Women and HIV in the United States

Women and HIV in the United States

Women represent the fastest growing demographic of HIV infections worldwide. In order to work on reversing this trend, we must have a thorough understanding of the unique issues that affect women living with HIV infection. To date, the medical community has focused a large amount of its research efforts on HIV/AIDS in men.^1,2 However, both clinical experience and the observational data that we do have suggest that, despite the many similarities between HIV-positive men and women, there are some sex/gender-related differences with important HIV prevention and treatment implications. These differences range from the interaction of HIV and the female immune system, to the social vulnerability that places women at higher risk for HIV and its complications. In order to design effective prevention and treatment strategies for HIV-positive women, we will need to understand and address any gender differences in the susceptibility to, and progression of, HIV infection. This article will review what we do know about women and HIV in terms of prevention and treatment, as well as highlighting areas that still require more research.

The Statistics

The statistics serve as a potent reminder that specific HIV prevention strategies for girls and women are greatly needed. Women represent 46% of all people in the world infected with HIV. However, the rate of new infections among women is climbing, with 50% of all new infections worldwide occurring in women (www.unaids.org). The United States has not escaped this global trend. The proportion of all AIDS cases in women has more than tripled in the past 15 years, from 7% in 1985 to 29% today.³

Women who are racial or ethnic minorities in this country are disproportionately at risk for HIV/AIDS. The Centers for Disease Control and Prevention (CDC) reports that, among HIV-positive women in the United States, over 80% are either African American or Hispanic. AIDS remains the leading cause of death in black women ages 25-34 in the U.S., while it represents the 10th leading cause of death in white women of the same age group.

The threat of death from HIV/AIDS remains high in older African American women as well: AIDS is the 3rd and 4th leading causes of death in black women ages 35-44 and 45-54 years old, respectively.⁴ Clearly, the rising rates of HIV infection in women and the disproportionate impact on women of color in this country require special attention.

Women May Be Unaware of Their Risks for HIV Infection

In order to prevent new HIV infection in women, we must first understand how women are being infected with HIV. According to many studies, approximately 40% of HIV-positive women report that they contracted HIV through sex with men. This number has not changed dramatically over the past two decades.

What has changed, however, is an increasing number of women who do not know how they got HIV. In one large study of over 2,000 HIV-positive women, 48% of participants could not identify how they had contracted HIV.⁵ Other studies have shown similar percentages of women not knowing how they contracted HIV, which likely indicates that women may not necessarily know the risk status of their male partners.⁶

A commonly-described phenomenon in the African American community, which may place black women at additional risk, is "down-low" behavior, where non-gay-identified men have secretive sex with other men and then unprotected intercourse with female partners.⁷ However, some analyses have shown that there is no real evidence that "down-low" behavior is fueling the epidemic among black women and that HIV prevention efforts in the African American community should not be focused on a single risk behavior.⁸

Because the majority of women in the United States acquire HIV through sex with men, often without any knowledge that they are at risk, prevention efforts in women must focus on increasing awareness of risk and routine diagnosis. Early diagnosis is critical to the prevention of HIV and AIDS.

We know that identifying HIV in an individual decreases the risk of him or her infecting somebody else because of behavior modification.⁹ HIV treatment also decreases a person's infectivity if he or she achieves undetectable viral loads. People who are diagnosed earlier also have a lower risk of progression to AIDS.