HIV remains a major health issue for women and adolescent girls, who account for more than 280,000 infections in the United States, according to the CDC.
The CDC estimated that 8,328 women aged 13 and older were diagnosed with HIV in 2014. Most women (84%) acquire HIV through heterosexual sex, and they are twice as likely to acquire HIV per sex act than men, according to Jennifer Sherwood, policy associate for amfAR, the Foundation for AIDS Research.
While the CDC reported that new HIV diagnoses in women declined 40% from 2005 to 2014, more efforts are needed to reduce racial disparities in HIV, Sherwood told Infectious Disease News.
“Recently, we received some good news that there’s some indication the numbers among new infections in women are going down,” she said. “The bad news is that behind all of this progress, there’s been raging racial disparities in the U.S.”
Black women accounted for 62% of new HIV diagnoses among all women in the U.S. in 2014, despite accounting for only 13% of the female population. Their lifetime risk for acquiring HIV is 20-fold that of white women and about four times that of Hispanic women, who accounted for 16% of new diagnoses but represent only 15% of women in the U.S., according to Sherwood.
“Unfortunately, it makes sense,” she said. “Black women in general have less access to health care and preventive health care, so that’s a big contributor. When we look at all patterns of infectious diseases, we often see a shift toward communities that have less access to health care who are already suffering from many other health and social disparities. It’s unfortunately not surprising that we’re seeing HIV following in the same suit.”
Geography also plays a role in HIV disparities, according to Sherwood. Many Southern states have not expanded Medicaid under the Affordable Care Act, and some states have passed policies that led to recent closures of family planning clinics, which are the primary source of preventive health for many women in the South, Sherwood said.
“These restrictions and closures have really disproportionately affected people who are living in these areas,” she said.
The CDC reported that some progress in combating racial disparities among women with HIV has been made, as new HIV diagnoses among black women declined 42% from 2005 to 2014, and the percentage of newly diagnosed black women linked to care increased 48% from 2012 to 2014. The CDC aims to intensify its efforts through the National HIV/AIDS Strategy by increasing the use of daily pre-exposure prophylaxis (PrEP) and ensuring that people living with HIV achieve and maintain viral suppression.
In recognition of National Women and Girls HIV/AIDS Awareness Day, observed annually on March 10, Infectious Disease News has compiled a list of the top five stories over the past year covering HIV in women and girls.
Dapivirine vaginal ring safely reduces HIV infections among women
Two studies presented at CROI 2016 suggest that preventive use of vaginal rings containing dapivirine could safely reduce the incidence of new HIV transmissions in women.
Although the ring provided overall protection of approximately 30% in both trials, younger women participating in the trial more often demonstrated new transmissions, higher levels of drug remaining in used rings and low drug plasma concentrations, researchers reported. Read more.
Stribild safer, more effective than combination treatment in women with HIV
An ART regimen consisting of once-daily Stribild may be safer and more effective in women with HIV-1 infection than a standard multidrug combination treatment, according to a study presented at ICAAC 2015. It was the first fully powered ART efficacy study to exclusively enroll women, and its results contrasted with those of a previous study of the drug that enrolled mostly men. Read more.
VOICE trial shows low PrEP adherence, efficacy among women
The final results of the VOICE trial showed a consistent pattern of nonadherence to PrEP among women dating back almost to the start of the trial.
Based on self-reports and the number of unused products such as gel applicators and leftover pills, PrEP adherence was calculated to be 86% to 90%. However, just 3 months into the trial, less than 40% of women taking some form of a tenofovir (TFV)-based regimen had detectable levels of the drug in plasma, and most of these women had no detectable TFV at subsequent visits. Read more.
Strokes, TIA more common among female, black HIV patients
Data presented at CROI 2016 suggested that among HIV patients, women and non-Hispanic blacks are more likely to have a stroke or transient ischemic attack.
Stroke or TIA incidence among men was 1.4 per 1,000 person-years, while incidence among women was increased to 2.88 per 1,000 person-years. Read more.
DMPA use increased HIV risk
Researchers have found more evidence that the injectable progestin contraceptive depot-medroxyprogesterone acetate, or DMPA, is linked to increased risk for HIV infection. They discovered that HIV acquisition was 50% more likely in women taking DMPA than women who did not use hormonal contraception. There was no significantly elevated risk for HIV infection associated with combined oral contraception or norethisterone enanthate use. Read more.