HIV IN WOMEN

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HIV in women – Woman leaning out of a kitchen and over an interior window frame, smiling into the camera

HIV IN WOMEN

CAN WOMEN GET HIV?

Put simply, yes, women can get HIV. In fact, globally, they are disproportionately affected by the virus. HIV-related inequities particularly affect adolescent girls and young women (aged 15 to 24 years).1

In Sub-Saharan Africa, adolescent girls and young women are three times more likely to acquire HIV compared to males of the same age, fuelling this global disparity.1

How common is HIV in women?

HIV has a substantial impact on women's health and quality of life, and women account for the majority of HIV diagnoses worldwide. In 2022, the number of people living with HIV globally was approximately 39 million. The global HIV statistics for women that year showed that they made up for 53% of that total.2,3

Depending on their geographical location, women are affected differently by HIV. In Sub-Saharan Africa, women and girls of all ages made up 63% of all newly acquired HIV diagnoses.3 In all other geographical regions, men and boys accounted for over 70% of the new HIV diagnoses in 2022.3

According to the World Health Organization (WHO), women accounted for approximately one-third (35.3%) of new HIV diagnoses in the European Region in 2018.4 In 2019, they made up for 19% of the new HIV diagnoses in the United States and dependent areas.5 In the UK, HIV in women accounts for a third of people living with HIV, and a quarter of all new HIV diagnoses are in women.1

These global statistics highlight the importance of representing women in HIV clinical trials and empowering young women to have a voice in the decisions that impact their health. Resolving the disproportionate effect that HIV has on women globally is one of the key focus areas of our health equity commitment.

HIV in women: Age, race, and financial status

Geographical location is not the only factor that affects how HIV impacts women globally: age, race, and financial status also play a key role.

For example, adolescent girls and young women continue to be disproportionately impacted by HIV. In 2017, in Eastern and Southern Africa, 79% of new HIV diagnoses among 10-19-year-olds were in women.7 In Sub-Saharan Africa, new diagnoses among young women and girls dropped by 42% between 2010 and 2021,1 but among men and boys, the decline was greater, with diagnoses dropping by 56%.1This shows how young women and girls continue to be left behind in the battle against HIV.

Race is also a key determinant of HIV status. In high-income countries like the US, women of colour, particularly Black women, face a higher vulnerability of acquiring HIV. In 2018 in the US, Black women/African American women made up 13% of the entire female population but accounted for 58% of HIV diagnoses among females. In contrast, 62% of women in the US female population were white, yet the incidence of new HIV in white women was significantly lower (just 21%).

Many Black women of transgender experience are also disproportionately affected by HIV on a global level.6 Significant barriers such as violence, stigma, discrimination, lack of cultural competency among providers, and inaccessibility of health facilities prevent Black transgender women from accessing HIV testing, prevention, and care.

Finally, income levels and financial status also play a role in how HIV affects women. Many women living with HIV also face significant financial burdens, as living with the condition and the ensuing stigma often lead to loss of income and financial support. Living in low-income areas can also greatly impact the risk and outcomes of HIV in women. For example, having fewer employment opportunities and less access to education, healthcare services, and HIV prevention all contribute to an environment where HIV is harder to stop.8,9

At ViiV, we are committed to closing the gender gap that exists globally in HIV incidence, prevention and care. We conduct HIV clinical trials that are dedicated to women, we are exploring how HIV medicines impact women in the real world, and we are activating campaigns to empower Black women of cis and trans experience, such as Risk to Reason. We are also committed to enabling global access to our medicines so that people affected by HIV can benefit from them, regardless of their income, geographical location, age, race or gender.

