Women represent more than half of all people living with HIV worldwide – that’s more than 17 million women living with HIV around the world. In some areas, women are disproportionately affected; in sub-Saharan Africa, for example, women now account for more than 60 percent of all HIV cases. Globally, HIV is the leading cause of death among women of reproductive age, and UNAIDS recently released a shocking statistic – one young woman is newly infected with HIV every minute.
Simply put, women’s bodies are different from men’s. These differences affect how women and girls prevent, get, and handle HIV infection. For example:
- During heterosexual sex, HIV is passed almost twice as easily from men to women than from women to men; younger women and girls are even more vulnerable to HIV given the biological immaturity of their reproductive tracts
- When women are first diagnosed, they tend to have lower viral loads (amount of HIV in the blood) compared to men who are newly diagnosed
- Women generally have lower CD4 cell counts than men with similar viral loads
Since HIV treatment studies (clinical trials) have traditionally included very small numbers of women, most information about the effectiveness and safety of HIV drugs comes from research done in men. This under-representation of women in trials has only recently begun to change.
The existing research that we do have has found little difference in the effectiveness of HIV treatment for women and men, in some cases the side effects may differ. For example, women living with HIV (HIV+) are at greater risk for weakened bones, and often experience different types of body shape changes than men.
How the HIV epidemic affects women and girls is also rooted in a complex combination of social and structural factors. The lives of women and girls are shaped by a number of gender-based inequalities including:
- social (e.g., less power in sexual decision-making)
- economic (e.g., less power to earn or control income)
- political (e.g., policies that deny women inheritance or give them little or no choice in reproductive rights)
These inequalities not only increase women’s vulnerability to HIV, but also negatively impact the health of women living with HIV. Women tend to be diagnosed with HIV later in their disease than men and fewer women than men are getting HIV treatment. Women may delay getting medical care and treatment for several reasons, including:
- limited access to health care and/or transportation
- lack of financial resources and/or social supports
- other responsibilities such as child care or caring for a sick family member
- stigma, discrimination, and criminalization associated with HIV
- depression, which is more common among HIV+ women than HIV+ men
Violence against women (VAW), which the World Health Organization calls a “global health problem of epidemic proportion,” also plays a role in how the HIV pandemic affects women. Several studies have shown that women with a history of physical and/or sexual abuse are more likely to become HIV positive, especially if that abuse first started during childhood years.
Among women living with HIV, research indicates that trauma and violence are associated with poorer health as a result of reduced HIV treatment and decreased treatment adherence. Finally, many women may be at risk of abuse or violence if they tell their partner or the person they live with about their HIV status.
One prime example: PrEP
In 2012, the US Food and Drug Administration approved a well-known HIV drug (Truvada) as a new HIV prevention tool – pre-exposure prophylaxis, or PrEP. Unlike condoms, PrEP can be used without the cooperation or knowledge of one’s partner. An oral daily pill, PrEP is attractive to many women because it puts the power of HIV prevention in their hands. While there was solid evidence demonstrating Truvada’s effectiveness among men at the time of approval, its effectiveness for women remains unclear.
Biologically, there is evidence to suggest that, when taken as directed, Truvada is an effective way to prevent HIV for women. However, in two key studies (FemPrEP and VOICE), there were low levels of adherence; fewer than one in three women took the drug regularly. Additionally, many women in the FemPrEP study did not consider themselves at risk for HIV. The social elements that play a role in why many women did not take their one pill daily as prescribed, and why many women did not consider themselves at risk for HIV are just as important in the design of an effective prevention strategy as any biochemical solution.
As we continue to research appropriate interventions and outreach strategies to guide both prevention and treatment efforts for women, it is crucial that interventions be designed not for the women, but with the women they are intended to serve. Women living with and vulnerable to HIV disease and their advocates must be involved at every level and in every step of research development and implementation, in order to ensure that safe and effective treatments, as well as appropriate prevention strategies, are developed for women and girls.
Despite the fact that women and girls clearly have unique needs for HIV prevention and treatment, UNAIDS reports that less than half of all countries set aside women-specific resources as part of their national response to the HIV/AIDS pandemic. In addition, UNAIDS reports that less than 30 percent of young women worldwide have accurate, comprehensive knowledge about HIV and how to avoid getting it. Ultimately, this lack of access to information and resources perpetuates the epidemic of HIV among women and girls.
For all these reasons and more, The Well Project set out more than 10 years ago and continues to inform, support, and advocate for women and girls affected by HIV worldwide. Join us!