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Women and HIV

Marene Gatali, MHSC, BASc and Chris Archibald, MDCM, MHSc, FRCPC (Health Canada)

Health Issue

The epidemic of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) in developed countries has changed over time. The earlier epidemic affected primarily men who have sex with men, while the current epidemic increasingly affects other groups, such as injecting drug users and heterosexuals. As a result, the number and percentage of women living with HIV and AIDS is increasing, as is the potential for transmission of HIV from mothers to their infants.

HIV manifests itself differently among women and men, especially with regard to early symptoms and later opportunistic infections. The presence of recurrent and persistent gynecological infections may be the first clinical manifestation of HIV in an infected woman and can occur early in the course of infection.

The two main ways that adult women acquire HIV are through injecting-drug use and heterosexual contact with an HIV-infected partner or a partner who is at risk of HIV infection. Heterosexual contact is now the main risk factor for HIV among women in Canada and worldwide. Women who work as commercial sex workers, those who inject drugs, and partners of injecting drug users are at increased risk of acquiring HIV.

Key Findings

The number of women in Canada living with HIV, including those with AIDS, has increased over time. Recent estimates indicate that by the end of 1999, an estimated 6,800 women were living with HIV, an increase of 48.0% from the 1996 estimate of 4,600. On an annual basis, women account for a growing proportion of positive HIV-test reports with known age and sex among adults in Canada. This proportion increased from 10.7% in the period 1985-1995 to 25% in 2001, due to both an increase in the number of positive HIV tests for women as well as a decreased number for men. A second, related finding is the rising proportion of females aged 15-29 among both positive HIV test reports and reported AIDS diagnoses in Canada. Third, HIV appears to be a particular problem for certain subgroups of women: women in prison, Aboriginal women, and black women. Finally, in Canada, the increasing proportion of HIV-positive test reports among women is attributed to heterosexual exposure (64% in 2001). Injection drug use, however, continues to be an important risk (32% in 2001).

Data Gaps and Recommendations

The authors identified the following data gaps and made the following recommendations:

• Better and more research is needed to address information gaps about risk behaviours, testing patterns, and HIV incidence and prevalence among women, especially in particular subgroups of women such as women in prison, young women, Aboriginal women, and women from endemic countries.
• Future research should include examination of the influence of the broader contextual factors on women's lives and on their risk of HIV infection. This data will help individuals to receive appropriate counselling and treatment, and help public health officials to better interpret surveillance data.
• Human immunodeficiency virus in women encompasses many facets of their lives and behaviours. The authors note that reducing the toll of the HIV epidemic among women will require efforts on several fronts:
  • Programs and prevention messages need to be tailored to specific social, cultural, and economic contexts in which women may be more vulnerable to HIV infection than men.
  • Prevention efforts must be gender - and age-specific and should target not only individual behaviours but also the social and cultural context in which these behaviours occur (e.g. increasing individual motivation to use condoms and reducing contextual barriers to their use).
  • Specific interventions are needed to address the intersection of injecting drug use and HIV transmission, including both women who inject and those who do not but whose sexual partners do.
  • Increased emphasis on appropriate HIV prevention, counselling, and testing, as well as treatment services for young women, is required.

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