HIV differences in males and females

While HIV affects both women and men, differences in transmission risk, health outcomes, and socio-economic factors means people are affected differently based on their gender. This is why considering gender-specific factors in HIV prevention, treatment, and support programmes is key.1

HIV TRANSMISSION IN WOMEN

According to the U.S. National Institutes of Health, women are most likely to acquire HIV from having condomless sex (including vaginal and anal sex) with a male partner who has untreated HIV.9

Multiple biological factors contribute to this increased risk, such as the fact that the vagina has a larger surface area compared to a penis.11,12 So, if the semen has detectable levels of HIV, a larger surface area means higher risk of transmission. Semen can also stay in the vagina for several days, resulting in longer exposure to the potential virus.11,12

A vaginal yeast infection, bacterial vaginosis, or an untreated sexually transmitted infection (STI) also increase the likelihood of HIV transmission.12 Age-related vaginal dryness can further increase the risk of transmission, as it can lead to tears in the vagina during sex.7

Female to female transmission of HIV is rarer than male to female transmission, but may still occur through cuts, bleeding gums, or sores in the mouth when giving oral sex.12 It is also possible to spread HIV through menstrual blood and shared sex toys.12

HIV can also be passed on by:13

  • Sharing needles
  • Receiving blood transfusions
  • Breastfeeding
  • Having sex without condoms or without preventive medication with someone who has untreated HIV
  • Using injectable drugs
  • Engaging in chemsex.

Occupational factors can also influence women's susceptibility to HIV. For instance, the incidence of HIV is 10 times higher among female sex workers compared to the general population.14

HIV AND WOMEN’S HEALTH

In general, HIV affects women's health similarly to men's. Nonetheless, HIV may result in certain health concerns specific to women, including:15

  • Gynaecological health problems
  • Higher likelihood of cervical cancer
  • Elevated risk of heart disease
  • Side effects of HIV medication and drug interactions
  • Issues related to ageing

The PRIME (Positive Transitions Through the Menopause) study discovered that women living with HIV may face a higher level of menopausal symptoms compared to HIV-negative women.16 These symptoms may include vasomotor symptoms (such as hot flashes, night sweats, and palpitations), sexual dysfunction, and mood changes.16

Despite HIV in women being a serious issue, women remain largely under-represented in HIV clinical trials.17 This under-representation leads to gaps in scientific knowledge about how treatment of HIV in women may interact differently compared to men.18

At ViiV Healthcare, we recognise the impact of the HIV epidemic on girls and women. We are committed to closing the research gap for HIV in women and contribute knowledge through our research programmes as part of our commitment.

If closing the gender research gap is also something that resonates with you, find out if you qualify for a clinical HIV trial.

Women, fertility, and HIV

Women living with HIV may experience difficulty conceiving as HIV affects the female reproductive system, which in turn can increase the risk of infertility.19 The use of assisted reproductive technology such as IVF can serve as an effective risk-reducing strategy for HIV-positive women.19

However, access and availability of fertility treatments for women living with HIV differ across the world and may be subject to regulations and disparities. For example, Finland and Norway offer no fertility assistance to couples where one partner is HIV-positive.20 Germany only offers assistance to couples with an HIV-positive male.21 The UK has now granted access to couples living with HIV to access IVF fertility treatment. However, overall, more fertility treatment options are available for men living with HIV than women, reflecting underlying gender discrimination in treatment.20

Women, pregnancy, and HIV

After conception, difficulties related to pregnancy may continue. In clinical studies pregnancy loss is more common among HIV-positive women than women without HIV. Higher rates of ectopic pregnancy have been reported in HIV-positive women than in the general population.21

Globally, 90% of HIV infections in children are a result of mother-to-child transmission, which is also known as vertical or perinatal transmission.21 The reported rates of HIV transmission from mother to child range from 15% to over 40% in countries where antiretroviral treatment is not available.21 HIV can be transmitted from a mother to her baby during pregnancy, childbirth, or when breastfeeding. However, the long-term use of antiretroviral treatment during pregnancy can reduce the risk of transmission by two-thirds.21

Breastfeeding contributes to HIV transmission to children in low-income countries. In some places, lower risk alternatives to breastfeeding, such as formula milk, are not always accessible for HIV-positive women, increasing the risk of vertical transmission.21

WOMEN AND HIV TREATMENT

Current HIV treatments are not different for males and females. However, a tailored HIV treatment plan may be advised for pregnant or breastfeeding HIV-positive women.21,22

Your HIV treatment may differ from others', so it is important for you to collaborate with your doctor to ensure that you are receiving the optimal HIV treatment for you.

