HIV stands for Human Immunodeficiency Virus. It is a sexually transmitted infection that damages a person’s immune system by destroying important cells that provide the ability to fight disease and infection. Left untreated, HIV can lead to Acquired Immunodeficiency Syndrome (AIDS), a chronic and potentially life-threatening condition. There is no effective cure for HIV until today, but the condition can be controlled with proper care.
Women account for more than half of the number of people living with HIV worldwide. (1)
In the US, one in four people living with HIV is a woman. (2)African-American women are disproportionately affected by HIV. They represent more than 57% of new HIV infections among women in 2018 but are only 13% of the female population in the US. (3)

This article will discuss five important facts about HIV in women.

1. While all women can get HIV, some are more at risk than others.

You have a higher risk of getting HIV if you :

  • practice unprotected sex
  • had sex with a person who has HIV
  • have sex under the influence of illegal drugs or alcohol
  • share injection needles with someone who has HIV
  • engaging in sexual activities with someone you have sex with, both men and women
  • have multiple sexual partners
  • have past or current STDs

STDs like genital herpes and syphilis increase significantly the risk of getting or passing on HIV. Research suggests that STDs cause an inflammatory reaction that activates our immunes cells. Unfortunately, HIV has an affinity for activated immune cells. If you have an STD in the mouth or on your genitals, there is a high concentration of activated immunes cells, making it easier for HIV to replicate and spread through the body. (4)

2. Women have a higher risk than men to get HIV during vaginal or anal sex

Women get HIV mostly through a sexual male partner who has HIV. During heterosexual sex, women have a higher risk of being infected than men for many reasons.
Anatomically, women are more vulnerable to HIV.

  • The fragility of the vaginal and anal tissues makes them susceptible to tear slightly during sex and let the virus penetrates the body. The risk is even higher among young girls under 18 who have lower vaginal mucus production. They are more likely to have vaginal tears during sex.
  • The vagina and anus have a much larger surface than the foreskin exposed to the virus. Therefore it increases the risk of infection.
  • After ejaculation, infected semen can remain in the genital tract for a longer time than the vaginal secretions on the penis.

3. HIV affects women’s fertility

Studies showed that HIV might affect reproductive organs’ function, which can lead to infertility. Besides, a longer duration of infection is associated with higher fertility reduction. (5)

The impact of HIV on the immune system can also affect the hormones (progesterone and estrogen) that control the periods. Therefore HIV infected women may also experience problems with their menstrual cycle, such as missed periods (amenorrhea), delayed periods(oligomenorrhea), heavy bleeding, a little bleeding, spotting between periods, or more severe premenstrual syndrome.

While HIV can affect women’s fertility for many reasons, some HIV medications can increase the risk of an unplanned pregnancy. These medicines can interact with hormonal birth control like pills, shots, or implants and make them less effective. Your healthcare provider can help you choose the appropriate form of birth control.

4. Women with HIV face many gynecological issues

In addition to menstrual problems, women living with HIV are also at increased risk of having many other gynecological issues.

Vaginal yeast infections

As HIV-positive women’s immune system gets weaker, they tend to have more vaginal yeast infections that are hard to treat. Some women with advanced HIV or AIDS can get it several times a year.

Bacterial vaginosis (BV)

BV is also common in women living with HIV. BV is caused by changes in the amount of Lactobacillus species, bacteria that naturally colonize the vagina. The lactobacilli are part of the vagina’s natural defense as they produce hydrogen peroxide, which is toxic for HIV. As a result, BV facilitates the acquisition of HIV and increases the risk of transmission of HIV to their sexual partners. (6)

Severe Pelvic Inflammatory Disease (PID)

Pelvic Inflammatory Disease (PID) is an infection of a woman’s reproductive organs such as the uterus, fallopian tubes, and ovaries. This condition is caused by STDs or other vaginal infections like BV. Available data suggest that PID occurs more frequently in women living with HIV. They often display more severe clinical manifestations of PID that are also harder to treat. (7)

Cervical Cancer

HIV-positive women have a substantially increased risk for cervical cancer when compared with HIV-negative women. It is the most common cancer among women living with HIV. Cervical cancer may also occur younger and is associated with an aggressive course, metastasis to unusual sites, poor treatment outcome, and frequent recurrences. (8) Cervical cancer is almost always caused by Human Papillomavirus (HPV) infection, and the type that causes cancer is common in women living with HIV. Therefore women with HIV must get regular Pap tests to look for cervical cell changes before they turn into cancer.

Menopause

Women living with HIV may enter in menopause younger. They also tend to experience more severe hot flashes than women who do not have HIV.

5. Pregnancy in HIV-positive women requires careful management

Having HIV does not mean you can’t have a baby. Unfortunately, there is a risk you can pass it to your baby during the pregnancy, the labor, the delivery, or by breastfeeding. Thanks to HIV medicines, the risks are minimal. With proper prenatal care and safe childbirth practices, pregnant women have less than a 1% chance of transmitting HIV to their baby. (9)

Most HIV medicines are safe and don’t raise the risk of birth defects. Getting treatment is crucial for pregnant women living with HIV. The amount of HIV in their body can be reduced to low levels called ‘undetectable’ (undetectable viral load). In that case, vaginal delivery can be planned because the risk of passing on HIV to the baby during vaginal birth is significatively reduce.
If the viral load is high, a cesarean section may be recommended, as the risk of transmitting HIV to your baby is smaller than a vaginal delivery.

References

1-https://www.unwomen.org/en/what-we-do/hiv-and-aids/facts-and-figures

2-https://www.womenshealth.gov/hiv-and-aids/women-and-hiv

3-https://www.cdc.gov/hiv/group/gender/women/index.html

4-Ward H, Rönn M. Contribution of sexually transmitted infections to the sexual transmission of HIV. Current Opinion in HIV and AIDS. 2010 Jul;5(4):305-10.

5-Massad LS, Springer G, Jacobson L, Watts H, Anastos K, Korn A, Cejtin H, Stek A, Young M, Schmidt J, Minkoff H. Pregnancy rates and predictors of conception, miscarriage, and abortion in US women with HIV. AIDS. 2004 Jan 23;18(2):281–6.

6-https://sti.bmj.com/content/76/1/3

7-9 Common HIV Symptoms in Women That Shouldn’t Be Ignored (healthline.com)

8-https://www.intechopen.com/books/gynecologic-cancers-basic-sciences-clinical-and-therapeutic-perspectives/cervical-cancer-in-human-immunodeficiency-virus-hiv-positive-patients

9-https://www.womenshealth.gov/hiv-and-aids/living-hiv/pregnancy-and-hiv

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About the Author

Hermione M.

My name is Hermione. I am the founder of WomenH and I write about women's health, wellness, mental health, and personal growth. I created this platform to inspire women to take care of themselves mentally, physically, and emotionally to become their best selves. Thank you for stopping by.

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