The Impact of HIV on Women
HIV (Human Immunodeficiency Virus) is a virus that attacks the immune system, and if left untreated, can lead to AIDS (Acquired Immunodeficiency Syndrome). While the incorrect perception that HIV only impacts men who have sex with men (MSM) still exists, we know that HIV can affect anyone regardless of their gender, sexual orientation, or race. However, the impact of HIV on women is particularly significant, as it not only affects their health but also their social and economic well-being.
According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), there were approximately 18.6 million women living with HIV worldwide in 2020, accounting for over half of all adults living with the virus[i]. In Australia, the number of women living with HIV is relatively small, with approximately 3,350 women living with the virus in 2019 – just over 11% of all people living with HIV in Australia[ii].
In fact, while HIV transmission still largely occurs as a result of male-to-male sex, this number is declining. 27% of new HIV infections in Australia in 2021 came about due to heterosexual sex. Of these new infections, just under 40% were attributed to women[iii]. However, despite the relatively small numbers, the impact of HIV on women in Australia cannot be underestimated.
HIV notifications by exposure 2021. Source: AFAO
The Impact of HIV on Women's Health
HIV can cause a wide range of health issues for women, some of which are specific to their gender. HIV affects the immune system, making it difficult for the body to fight off infections and illnesses. Over time, HIV can weaken the immune system, making it more susceptible to a variety of infections and illnesses.
Sexual and Reproductive Health
HIV can have a significant impact on a woman's sexual and reproductive health. Women living with HIV are more likely to experience vaginal and cervical infections, which can lead to serious health complications such as cervical cancer[iv]. Women living with HIV may also experience menstrual irregularities, including heavy or prolonged periods, which can affect their fertility[v]. They may also be at a higher risk of developing sexually transmitted infections (STIs), including herpes, chlamydia, and gonorrhoea.
Pregnancy
Pregnancy can be a challenging time for women living with HIV, as there is a risk of transmitting the virus to the baby during childbirth or through breastmilk[vi]. However, with the right medical care, the risk of transmission can be significantly reduced, allowing women living with HIV to have healthy pregnancies and give birth to healthy babies. Antiretroviral therapy (ART) can help to reduce the amount of virus in the mother's blood and can also reduce the risk of transmission to the baby. Women living with HIV are also advised to avoid breastfeeding, as this can also increase the risk of transmission to the baby.
Bone Health
HIV can also affect bone health, which can lead to osteoporosis, a condition in which bones become weak and brittle. Women living with HIV are more likely to experience bone loss, particularly after menopause. This is because the virus can cause inflammation, which can lead to the breakdown of bone tissue. Some antiretroviral medications can also contribute to bone loss[vii].
Cardiovascular Health
Women living with HIV are also at an increased risk of cardiovascular disease. HIV can cause inflammation, which can contribute to the development of atherosclerosis, a condition in which plaque builds up inside the arteries, making it difficult for blood to flow through[viii]. This can lead to a range of cardiovascular problems, including heart attack and stroke.
Mental Health
Women living with HIV may also experience mental health issues, including depression and anxiety. This may be due to the social and emotional challenges of living with HIV, as well as the stigma and discrimination that many women face. Mental health issues can have a significant impact on a woman's overall well-being, making it important to provide support and resources to address these issues.
The Impact of HIV on Women's Social and Economic Well-being
HIV can have a significant impact on the social and economic well-being of women, particularly in low- and middle-income countries where access to healthcare and support services may be limited.
Women and girls living with HIV globally 2022. Source: UNAIDS
Stigma and Discrimination
Women living with HIV may experience stigma and discrimination, which can have a range of negative consequences for their social and economic well-being. Stigma and discrimination can lead to social isolation, exclusion from social networks, and a loss of community support. This can be particularly challenging for women who may rely on their social networks for emotional support and practical assistance.
Stigma and discrimination can also lead to economic consequences, such as loss of employment, reduced income, and limited access to education and training opportunities. Discrimination can also limit access to healthcare and other essential services, further exacerbating the health challenges faced by women living with HIV.
Gender Inequality
Gender inequality can also contribute to the social and economic challenges faced by women living with HIV. In many countries, women may have limited access to education, healthcare, and employment opportunities, making it difficult to access the resources and support needed to manage HIV.
Women may also face gender-based violence, including sexual violence, which can increase the risk of HIV transmission and further exacerbate the social and economic challenges faced by women living with HIV.
Motherhood and Caregiving
Women living with HIV who are mothers or caregivers may also face additional social and economic challenges. Mothers living with HIV may face discrimination and stigma, making it difficult to access healthcare and support services for themselves and their children.
