Gender-specific Problems

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• Biological and Physical Makeup
• Violence Against Women – Sexual Assault
• Barriers to Care
• HIV and African American Women
• A Secret World: Men on the "Down Low"
• Additional Information on Gender-specific Problems

On average, women — especially young women — are more at risk of getting HIV/AIDS because they have a hard time talking to their male partners about safer sex such as condom use. Many believe that it is the norm for women to have less power in the relationship and rely heavily on their male partners. Thus, women may be less likely to leave an abusive or otherwise harmful relationship if they are dependent on men. And women in this position may feel forced to take part in unsafe sexual practices.

Concerns about high rates of HIV among women have brought new attention to the role of gender in sexual and reproductive behavior.

Biological and Physical Makeup

Female Genitals

Male Genitals

Women are more likely to get HIV for several biological reasons.

• There is a more exposed surface area in the female genitals (sex organs) than in the male genitals.
• There are higher levels of HIV in semen than in vaginal fluids.
• More semen is exchanged during sex than vaginal fluids.
• Women often have untreated STDs, which makes them more likely to get HIV.

Many HIV positive women with negative partners worry about giving HIV to their partner(s). While research shows that men give HIV more easily than women give the virus, women can still pass HIV to uninfected partners — both male and female — through sex. This is because HIV is in blood (including menstrual blood), vaginal fluids, and in cells in the vaginal and anal walls.

HIV levels in vaginal fluids also increase a lot in the presence of vaginal yeast infections and STDs. Swelling of the vagina, a common symptom of such infections, causes tiny scrapes and cuts on the delicate skin of the vaginal area that can hide HIV. HIV levels can also increase temporarily after getting treatment for some of these conditions.

In short, the surest way to avoid passing any STDs, including HIV, is to not have sex. There is no way to know when you are more or less likely to give HIV to your partner(s). Exposure to vaginal fluids with high levels of HIV increases the risk of passing the virus. The risk increases even more when your partner has an infection or inflammation.

If you do have sex, use a latex condom every time.

Violence Against Women – Sexual Assault

Violence against women plays a huge role in increasing the risk of HIV infection for women. It is a key reason why women are more likely to get HIV infection than men, particularly during violent or forced-sex situations. The cuts caused through forced penetration allow easy entry of the virus. This is especially true for young girls, whose reproductive tracts are less fully developed.

Fear of violence is a factor in terms of seeking treatment. Women may delay being tested for HIV or fail to return for the results because they are afraid that sharing their HIV positive status may result in physical violence.

Barriers to Care

Women infected with HIV may have less access to or lower use of health care resources. This may be due to:

• fewer financial resources
• less access to transportation
• added responsibility of caring for others, especially children

Many experts also believe poverty, unemployment, and lack of education are helping to "drive" the growing HIV problem among women. Women living in inner-city poor neighborhoods are often in poor health and without access to health care for prevention or treatment. While high-risk behavior in these communities directly spreads HIV/AIDS, urban poverty is clearly playing an important role.

Yet, the HIV problem does not only belong to poor neighborhoods in large cities, such as New York and Washington, DC. HIV also affects women in more rural neighborhoods in southern states. Researchers in North Carolina found that African American women with HIV infections were more likely to:

• be unemployed
• receive public assistance
• have had 20 or more lifetime sexual partners
• have a lifetime history of genital herpes infection
• have used crack or cocaine
• have traded sex for drugs, money, or shelter

In addition to these challenges, research has highlighted other issues that affect the lifespan of women with HIV. Studies have shown that women with HIV do not live as long as men with HIV, perhaps because women are less likely to be diagnosed early. Early diagnosis of HIV allows women to benefit more from antiretroviral treatments. Other issues may also play a role in this difference in survival.

• Women with HIV may have less access to or lower use of health care resources than men with HIV.
• HIV positive women in abusive relationships may suffer violent reactions from partners.
• Women who are homeless have less access to care. Homeless women who are able to get treatment may not be able to stick with care routines because of irregular meals or not having proper places to store medicines.
• Some women with HIV may not have a people around to provide emotional support or other types of help.

