March 10 Is National Women & Girls HIV/AIDS Awareness Day

On March 10, National Women & Girls HIV/AIDS Awareness Day, amfAR highlights the challenges women continue to face as the HIV/AIDS epidemic has more than tripled in this population over the last three decades. Across the world and in America, HIV is still impacting this demographic. Women now represent one in five of the new HIV diagnoses in America, with 64 percent of these women being African American.

"Women and girls constitute half of people living with HIV globally, and one in four HIV-positive Americans," said Jennifer Sherwood, amfAR's Policy Expert on HIV Among Women. "Our major push is to reach women and girls in the U.S., to improve their uptake of knowledge, testing, and engagement in care. In the U.S., while we have around 88 percent of women getting tested, we still have a gap."

This gap is that, even after testing positive for HIV, only 41 percent of these women are prescribed ARTs, and only 32 percent are virally suppressed. Sherwood said that a lot of this has to do with barriers to accessing health care.

"The availability of health care is still patchy in our nation, and I think there are a lot of other unique barriers to women's care," she said. "We know that women are the primary survivors of violence and trauma, and that the rates of violence among women living with HIV/AIDS are double the national average, at 55 percent."

When women are living in a traumatic environment, they tend to prioritize their own safety rather than their HIV care. Often the primary caregivers, they also prioritize the safety and care of their children or elderly parents above their own. In addition, women living with HIV may also be battling other health needs like diabetes and obesity.

For transgender women, the risks double. Biologically, they are at increased risk of HIV infection compared to men. Social risks are layered on top of that, as transgender women may be in violent or coercive relationships, where they may not be empowered to seek healthcare. Their partners might have other partners, they may have less negotiating power over safer sex protections, and emotional components of abuse may play in, causing depression and mental health issues. A lack of reliable housing also plays a big factor.

"There's definitely a link between having safe and reliable housing and being able to stay on your medication, go to doctor's appointments and continue to engage in medical care," said Sherwood. "When we talk about why people are not virally suppressed, housing is part of that equation. When you don't have a stable place to live and you have to deal with meeting day-to-day shelter needs, you may not have a place to store your meds, you may have to miss appointments, you may be moving across a city or cities, so staying in care becomes a huge challenge."

Some promising data has emerged nationwide. According to most recent data from the Centers for Disease Control and Prevention, we've seen a 21 percent decline in new infections between 2008-2010, the first significant decline among women in over a decade. African-American women have also seen a major decline. And in the U.S., we've nearly eliminated mother-to-child transmission.

"One of the big success stories of this decade is the dramatic decreases in MTC transmission; it's virtually been eliminated in the U.S.," said Sherwood. "It speaks to the fact that perinatal care and maternal care in the U.S. is doing a good job at testing women who come in pregnant, and prioritizing their care."

But one of the most troubling new developments is the rise of HIV infection among young women. HIV/AIDS is now the leading cause of death among women worldwide during their reproductive years, age 15-49.

Said Sherwood, "We've always had trouble engaging young people in services and care, young men and women alike. There are a lot of barriers in place for youth specifically that make it harder to get HIV testing."

Confidentiality issues may make teens reluctant to get tested for HIV, as they don't want it appearing on their parents' insurance. They may have transportation issues in getting to a clinic. There may not even be a clinic, as recent attacks against Planned Parenthood facilities providing confidential testing services are threatening this resource. They may not have the financial means to receive an HIV test, even on a sliding scale. And the level or quality of sex education in their school is context dependent.

"If you're in a school district that prioritizes this knowledge, you might fare better than if you're at a school that doesn't talk about condom use and HIV transmission," said Sherwood.

Recent results out of the Conference on Retroviruses and Opportunistic Infections (CROI) recently held in Boston have provided some of what Sherwood calls "cautiously optimistic" results, including a vaginal ring that could contain both contraceptives and slow-release ARTs, which she said, "would be a real game-changer."

Two large clinical trials of this vaginal ring showed only a 30 percent reduction in HIV among the treatment group overall -- not nearly as effective as recent PrEP trials among MSM. But Sherwood said that when they split the data group into women over 25, they saw a 60 percent reduction in HIV infection.

"A lot of it has to do with adherence; older women are much more likely to use this consistently," said Sherwood. "We are not clear exactly how much efficacy, but the more you use the ring, the better it works."

Clearly more research needs to go into preventing HIV among women and girls. But for today, Women & Girls HIV/AIDS Awareness Day, you can join in the many locations around the nation who are holding events around empowering young women to learn about HIV, getting tested and encouraging your sexual partners to get tested as well.

"The CDC comes out with bullet points every year on what women can do to protect themselves," said Sherwood. "And for today, they've got a major push happening around sharing this information and education, and breaking down the silence that always enshrouds HIV."