Caregiving responsibilities can also be challenging, particularly in low and middle-income countries where healthcare and social support services may be limited. Women living with HIV who are caregivers may face additional financial and emotional stress, which can impact their overall well-being and ability to manage their health.
HIV transmission in Australia 2021. Source: AFAO
Addressing the Impact of HIV on Women
Addressing the impact of HIV on women requires a multi-faceted approach that takes into account the social, economic, and health challenges faced by women living with HIV. Some key strategies for addressing the impact of HIV on women include:
Promoting Gender Equality and Women's Empowerment
Gender inequality is a major driver of HIV transmission and impacts the well-being of women living with HIV. Promoting gender equality and women's empowerment can help to address the underlying social and economic factors that contribute to HIV transmission and impact the well-being of women living with HIV.
This may involve initiatives such as increasing access to education and economic opportunities for women, addressing gender-based violence, and empowering women to take control of their sexual and reproductive health.
Providing Access to HIV Prevention, Testing, and Treatment
Access to HIV prevention, testing, and treatment is essential for addressing the impact of HIV on women. Women living with HIV need access to antiretroviral therapy (ART) to manage their health, prevent transmission, and reduce the risk of HIV-related complications.
In addition, ensuring access to HIV prevention tools such as condoms and pre-exposure prophylaxis (PrEP) can help to reduce the risk of HIV transmission among women. HIV testing and counselling services are also important for identifying new cases of HIV and linking women to care and support services.
Addressing Stigma and Discrimination
Stigma and discrimination can be major barriers to HIV prevention, testing, and treatment for women. Addressing stigma and discrimination is essential for promoting the health and well-being of women living with HIV.
This may involve initiatives such as community education campaigns to reduce HIV-related stigma, addressing discrimination in healthcare settings, and providing legal and policy protections for people living with HIV.
Providing Support Services for Women Living with HIV
Women living with HIV may face a range of social and economic challenges that impact their health and well-being. Providing support services such as counselling, peer support, and economic empowerment programs can help women to manage their health and improve their quality of life.
In addition, providing support services for mothers and caregivers can help to address the unique challenges faced by women living with HIV who are caring for children or family members.
Promoting Research and Innovation
Research and innovation are essential for addressing the impact of HIV on women. This may involve initiatives such as developing new prevention and treatment options, improving access to HIV testing and care, and addressing the unique health needs of women living with HIV.
Conclusion
HIV remains a significant public health challenge, particularly for women who are disproportionately affected by the virus. To address the impact of HIV on women, it is essential to adopt a comprehensive approach that addresses both the medical and social dimensions of the issue, as well as the intersectional nature of HIV. By prioritising the voices and experiences of women living with HIV, we can work together to ensure that all women have access to the care and support they need to live healthy, fulfilling lives.
References
[i] UNAIDS, 2023, Global HIV & AIDS statistics, https://www.unaids.org/en/resources/fact-sheet
[ii] Positive Life NSW, 2023, HIV Statistics, Positive Life NSW, viewed 8/3/2023, <https://www.positivelife.org.au/hiv-info/hiv-statistics/#:~:text=Women%20make%20up%20just%20over,350%20women%20living%20with%20HIV>.
[iii] AFAO, 2023, HIV in Australia, AFAO, viewed 8/3/2023, <https://www.afao.org.au/about-hiv/hiv-in-australia/#:~:text=In%202021%2C%2060%25%20of%20HIV,3%25%20to%20other%2Funspecified>.
[iv] WHO, 2022, Cervical cancer, https://www.who.int/news-room/fact-sheets/detail/cervical-cancer
[v] Valiaveettil, C., Loutfy, M., Kennedy, V.L., Caddy, S., Yudin, M., Conway, T., Ding, E., Sereda, P., de Pokomandy, A. & Kaida, A., 2019, 'High prevalence of abnormal menstruation among women living with HIV in Canada', PLoS One, PMC6934328
[vi] BetterHealth Channel, 2020, HIV and women - having children, BetterHealth Channel, viewed 8/3/2023, <https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/hiv-and-women-having-children>.
[vii] HIV Info, 2021, HIV and Osteoporosis, NIH, https://hivinfo.nih.gov/understanding-hiv/fact-sheets/hiv-and-osteoporosis#:~:text=HIV%20infection%20and%20some%20HIV,be%20managed%20by%20lifestyle%20changes.
[viii] Poznyak A.V., Bezsonov E.E., Borisov E.E., Grechko A.V., Kartuesov A.G. & Orekhov A.N., 2022, 'Atherosclerosis in HIV Patients: What Do We Know so Far?', Int J Mol Sci, PMC8910073
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8910073
