Women & HIV/AIDS

Women Are at Risk

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• Women Can Get HIV Easily
• Young Women
• Women Over 50
• Violence Against Women
• African American Women
• Women Who Have Sex with Women
• Barriers to Care
• A Man's Secret: "On the Down Low"
• Additional Resources

Even though more men than women have HIV, about one-quarter of people living with HIV in the United States are women. High rates of HIV among women have brought new attention to the unique issues and special challenges that make it harder for women to prevent HIV or to take care of themselves if they have HIV. This section explores these and other reasons women are at risk for HIV infection.

Women Can Get HIV Easily

Female Genitals

Male Genitals

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

• The lining of the vagina provides a large area, which can be exposed to HIV-infected semen.
• Semen has higher levels of HIV than vaginal fluids do.
• More semen is exchanged during sex than vaginal fluids.
• Having untreated sexually transmitted infections (STIs) makes it more likely for women to get HIV.

Many HIV-positive women with negative partners worry about giving HIV to their partner(s). Research shows that men give HIV more easily than women give the virus. But 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 STIs. Swelling of the vagina caused by 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 STI, 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 (vaginal, anal, or oral), make sure to use a latex condom correctly and every time.

Young Women

Young people in the United States are at a greater risk of getting HIV infection. In 2006, young adults aged 13 to 29 accounted for the largest number of new HIV infections in the United States. According to CDC research on disadvantaged youth, the rate of HIV among young women aged 16 to 21 is 50 percent higher than the rate among young men in that age group. African American women in this study were seven times as likely as white women to be HIV-positive.

Young women are at a greater risk of getting HIV for several reasons, including:

• Biological reasons
• Lack of awareness
• Not knowing their partners' risk factors, such as a history of unprotected sex or injection drug use
• Feeling less power in relationships
• Having sex with older men who are infected

Many young women infected with HIV as infants from their mothers are now facing decisions about becoming sexually active as well. In a recent American Journal of Public Health article, some of these young women grow up without knowing they are HIV-positive. Family members and caregivers delayed telling them because of fear or shame. Other research shows that once these young women are aware, they are more likely to have risky sex without telling partners they are HIV-positive.

Many young people do not know about HIV risk and don’t worry about becoming infected. HIV prevention outreach and education efforts, including programs on abstinence and HIV screening, are key to preventing the spread of HIV by young people. The following are some CDC-tested prevention programs that state and local health departments provide for youth across the country.

• Teens Linked to Care is focused on young people aged 13 to 29 who are living with HIV.

• Street Smart is an HIV/AIDS and STI prevention program for runaway and homeless youth.

• PROMISE (Peers Reaching Out and Modeling Intervention Strategies for HIV/AIDS Risk Reduction in their Community) is a community-level HIV prevention intervention that relies on role-model stories and peers from the community.

Women Over 50

If you are over 50, you may not think that you are at risk for HIV infection for many reasons.

• You may not realize that you need to protect yourself against HIV.
• You may not know the term “sexually transmitted infections" or STIs. You were taught about "venereal diseases" or VD.
• You may not know how to prevent HIV.
• You may think you don't need to use condoms because you don't worry about getting pregnant. Or, you may be dating again after many years and don't know how to talk to your partner about using condoms.

But anyone at any age can get HIV and AIDS. If you have not been tested for HIV, don’t wait. Get tested now. You might be at risk for HIV if:

• You are sexually active and do not use condoms.
• You do not know your partner's drug and sexual history, including your partner's HIV status.
• You have had a blood transfusion or operation in a developing country at any time.
• You had a blood transfusion in the United States between 1978 and 1985.

You can lower your risk of HIV if both you and your partner know your HIV status and are faithful to each other. Using condoms correctly and every time you have sex also can lower your risk of HIV. Learn more about steps you can take to protect yourself from HIV no matter what your age.

Older women with HIV also need to think about other health problems that are common in older women, such as heart disease and osteoporosis. If you have HIV, talk to your doctor about steps you can take to lower your risk of other health problems, such as quitting smoking and eating heart-healthy food. Also ask your doctor about preventive screenings you might need as you age, including screenings for breast cancer, colon cancer, and bone health.

Violence Against Women - Sexual Assault

Violence against women plays a big role in increasing the risk of HIV infection among women. In violent or forced-sex situations, forced penetration can cause cuts that allow easy entry of HIV. This is especially true for young girls, whose reproductive tracts are less fully developed.

Fear of violence keeps some women from insisting on condom use. Fear of violence also keeps some women from 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.

African American Women

AIDS is the leading cause of death among African American women aged 25 to 34 years living in the United States. And of all U.S. women living with HIV/AIDS, 64 percent are African American. There are many reasons why African American women are affected by HIV/AIDS more so than women of other races, including:

• Poverty — The U.S. Census found that one in four African American women lives in poverty. Studies have shown a strong link between poverty and the risk of HIV infection. People living in poverty also get lower-quality health care in general, which can mean advancing from HIV infection to AIDS more quickly.
• STIs — HIV is most commonly spread to women through sexual contact. Untreated STIs that break the skin, such as genital herpes and warts, give HIV easy access into the bloodstream. African American women are at much greater risk for some STIs. For instance, gonorrhea rates among African American women were 14 times higher than among white women in 2006.
• Incarceration of African American men — Based on current rates of incarceration, nearly one-third of all African American men will enter prison during their lifetimes. Cycling in and out of the prison system leads to fewer available African American men in the community. Living in prison 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.

