It has been well over 30 years since the very first diagnosis of AIDS within the United States. Even though, these cases were mostly men, there were a handful of women who were part of the first cases. AIDS was believed to only affect gay men.
Yet, while the years passed, women have become another group that has been hit very hard by AIDS and HIV epidemic. All over the world, women who are living with HIV make up about 50% of all the people who have HIV, and in most countries, women outnumber the men who are living with HIV. Globally, transwomen or transgendered women are often the group that is most affected by HIV across other groups. It is shown to be 49 times higher than those who are living with HIV in all general categories of adults.
Based on data from 2016, out of every 5 new HIV diagnosis, one of those were women. However, African American women were affected the most. Yet, adult and adolescent women made up 13% of the population of females within the United States and made up 6 out of 10 new diagnoses for HIV during 2016. The Latina group was around 17% of the population of females within the United States. This shows that when Latinas and African American women were compared, the African American group had the highest rates of HIV diagnosis, being around 16% higher than Caucasian women. Latinas were only 3 times higher than Caucasian women.
Even though it is not talked about that often, Alaskan Native and American Indian communities will often experience high rates of HIV of most racial groups within the United States while Pacific Islander and Asian communities are not impacted as much by HIV. This may be due to cultural factors which could leave women within these particular communities which make it hard to connect to HIV care and vulnerable to getting HIV.
It was between 2011 to 2015 that the number of new diagnosis of HIV among United States women had dropped by 16%. Yet, Latinas and African American women were disproportionately affected by new HIV diagnoses, yet the new diagnoses of these communities have also dropped.
HIV will affect both older and younger women, truth is that recently, the rate of HIV diagnoses within older women has raised to almost 37% in 2013 which is more than twice the rate of women who were between the ages of 14 and 24 which made up 14%.
Based on data from WHO or World Health Organization, there are at least 18 million adults who are living with HIV and are women just in 2014. Even though women make up 50% of all people who have HIV all around the globe, the percentage of those who are living with HIV will vary based on the country that they are in. There are some estimates that are showing that 1 out of 3 people who are living with HIV inside of the United Kingdom are going to be a woman. When it comes to India, it is 4 out of 10 people who are living with HIV will be women. However, based on information for sub-Saharan Africans who are living with HIV it comes up to 6 out of 10 people who have HIV are women. Reports from the UNAIDS has stated that teen girls who are aged from 15 to 19 all over the globe, around 21% of them will know enough about HIV in order to stay non-reactive or negative.
When it comes to transgendered women worldwide, transwomen will often have higher percentages of people who are affected by HIV. It has been estimated that the number of transwomen who have HIV is 50 times higher than the general population of adults. This is seen to be very much true for the transwomen who are living in high, middle or low resource countries. 19 out of every 100 transwomen in any population will be HIV positive.
When it comes to older women who are living with HIV worldwide, it can be seen as the numbers are growing. This is not just because the amount of older woman who have recently been found to HIV is rapidly increasing, but because those who are found to be HIV positive are living healthier and longer lives and are aging well with HIV. Older women will often deal with 2 issues when it comes to living with HIV, these are the fact that they have HIV which is spread through drug use or sexual contact and being older. It is because of this that most older women who are diagnosed with HIV will be at later stages of infection when their immune systems have already weakened a lot.
The most common way for a person to get HIV is through heterosexual sex or the sex that happens between a woman and a man for women within the United States. Whenever hetero sex is being done, HIV is being passed much easier from a man to a woman when compared to from a woman to a man. It is shown that 8 out of 10 women who are HIV positive and living with HIV within the United States has gotten the virus from sex with a man who is HIV positive. This is the same for women who are diagnosed with HIV inside of other countries such as Western Europe, Africa and South America.
Another very common way for a person to contract HIV is through using contaminated syringes for injecting drugs.
It was not until recently that research started to pick up for HIV and women. While there are still a lot of questions that will need to be answered, all over the information that is available has shown that HIV will affect women differently and the same goes for men.
Whenever a woman is first diagnosed, she will often have much lower amounts of HIV in her blood, which is also called a viral load, when compared to men who are recently diagnosed.
Women will also often be first diagnosed whenever they are pregnant, are thinking about getting pregnant, or have recently been hospitalized for some type of illness.
Women will also have lower CD4 cell counts when compared to men who have similar viral loads.
Women are also more likely to have complications such as getting bacterial pneumonia. They also have a higher chance of getting thrush, which is a type of yeast infection, in the throat than a man. They also have much higher rates of having the herpes infection.
However, men are much more likely to develop KS or Kaposi’s Sarcoma, which is a type of cancer disease that is caused by the herpes simplex virus.