In certain countries, women's access to quality healthcare services, such as prenatal and reproductive health services, may be restricted, hindering their ability to obtain HIV treatment and prevention services.7 In many countries, for example, women must obtain the consent of their spouse or partner in order to access sexual and reproductive health services.23

Global initiatives have aimed to address the disparities in the HIV response and enhance the availability of HIV prevention and treatment services for women and children. Worldwide, around 210,000 adolescent girls and young women (aged 15-24 years) acquired HIV in 2022, which is half the number compared to 2010.24 Programmes focused on preventing mother-to-child transmission have prevented 3.4 million new HIV infections in children since 2000.24

Transgender individuals, including transgender women, are often significantly impacted by HIV. Providing gender-affirming care alongside HIV care and prevention is crucial to engage transgender women effectively. It is generally considered safe and effective for transgender women to receive gender-affirming hormone therapy alongside HIV treatment.25 However, some antiretroviral drugs used in HIV treatment may have interactions with gender-affirming hormone therapy.25 Healthcare providers must monitor and adjust treatment plans accordingly.25

Women, PrEP and PEP

Pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) are very effective prevention methods. Whilst PrEP is taken before a potential HIV exposure, PEP is taken as soon as possible (up to 72 hours after a potential exposure) as a short course medication.

Access to PrEP and PEP for women is not the same across the world, however. For example, only around 42% of sub-Saharan African districts with high HIV incidence have dedicated HIV prevention programmes for adolescent girls and young women. Closing these gaps and improving access to female-friendly biomedical prevention tools, like oral PrEP, would significantly decrease their chances of acquiring HIV.24

Numerous studies have revealed that awareness of PrEP among women is markedly low. This lack of awareness is further complicated by stigma and other barriers that hinder access to and adherence to HIV prevention.26

Stigmatisation surrounding HIV and PrEP can deter individuals from seeking PrEP, especially in transgender populations where HIV stigma may intersect with gender identity stigma. Some trans women of colour may have experienced medical mistrust, which can affect their willingness to engage with PrEP services.27

WOMEN LIVING WITH HIV AND STIGMA

Women from key populations who are living with HIV (such as transgender women or female sex workers) are especially vulnerable to violence, stigma, and discrimination, and therefore need specialised peer support.1,7,28

HIV-related discrimination can have damaging effects on the physical health and mental health of women around the world due to gender-based inequalities in sexual decision-making, reproductive rights, education systems, labour, and other social constructs.7

Also, women often experience gender-based violence due to the stigma associated with their HIV status. This hinders their ability to access HIV services and makes it particularly difficult for them to make decisions about engaging in sexual activity and negotiate safer sex.7 Furthermore, the violence deters many women living with HIV from disclosing their status to their partners, families, and healthcare providers, and it also poses challenges for women and girls in adhering to HIV treatment.7

Some countries maintain legislation that limit the sexual and reproductive choices women can make.29 Additionally, transgender individuals face criminalisation and/or prosecution in many countries across the globe, while other countries mandate HIV testing for marriage.28 The existence of such laws and policies significantly amplifies the stigmatisation faced by these marginalised groups, hindering women living with HIV from accessing necessary treatment and prevention services due to the fear of being criminalised.28

In many places around the world, efforts are underway to actively combat the stigma associated with HIV. These efforts involve upholding human rights and involving affected communities in the HIV response. This includes addressing criminalising laws and policies, gender and other inequalities, stigma and discrimination, as well as human rights violations.24

At ViiV Healthcare, we have a long-standing history and commitment to fighting the HIV stigma and discrimination that people living with HIV face every day.

HIV: LIVING A HEALTHY LIFE

Due to ongoing improvements in HIV care, women who are taking treatment are living long, healthy lives with HIV. The concept of U=U, or Undetectable equals Untransmittable, is a key reason for this.

U=U means that individuals with HIV who maintain an undetectable viral load cannot transmit the virus. This empowers HIV-positive women in dating and intimate relationships, ensuring they can fully enjoy the pleasures of intimacy without HIV transmission concerns

Many women living with HIV have shared their stories, empowering others to live happy, fulfilling lives by talking about their experiences of living with HIV.

