence rates and the likelihood of complete viral suppression.

Sources:

U.S. Centers for Disease Control and Prevention (CDC). "HIV Among Women - Fact Sheet." Atlanta, Georgia; accessed February 11, 2016.

Henry J. Kaiser Family Foundation (KFF). "Black Women and HIV/AIDS." New York, New York; accessed February 11, 2016.

Microbicide Trials Network (MTN). "About Microbicides Fact Sheet| Microbicide Trials Network." Pittsburgh, Pennsylvania. Fact sheet issued June 13, 2013.

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