Considerations of Sex and Gender: A Recap from the 2nd US HIV Cure Research Academy

Submitted on May 27, 2026

By Katie Willingham

The US HIV Cure Research Academy took place April 22 – 24, 2026, in Durham, North Carolina. This year's academy welcomed more than 30 talented participants working in the HIV field and interested in building knowledge of HIV cure science and skills in translation. The selected fellows had a unique opportunity to interact with leading researchers and advocates over 2.5 days of intensive training, networking opportunities, and hands-on experience. Read on for perspectives on the meeting from one of the two members of The Well Project's community advisory board that attended as fellows.

On one of the mornings of the conference, Nancie Archin, PhD, of the University of North Carolina at Chapel Hill, presented on sex and gender issues in HIV cure research. Honestly I was still a little sleepy at that time of the day, but when I saw sex and gender on the presentation screen I perked right up. This is of course a very interesting and important topic for me and for The Well Project. To help in writing this article, I also used a slide deck by Eileen Scully, MD, PhD, an associate professor of medicine at Johns Hopkins University, from a previous HIV Cure Academy.

Sex is assigned at birth and refers to things such as anatomy and chromosomes. Gender is not assigned at birth and is part of one’s internal sense of self. Both are valid and important to one’s health. Some things to consider in cure research are biological determinants of sex differences and gender determinants of health. These are not the same thing. The biological determinants of sex differences are related to the body, while gender determinants of health are related to mental health.

The impacts of sex and gender on cure research, such as engagement with care and adherence to medication; engagement in research; impact of smoking, diet, and stress; differences in size and activity of HIV reservoirs (places where HIV cells may hide in the body); distinct features of the immune response; and different responses to drugs can all vary between men and women. The differences to consider between sex versus gender are hormones, environment, chromosomes and sociobehavioral factors.

Representation matters in studies and for many people, just knowing that a study includes “people like me” builds trust in the outcomes and may support greater participation. Does sex and gender matter in HIV pathogenesis (the lifecycle of a disease)? The short answer is yes, there is a lower set point (the level of viral load when the virus settles after initial viral spike) viral load in women with untreated HIV, a similar rate of disease progression, and a higher level of immune system activation per viral load in women as compared to men. But there are higher numbers of spontaneous controllers among women. All this means that women’s bodies are better equipped to handle the virus than men. And the idea of “spontaneous control”? That’s very exciting to me. I want to learn more about this spontaneous control. What does it mean? Is it possible for the masses? Is it possible for me? I want some of that lol!

Women have lower levels of HIV but still have higher immune activation and a similar rate of disease progression; this is a higher immune response, which is actually a bad outcome. However, women are also more likely to develop the rare phenotype of spontaneous HIV control, which is a good outcome. One question researchers are asking is how do these differences impact potential approaches to HIV cure?

In summary, sex and gender both impact a variety of health outcomes. Representation will allow the identification of important differences and may point to better treatment pathways. There are multiple lines of evidence showing differences by sex and these may impact strategies towards finding a cure.