Women face particular issues when it comes to HIV:
- biological and social vulnerability to HIV infection
- invisibility in research and medical care
- HIV-related illness and medication side effects
- sexual stigma
- caregiving responsibilities
- gender abuse and violence
- dangers of disclosure
Biological and social vulnerability to HIV infection
During heterosexual sex, there is a higher likelihood of transmitting HIV from men to women than the other way around. This is because the vagina, cervix, and anus have more tissue that HIV can pass into than the penis does. Penile ejaculation during vaginal or anal sex without a condom means that semen, which can have high amounts of HIV, stays in contact with women’s tissues longer. Young women and older women, who have less resilient genital tissue, are particularly vulnerable.
The unique phyisiology of trans women may in some cases increase the risk of HIV. A lack of research about trans women means it has not been determined how use of hormones and genital surgery factor into HIV transmission.
Gender inequality creates economic and social dependence upon men and prevents many women from being able to protect themselves against HIV. For example, women often cannot insist on condom use, because men typically decide whether to use a condom. When injecting drugs with a partner, in many cases the man injects himself first, then uses the same needle to inject the women or passes the needle to her to use. Forms of discrimination such as racism, homophobia, and ableism further put women at risk.
Violence is a huge risk factor for HIV, and gender-based violence is an issue in all societies.
Invisibility in research and medical care
Women continue to be underrepresented in HIV research, despite their unique experiences and health needs. The proportion of women participating in clinical trials for HIV drugs is still too low, and advocates continue to call for greater inclusion. When designing studies, researchers need to aim for appropriate gender balances and address possible barriers to women’s participation. Advocates would also like to see more research focused specifically on women with HIV.
It can be difficult for women to find the information they need or access appropriate and respectful health care. One member of PWN said she had to convince a doctor to test her for HIV, because her doctor didn’t she was “the type” to have the virus. Media stereotypes of women with HIV don’t reflect the reality that HIV can affect anyone. Women of colour, migrant women, Indigenous women and queer women may face added discrimination due to misinformed assumptions made by health care workers.
HIV-related illness and medication side effects
Women may be impacted by HIV-related infections and diseases women differently than men. For example, women with HIV are more likely to get bacterial pneumonia, recurrent herpes simplex infections, pelvic inflammatory disease, vaginal yeast infections, and cervical cancer.
Women are also affected differently by medications. They are more likely to have side effects such as allergic reactions and rashes. They may develop more fat (lipodystrophy) in their breasts and stomach. They are also more likely to develop anemia and bone loss. Women generally weigh less than men, and may receive unnecessarily high doses of medication.
Sexual health information does not always reflect the realities of people’s lives. Healthy sex lives can include a number of partners of all genders and a wide variety of sexual acts. Yet when women talk frankly about their sex lives, they may be stigmatized as promiscuous, immoral, or deserving of HIV. Sexual health information also does not always include the variety of possibilities for HIV transmission or acknowledge power imbalances in relationships. If women are not in a position to insist on safer sex, it’s not their fault.
Women continue to be the main caregivers in their families and societies. Many people believe that caring is “women’s work,” and women are expected to care for partners, children, and parents. Taking care of others means that women may have little time for their own health. This makes it tough for women living with HIV to access medical appointments, support groups, nutritional supplements, and other tools necessary to manage their health.
Gender abuse and violence
Gender-based violence and HIV are closely linked. Violence puts women at risk of HIV, and women with HIV experience more frequent and intense violence from partners.
A partner may isolate a woman by limiting her access to friends and family, or withhold money to keep her dependent. Or verbal abuse may be used to destroy her self-esteem. By telling a woman that she’s damaged and lucky to have anyone, a partner can manipulate her. A partner may forbid a woman from talking to others about HIV, or stop her from accessing essential medicines or support. Blackmail. threats, sexual assault, and physical violence are other common occurrences for women living with HIV.
Dangers of disclosure
For many women, disclosing that they have HIV can put them in precarious situations. Women may face the threat of losing their children, employment, and community. They may be blamed for bringing HIV into a relationship, regardless of whether that’s true. They may experience physical violence from partners. These circumstances can leave women feeling very isolated and unsafe, and also prevent them from accessing the support and information they need in order to live with HIV.