Burden of HIV on Women Living in the United States

HIV blood sample © jarun011 - stock.adobe.com

Cisgender women experience the highest burden of HIV globally, accounting for 46% of new cases in 2022. In the United States, women account for 23% of the current 1.2 million HIV cases, according to a recent article published in the Nursing Clinics of North America.

Risk factors contributing to this epidemic include socioeconomic status, gender inequality, education, housing, stigma, poverty and partner violence.

Most (about 85%) of HIV cases in women come from heterosexual contact, followed by drug use (nearly 16%).

Black women currently have the highest prevalence of HIV from heterosexual contact, accounting for 92% of infections. They also account for 54% of new HIV infections overall, despite only representing 13% of the female population. Although HIV rates have dropped for American-born Black women, rates Black women born outside the United States have risen.

In her lifetime, a Black woman has a 1 in 54 chance of being diagnosed with HIV. Hispanic women are at a 1 in 256 risk, and White women have a 1 in 941 chance.

Regional differences also play a role. The southern United States has higher rates of HIV for Black and White women. Hispanic women have a higher HIV risk in the Northeastern United States.

Despite its effectiveness, pre-exposure prophylaxis (PrEP) uptake is low in women.

“Among high-risk women, only 14.9% had adequate knowledge of PrEP,” Dominique Guillaume, MSN, AGPCNP-BC, AAHIVE, author and Ph.D. candidate at Johns Hopkins University, writes in her article. “Even among women who have high PrEP awareness, knowledge toward PrEP has been found to be generally low, with women believing misconceptions such as PrEP being solely for individuals in the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community.”

Antiretroviral therapy is still the main choice of treatment for people with HIV, but a host of challenges surround it. When compared with men, women gain significantly more weight on ART, which leads to more women stopping. Women who do stick with ART live longer and therefore may have more health problems associated with age. Compared with HIV-positive men, HIV-positive women have a 1.5 to 2-fold higher risk for stroke, heart attack and heart failure, due to sex-specific and age-specific risk factors such as menopause.

Poverty and housing challenges are additional risk factors because they can potentially lead to a host of unsafe behaviors such as unprotected sex work to earn income or substance abuse to cope with stress. High-risk behaviors and poverty have a greater association with intimate partner violence, which affects an estimated 55% of HIV-positive women.

“Clinical interventions must account for these aforementioned factors, in order to promote women’s engagement in HIV prevention and treatment services and subsequently reduce women’s burden of HIV in the United States,” researchers wrote. “Reducing the burden of HIV among women and successfully reaching Center for Disease Control Ending the HIV Epidemic (EHE) targets will require a culmination of efforts that go beyond biomedical approaches and adequately address structural and social determinants.”