References:

  1. Dangerous inequalities: World AIDS Day report 2022. Geneva: Joint United Nations Programme on HIV/AIDS; 2022. Licence: CC BY-NC-SA 3.0 IGO.
  2. HIV and AIDS Epidemic Global Statistics. HIV.gov. Published 2022. Accessed September 28, 2023. https://www.hiv.gov/hiv-basics/overview/data-and-trends/global-statistics/
  3. UNAIDS. 2022 GLOBAL HIV STATISTICS.; 2022. Accessed September 28, 2023. https://www.unaids.org/sites/default/files/media_asset/UNAIDS_FactSheet_en.pdf
  4. Mårdh O, Quinten C, Giorgi Kuchukhidze, et al. HIV among women in the WHO European Region – epidemiological trends and predictors of late diagnosis, 2009-2018. Eurosurveillance. 2019;24(48). doi:https://doi.org/10.2807/1560-7917.es.2019.24.48.1900696
  5. CDC. HIV Diagnoses. Centres for Disease Control and Prevention. Published August 18, 2022. Accessed September 28, 2023. https://www.cdc.gov/hiv/group/gender/women/diagnoses.html
  6. Poteat T, Ackerman B, Diouf D, et al. HIV prevalence and behavioural and psychosocial factors among transgender women and cisgender men who have sex with men in 8 African countries: A cross-sectional analysis. PLOS Medicine. 2017;14(11):e1002422-e1002422. doi:https://doi.org/10.1371/journal.pmed.1002422
  7. UNAIDS. Women and HIV: a spotlight on adolescent girls and young women.; 2019. https://www.unaids.org/sites/default/files/media_asset/2019_women-and-hiv_en.pdf
  8. Chaturaka Rodrigo, Senaka Rajapakse, HIV, poverty and women, International Health, Volume 2, Issue 1, March 2010, Pages 9–16, https://doi.org/10.1016/j.inhe.2009.12.003
  9. American Psychological Association. HIV/AIDS and Socioeconomic Status. https://www.apa.org. Published 2010. Accessed September 28, 2023. https://www.apa.org/pi/ses/resources/publications/hiv-aids
  10. HIV and Women | NIH. Nih.gov. Published 2021. Accessed September 29, 2023. https://hivinfo.nih.gov/understanding-hiv/fact-sheets/hiv-and-women
  11. CATIE. Canada’s source for HIV and hepatitis C information. Published July 4, 2022. Accessed September 29, 2023. https://www.catie.ca/prevention-in-focus/hiv-and-the-female-genital-tract-what-does-it-mean-for-hiv-prevention
  12. Office on Women's Health. Women and HIV | Office on Women’s Health. Womenshealth.gov. Published 2013. Accessed September 29, 2023. https://www.womenshealth.gov/hiv-and-aids/women-and-hiv
  13. CDC. HIV Transmission. Published 2023. Accessed September 29, 2023. https://www.cdc.gov/hiv/basics/hiv-transmission/ways-people-get-hiv.html
  14. UNAIDS. Prevention Gap Report; 2016. Accessed September 29, 2023. https://www.unaids.org/sites/default/files/media_asset/2016-prevention-gap-report_en.pdf
  15. HIV.gov . How Does HIV Impact Women’s Health? HIV.gov. Published 2022. Accessed October 13, 2023. https://www.hiv.gov/hiv-basics/staying-in-hiv-care/other-related-health-issues/womens-health-issues/
  16. Tariq S, Burns F, Gilson R, Sabin C. PRIME (Positive Transitions Through the Menopause) Study: a protocol for a mixed-methods study investigating the impact of the menopause on the health and well-being of women living with HIV in England. BMJ Open. 2019;9(6):e025497-e025497. doi:https://doi.org/10.1136/bmjopen-2018-025497
  17. Mirjam Curno, Rossi S, Ioannis Hodges-Mameletzis, Johnston R, Price MA, Heidari S. A Systematic Review of the Inclusion (or Exclusion) of Women in HIV Research. Journal of Acquired Immune Deficiency Syndromes. 2016;71(2):181-188. doi:https://doi.org/10.1097/qai.0000000000000842
  18. British HIV Association. British HIV Association guidelines for the treatment of HIV-1-positive adults with antiretroviral therapy 2015 (2016 interim update). Available at: https://www.bhiva.org/file/RVYKzFwyxpgiI/treatment-guidelines-2016-interim-update.pdf. Accessed September 2023