HIV and African American Women

AIDS is the leading cause of death among African American women aged 25-34 years, living in the United States. There are many issues that may contribute to the problem.

• Poverty — The 2000 U.S. Census found that one in four African American women lived in poverty. Studies have shown a strong link between poverty and the risk of HIV infection. Poor people in general also get lower-quality health care, which can mean advancing from HIV infection to AIDS more quickly.

• STDs — HIV is most commonly spread to women through sexual contact. Untreated STDs that break the skin, such as genital herpes and warts, gives the HIV virus easy access into the bloodstream. African American women are at much greater risk for some STDs. For instance, gonorrhea rates among African American women were 14 times higher than among white women in 2005.

• Incarceration of African American men — Nearly one-third of all African American men have been incarcerated either as teens or adults. Cycling in and out of the prison system leads to fewer available African American men in the community. Prisons also exposes many men to anal sex, whether forced or by choice, and injection drug use. These practices raise the risk of passing HIV to both the men and their female partners at home.

African American men on the "down low" may also be a factor in the burden of HIV on African American women.

A Secret World: Men on the "Down Low"

The term "down low" or "DL" means to keep something private, whether related to information or actions. Being "on the down low," "on the DL," or "on the low low," are terms that are often used to describe men who have sex with men as well as women, but do not identify themselves as gay or bisexual.

While the term "DL" has most often been identified with African American men, research has shown that it also describes the lives of some White and Hispanic men. Yet because being "on the DL" is defined by secrecy, very little is known about these men. It is not known how many of these men:

• have HIV or AIDS
• practice unsafe sex with any partner
• engage in other actions that put them at risk of HIV, such as injection drug use

Researchers are working to better understand the sex-related HIV risks of men who are "on the down low." The concern for women remains exposure to HIV without them knowing, if their partners get HIV from unsafe sex with HIV positive men.

Additional Information on Gender-specific Problems:

Publications

1.   Global Coalition Works to Protect Women, Girls from HIV/AIDS - This article provides information on the biological and social differences between men and women that make women twice as likely to become infected with HIV.

   http://www.america.gov/st/washfile-english/2004/February/20040205153600XCretroP0.8917963.html...

2.   Prevention Challenges - This fact sheet outlines the major biological and social factors that make women more vulnerable to becoming infected with HIV.

   http://www.cdc.gov/hiv/topics/women/challenges.htm

3. HIV/AIDS and Women (Copyright © IWHC) - This publication describes women's vulnerability to AIDS and suggests recommendations for changes in international prevention programs.

   http://www.iwhc.org/issues/hivaids/overview.cfm

4. Treatment information for Women and their Providers (Copyright © Project Inform) - This web site links to information from Project Inform specifically for women with HIV/AIDS.

   http://www.projectinform.org/info/index_w.shtml

5. Women and HIV (Copyright © AIDS InfoNet) - This publication explains the biological and social factors that put women at risk for contracting HIV. Additional information is provided regarding the rise in HIV infection in women and the prevention of the spread of AIDS.

   http://www.aidsinfonet.org/fact_sheets/view/610

6.   Women and HIV/AIDS in the United States (Copyright © KFF) - The Kaiser Family Foundation (KFF) reports that HIV is affecting more women than ever before. This report provides statistical information on the demographics of infected women and provides an explanation for why a disproportionate concentration of HIV/AIDS among women and minorities exists.

   http://www.kff.org/hivaids/upload/6092-04.pdf

Organizations

1.   AIDSInfo
2.   Division of Acquired Immunodeficiency Syndrome(DAIDS), NIAID, NIH, HHS
3.   Office of Special Health Issues, FDA, OPHS, HHS
4. Center for AIDS Prevention Studies, ARI, UCSF
5. Project Inform
6. Society for Women's Health Research

= Indicates Federal Resources

Content last updated January 25, 2008.