From Mark Cichocki, R.N.,
Your Guide to AIDS / HIV.
FREE Newsletter. Sign Up Now!

About.com Health's Disease and Condition content is reviewed by Susan Olender, MD

The HIV virus does not discriminate between men and women. Either can be infected, and both can infect others. But there are considerable differences between men living with HIV and women living with HIV. Infection rates and infection prevalence are not the same across the sexes, and there are needs and concerns unique to women living with the disease. Let’s take a look at women and HIV. What are those differences and how do they impact women who live with this disease?

The Facts About Women and HIV

Here are some facts:

• Today, roughly 40 million people worldwide are living with HIV.
• It’s estimated that 50 percent of those people living with the disease are women.
• While men still make up the majority of HIV cases in the United States, about 300,000 women are living with HIV.
• The proportion of HIV cases that are women has tripled from about eight percent to 27 percent since 1985.
• From 2000 to 2004, the number of men living with HIV has increased by seven percent while the number of women infected has increased 10 percent.

HIV and Women - What Does it Look Like in the United States?

There are some disturbing trends emerging in the United States with regard to HIV and women. In this time of increasing HIV infection among women, young women and women of color have been the hardest hit.

• Women of color account for 79 percent of all new infections among women 13 to 19 years of age, and 75 percent among women 20 to 24 years of age.
• Among all HIV cases in people 13 to 19 years of age, women of color account for 50 percent of them.
• In 2002, AIDS was the leading cause of death among black women 25 to 34 years old.

It’s obvious that women are being impacted by HIV at an alarming rate. But why is this? If HIV does not discriminate, how can these statistical differences be explained? The sad truth is that women are more vulnerable to HIV infection in many ways.

Why Are Women Vulnerable to HIV?

There are vulnerabilities to HIV that are unique to women. These help to account for the differences in infection rates between men and women worldwide. Some of those vulnerabilities include:

• Physical Differences - The incidence of heterosexual transmission in the United States has been on the rise since 1985. At that time, about three percent of all known cases were heterosexually transmitted. That figure today is about 27 percent. Finally, 70 percent of all new HIV infections are a result of heterosexual sex; worldwide, 90 percent of all infections are heterosexual. Women are especially susceptible to heterosexual transmission physically because the mucosal lining of the vagina offers a large surface area to be exposed to HIV-infected seminal fluid.

• Easier to Transmit from Men to Women than Women to Men – Again, anatomical differences between men and women mean transmission from men to women is easier than the other way around. Much like the rectal mucosa makes transmission during anal intercourse easier, the mucosal lining of the vagina offers a large surface area to be exposed to infected seminal fluid. Plus, the vagina is more susceptible to small tears and irritation during intercourse than is the penis. These properties offer a portal for HIV to enter the body and infect the woman.

• Gender Inequities – Especially in developing countries, prevailing gender inequities leads to higher-risk behaviors. For instance, in many cultures women are not free to refuse sex or to insist on safer sex using condoms. Men assume a position of power and control over women, minimizing the amount of input and consent from women. In addition, women have less access to employment and education in these developing countries. Often, the sex trade is one of the few options for women trying to earn money and support themselves and their children. Finally, sexual violence against women is very high in some areas, again exposing them to high-risk behaviors without their consent.

What Challenges Do Women Face?

Obviously, HIV impacts anyone who has the disease, whether male or female. An HIV diagnosis, while not a death sentence, will most certainly be a life-changing event. However, there are some challenges that are unique to women:

• There is an increased risk of reproductive illnesses including vaginal yeast infections, pelvic inflammatory disease (PID), Human Papillomavirus (HPV) and cervical cancer.

• Because women often have lower incomes than men or work lower paying jobs with minimal benefits, women have less access to HIV care and affordable medical insurance.

• Women are more likely to postpone health care due to illness or lack of transportation than are men.

• Women assume more family care responsibilities and are more likely to sacrifice their own health care in order to care for their family, especially their children.

Is Anything Being Done?

The disparities between men and women who live with HIV have not gone unnoticed. In fact, the National Institute of Allergy and Infectious Diseases (NIAID) has placed a new emphasis in women-focused HIV research, funding and sponsoring studies around the world. Once such example is the research being done in hopes of developing a microbicide gel or cream that would provide an inexpensive and easy-to-use product that would allow women to assume more control over safer sex.

While work is being done to close the gap between men and women, the fact remains that a disparity does exist. Until that gap is closed, we will see infection rates among women continue to climb, something none of us can really afford to let happen.

_Source:

1. Anderson RN, Smith BL. "Deaths: Leading Causes for 2002. National Vital Statistics Reports 2005;53(17).

2. "HIV Infection in Women." 01 May 2006. US Department of Health and Human Services. 31 Dec 2006.

3. "The Impact of HIV/AIDS in Women." 12 Dec 2004. Health Care - Body Care. 31 Dec 2006.