  19. Kushnir VA, Lewis W. Human immunodeficiency virus/acquired immunodeficiency syndrome and infertility: emerging problems in the era of highly active antiretrovirals. Fertility and Sterility. 2011;96(3):546-553. doi:https://doi.org/10.1016/j.fertnstert.2011.05.094
  20. Bell M, Edelstein M, Hurwitz S, Irwin R. Accessibility and availability of assisted reproductive technology for people living with HIV in Europe: a thematic literature review. Aids Care-psychological and Socio-medical Aspects of Aids/hiv. 2019;32(8):949-953. doi:https://doi.org/10.1080/09540121.2019.1707471
  21. UNAIDS. HIV in pregnancy: a review acknowledgements.; 1998. Accessed 2023. https://www.unaids.org/sites/default/files/media_asset/jc151-hiv-in-pregnancy_en_1.pdf
  22. NIH | Nih.gov. HIV Medicines During Pregnancy and Childbirth. Published 2021. Accessed October 9, 2023. https://hivinfo.nih.gov/understanding-hiv/fact-sheets/hiv-medicines-during-pregnancy-and-childbirth
  23. UNAIDS. Women and girls and HIV;2018. Accessed 2023. https://www.unaids.org/sites/default/files/media_asset/women_girls_hiv_en.pdf
  24. UNAIDS. The Path That Ends Aids 2023 Unaids Global Aids Update Executive Summary; 2023. Accessed October 9, 2023. https://www.unaids.org/sites/default/files/media_asset/2023-unaids-global-aids-update-summary_en.pdf
  25. Van Gerwen OT, Blumenthal JS. Providing gender-affirming care to transgender and gender-diverse individuals with and at risk for HIV. Topics in antiviral medicine. 2023;31(1):3-13. Accessed October 9, 2023. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10089290/
  26. Lakshmi Goparaju, Praschan N, Lari Warren-Jeanpiere, Experton LS, Young M, Kassaye S. Stigma, Partners, Providers and Costs: Potential Barriers to PrEP Uptake among US Women. Journal of AIDS and Clinical Research. 2017;08(09). doi:https://doi.org/10.4172/2155-6113.1000730
  27. Baldwin A, Light B, Allison WE. Pre-Exposure Prophylaxis (PrEP) for HIV Infection in Cisgender and Transgender Women in the U.S.: A Narrative Review of the Literature. Archives of Sexual Behaviour. 2021;50(4):1713-1728. doi:https://doi.org/10.1007/s10508-020-01903-8
  28. UNAIDS. We’ve got the power - Women, adolescent girls and the HIV response; 2020. Accessed 2023. https://www.unaids.org/sites/default/files/media_asset/2020_women-adolescent-girls-and-hiv_en.pdf
  29. Women and HIV: Invisible No Longer | Terrence Higgins Trust. Tht.org.uk. Published 2023. Accessed October 31, 2023. https://www.tht.org.uk/our-work/our-campaigns/past-campaigns/women-and-hiv-invisible-no-longer
  30. PEP/PREP: Sexual Health South West London. Sexual Health South West London. Published 2023. Accessed October 31, 2023. https://shswl.nhs.uk/pepprep
  31. Centers for Disease Control and Prevention (CDC), Diagnoses of HIV Infection in the United States and Dependent Areas, 2018: Women. Published May 7, 2020, Accessed November 21, 2023. https://www.cdc.gov/hiv/library/reports/hiv-surveillance/vol-31/content/women.html

NP-GBL-HVX-COCO-230024 | December 2023

Reporting of side effects

If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in the package leaflet. You can also report side effects directly via the Yellow Card Scheme at www.mhra.gov.uk/yellowcard or search for MHRA Yellowcard in the Google Play or Apple App store. By reporting side effects, you can help provide more information on the safety of this medicine.

If you are from outside the UK, you can report adverse events to GSK/ViiV by selecting your region and market, here.