One thing that can be seen as being harmful is the fact that women will often be diagnosed much later than a man, and there are less women who are getting treatment for HIV. Women will often delay going to get medical treatment and care and even choose not to disclose HIV status for many reasons which include taking care of everyone in their household, but not putting themselves first, mistrust of healthcare providers, lack of social support, lack of financial resources, depression, problems with addiction of substance abuse, stigma around HIV, taking care of children or sick family members, fear of violence at home, unstable housing, and having limited access to healthcare because of lack of transportation or insurance.
There have been a lot of studies that have show that if someone has HIV and is taking HIV drugs and the viral load is undetectable – which means that there is not enough HIV within the blood stream for the test to measure, then that person is unable to transmit HIV to sexual partners who happen to HIV negative. This goes for men as well, but there will need to be much more research done into this particular development on how it will affect women – especially when it comes to breastfeeding or unfair power dynamics that a woman may experience within a relationship.
There have been clinical trials and HIV treatment studies that have not really included a lot of women. It is because of this that most information that are on just how safe and how effective the treatment of HIV drugs will come from research that has been done on men. This is seen to be an under-representation of women within needed studies which is starting to really change. There are many organizations that are working hard to help improve the research for women who are living with HIV.
There is some research that exists that has found that there is barely little difference between the effectiveness of certain HIV treatments for a man and a woman. Women who are living with HIV will start to begin their treatments will do so and this goes for men as well. Even though the treatment has been seen to work just as well in women as men, yet the side effects may be a little different.
There are some differences when it comes to side effects between women and men which may be caused by the interactions between female hormones and HIV treatments. They may even be a result of the smaller size of the woman due to the standard doses for treatments being based on men.
Women who are living with HIV will need to be very careful when it comes drug interactions. There are some HIV treatments that can cause levels of other medications within the female body to change. For instance, there are some HIV treatments that will affect how well birth control will work and just how effective the birth control will be when it comes to preventing pregnancy.
It is very important that women who happen to be HIV positive be treated by a health provider who have a lot of experience when it comes to treating women who have been diagnosed with HIV. You will need to talk to your health provider about any medical conditions and talk about what medications that you are taking. If you are experience any type of side effects from the HIV treatments, then you will need to speak to your health provider about what you will need to do.
Women will often end up with certain type of gynecological problems which are common and can be difficult to treat and more serious for women who are HIV positive when compared to women who are HIV negative. Some of these are:
However, there is not a lot of research that is available for periods and HIV, yet many women who have HIV have reported that they do not have normal periods. There are some that will bleed heavily, while others report that their period has stopped altogether.
HPV or Human Papillomavirus is a type of sexually transmitted infection which can cause cervical cancer and/or genital warts. Women who have HIV are more likely to be infected with HPV. Women who have HIV are less likely to get rid of or be clear of HPV, and those who have advanced HIV with low CD4 counts are very likely to get dysplasia or abnormal cervical cells because of HPV.
Dysplasia is basically abnormal cells are located on the cervix and it is much more severe and harder to treat and when dysplasia is untreated then it can cause cervical cancer. It is very important that HPV is found early and get treatment to prevent any health problems. Regular screenings should be done.
There are 3 very effective vaccines for HPV. Since the first HPV vaccine was introduced in 2006, those who have had gotten HPV has dropped by 50%. It is very important women to be vaccinated for HPV before they ever have sex, before they can be exposed to HPV, since those who have been infected with HPC are not protected by the vaccines. There are a lot of strains of HPV, so even if a woman who has a single strain of HPV will benefit with the vaccination, since it will protect against any other strain. The vaccines have been found to be effective and safe for women who happen to have HIV infections.
Due to all the advancements in treatment and care of HIV, there are a lot of women who are living much healthier and longer lives with HIV. However, there are some women who will start to think about the future, and they are deciding to have children. Women who have HIV who want to become pregnant will need to discuss this with their doctors.
The great news is that because of these advancements, HIV treatments have reduced the chances that a mother will pass the virus to the child through mother to child transmission. If the mother is safe and takes all medical precautions, then the transmission rates can be reduced to 1 to 100 births. Additionally, there are some studies that have shown that being pregnant will not cause HIV to get worse.
The number of women who have HIV is increasing. It is very important to get tested regularly and do what you can be to be aware of your risks for HIV. There are many countries which include the United States that will test for HIV as a part of preventative care and routine health screenings. If you receive a negative test result, then take steps to keep it that way. If you receive a positive result, then take steps to stay healthy and prevent transmission to others. Even though there is not a cure for HIV, there are plenty of women who are living stronger and longer while having HIV because of effective treatments and care.
Written by Mark Riegel, MD
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