Women Who Have Sex With Women

Women who only have sex with women might think they are safe from HIV. But experts think it’s possible for a woman to get HIV through sexual contact with a woman infected with HIV. Experts think this could happen if soft tissues, such as in the mouth, come in contact with the vaginal fluid or menstrual blood of a woman infected with HIV. Women who have sex with women also can become infected with HIV through injection drug use or by having unprotected sex with a man who has HIV.

A woman who has sex with women should know her HIV status as well as her partner’s status. That way, she can take steps to protect herself from HIV or prevent the spread of HIV to others. You can lower your risk of HIV by using condoms correctly and every time you have sex with men or when using sex toys. Dental dams have not been studied, but might lower the risk of getting or spreading HIV.

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 risky behaviors 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 communities 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 people around to provide emotional support or other types of help.

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 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 Resources:

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.   HIV Infection In Women — AIDS is the fifth leading cause of death for women ages 35 to 44 in the United States. This fact sheet addresses the special concerns that women with HIV/AIDS face.

   http://www3.niaid.nih.gov/topics/HIVAIDS/Understanding/Population+Specific+Information/womenHiv.htm...

3.   HIV, AIDS, and Older People — This publication explains what HIV is, how it is spread, how it is treated, why it is increasing among older adults, and how it affects them.

   http://www.nia.nih.gov/HealthInformation/Publications/hiv-aids.htm

4.   HIV/AIDS Among African Americans — This publication provides statistical information about African Americans infected with HIV/AIDS in the United States. Also discussed are the interrelated challenges to prevention in African American communities.

   http://www.cdc.gov/hiv/topics/aa/resources/factsheets/aa.htm

5.   HIV/AIDS Among Men Who Have Sex With Men — This publication discusses the increase of HIV among men who have sex with men, the risks, and possible prevention.

   http://www.cdc.gov/hiv/topics/msm/resources/factsheets/msm.htm

6.   HIV/AIDS Among Persons Aged 50 and Older — This publication discusses the increase of HIV among persons aged 50 and older, the prevention challenges and what the Centers for Disease Control and Prevention is doing to combat HIV in this population.

   http://www.cdc.gov/hiv/topics/over50/resources/factsheets/over50.htm

7.   HIV/AIDS Among Women Who Have Sex With Women — This fact sheet discusses risk factors for female-to-female transmission of HIV, as well as potential prevention measures. Vaginal secretions and menstrual blood are potentially infectious, and mucous membrane (e.g., oral, vaginal) exposure to these secretions can potentially lead to HIV infection.

   http://www.cdc.gov/hiv/pubs/facts/wsw.htm

8.   HIV/AIDS Among Youth — This fact sheet provides an overview of HIV/AIDS among adolescents, as well as risk factors and barriers to prevention. In the United States, HIV-related death has the greatest impact on young and middle-aged adults, particularly racial and ethnic minorities.

   http://www.cdc.gov/hiv/resources/factsheets/youth.htm

9.   HIV/AIDS Surveillance in Women — This slide series tracks the occurrence of HIV and AIDS in women from 1985–2006.

   http://www.cdc.gov/hiv/graphics/women.htm

10.   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

11.   Questions and Answers: Men on the Down Low — This publication provides a definition for the term "down low" and its implications for sexual risk factors and HIV/AIDS. It also talks about the steps the Centers for Disease Control and Prevention is taking to address this population.

    http://www.cdc.gov/hiv/topics/aa/resources/qa/downlow.htm

12. Aging With HIV (Copyright © SFAF) — This publication describes how heart disease and bone loss can affect aging women with HIV and provides tips to lower risk factors for these problems.

    http://www.sfaf.org/beta/2006_win/aging.html

13. Older People and HIV (Copyright © AIDS InfoNet) — Not just young people get HIV. This article describes how many older adults have HIV, why they are getting infected, and how HIV affects them differently.

    http://www.aidsinfonet.org/fact_sheets/view/616

14. 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 HIV prevention.

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

15.   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.   Divisions of HIV/AIDS Prevention, CDC, HHS
4.   National Institute of Allergy and Infectious Diseases, NIH, HHS
5.   National Institute on Aging Information Center, NIA, NIH, HHS
6.   National Prevention Information Network, CDC, HHS
7.   Office of Special Health Issues, FDA, OPHS, HHS
8. Center for AIDS Prevention Studies, ARI, UCSF
9. HIV Wisdom for Older Women
10. National Association on HIV Over Fifty
11. Project Inform
12. Society for Women's Health Research

= Indicates Federal Resources

Content last updated March 4, 2009.