Yale J Biol Med. Published online Jun Meyer Find articles by Jaimie P. This article has been cited by other articles in PMC. Abstract Women comprise nearly one-quarter of all people living with human immunodeficiency virus HIV in the U.
Though women overall are more likely than men to be diagnosed with HIV and engage in care, they are as unlikely to successfully achieve viral suppression with antiretroviral therapy, suggesting gender-based disparities that should be addressed by gender-responsive policies and programs. Using the socioecological model of health and syndemics theory, we comprehensively reviewed published literature to evaluate reasons for and ways to address gender differences in HIV risk and treatment.
We discuss the biologic, sociocultural, interpersonal, and behavioral contexts of HIV risk that affect women, comprehensive healthcare for women with HIV that includes pregnancy planning or prevention, and policy implications.
A year old woman with recently diagnosed HIV presents to initiate care. She has no history of sexually transmitted infections, substance use, transactional sex, or incarceration, and was HIV tested routinely during an annual gynecology visit. She is distressed by the diagnosis and fearful of disclosure, which compounds the stresses of her job, unstable housing, and caring for her two children, and has exacerbated her depression and post-traumatic stress disorder.
While initiating antiretroviral therapy, how can the clinician best address her needs and deliver high quality care in a way that is gender-sensitive? HIV devastated communities of young gay men with high mortality rates, sparking outrage and community coalition-building that are still reflected in most representations of HIV in popular media.
In June , the Centers for Disease Control and Prevention CDC reported the first cases of women acquiring AIDS through heterosexual sex [ 1 ], but it was a more politically palatable focus on prevention of maternal to child transmission that rallied public cries about HIV in women.
In the last several years, there has been growing attention to gender in HIV prevention and treatment. Women, especially women of color, now comprise a key target population for HIV diagnosis, treatment, and retention in care in the latest U.
A research pipeline is insured by newly announced NIH funding opportunities to develop HIV interventions for key populations, including women who use drugs and those who engage in transactional sex. Despite these exciting developments, many clinicians and the latest U.
HIV treatment guidelines still consider women worthy of special consideration mostly in terms of their childbearing potential [ 10 ]. Nonetheless, there remain gender differences in HIV risk behaviors and engagement in a continuum of care, as depicted in Figure 1 , which shows gender differences in key treatment outcomes among people living with HIV in the United States [ 11 - 17 ].
Gender disparities in care engagement are greatest among people who use drugs, veterans, and those in the criminal justice system [ 13 , 18 ]. Why are women, who are more likely than men to have HIV diagnosed and to subsequently engage in care, as unlikely as or less likely than men to achieve viral suppression?
It may be that gender differences are due only in part to the biological basis of disease, and are also attributable to the sociocultural contexts that frame behavior. The goal of this comprehensive literature review was to explore gender differences in HIV epidemiology and contexts of risk that can guide the development of gender-responsive policies and programs of HIV care.