The Centers for Disease Control and Prevention estimate that women comprise 23.7% of people living with HIV in the U.S. with another 11% who are unaware of their status. As found in a recent research article summarized here, insufficient attention is given to how HIV uniquely impacts this population, including women aging with HIV. For example, 16% of new HIV diagnoses occurred among those women who were 55 years old or older, yet HIV prevention efforts rarely include older women who are at risk. This reflects the importance of outreach and education that includes this population.
As more people with HIV are living longer, it is important to ensure health and wellness as they age. For example, cisgender women, when going through menopause, may be more vulnerable to HIV due to drying and thinning of vaginal tissue, Black women are disproportionately impacted by HIV and are also more likely to experience early menopause onset. Early onset is also linked to being overweight, smoking, or other substance use. There is also some evidence that HIV is linked to more intense menopausal hot flashes and other symptoms. Yet in general, more research is needed to validate the actual impacts of HIV on menopause, including ARV interaction and risk of bone density loss. This reflects how issues that impact women with HIV- especially older women- continue to be overlooked. Compared to men aging with HIV, women are also more likely to experience pronounced weight gain (especially Black women) and may be more vulnerable to neurocognitive impairment. They are also at higher risk for cardiovascular disease and strokes compared to women without HIV.
In addition to tailored treatment and prevention services- especially targeting transgender and women of color- research must prioritize the needs of women aging with HIV. Women of all ages must be included in all clinical trials. As the article highlighted here, research indicates that women experience differences in HIV latency and the size of the HIV reservoir. Yet women currently represent only a median of 19% of participants in antiretroviral studies, 38% in vaccination studies, and 11% studies aiming to find a cure. Lastly, there is also a lack of knowledge regarding how HIV medications interact with the feminizing hormones that transgender women often take. As people with HIV continue to live longer, we must ensure all are able to age well, regardless of gender identity.
Adimora, A.A. et. al. (2021) HIV & women in the USA: what we know and where to go from here. The Lancet, Vol. 397(10279) pp. 1107-15. https://doi.org/10.1016/S0140-6736(21)00396-2