Deeper Look: HIV among Women

In 2022, 19% of the new HIV diagnoses in the United States and dependent areas were among women and 23% of all people living with HIV were women. In addition, Black women represent 54% of new HIV diagnoses among women.

The most common way that women get HIV is through sex with a male partner who has HIV without using a condom. Most women who have HIV know that they are HIV positive, but many women are still not getting the HIV care and treatment they need.

Among all PrEP users in the U.S. in 2023, 92% were male and only 8% were female, despite the fact that women comprised 19% of new HIV diagnoses.

64% of all women were virally suppressed in 2022, but research suggests percentages vary by race/ethnicity and gender identity.

Black Women and HIV

Black women continue to be disproportionately impacted by HIV, accounting for 54% of new HIV diagnoses in U.S. women, despite making up 14% of the female population.
Among Black women, 91% of new HIV infections were attributed to heterosexual contact.

The HIV infection rate among Black women was the highest compared to women of all other races and ethnicities.

Additionally, a recent CDC study found that Black transgender women accounted for 62% of HIV infections among transgender women with HIV living in seven major U.S. cities.

Black women are also underserved by prevention methods such as PrEP relative to their need and have lower rates of viral suppression than Hispanic/Latina, White, and Asian women.

PrEP Use among Women

What is Pre-exposure prophylaxis (PrEP)?

• Pre = before
• Exposure = coming into contact with HIV
• Prophylaxis = treatment to prevent an infection from happening

The PrEP utilization data on AIDSVu reveal a 52% average annual increase in persons using PrEP across the U.S. — including a 20% increase from 2021 to 2023. While these data point to significant growth in PrEP use nationwide, they also highlight important disparities in PrEP use across different sexes, races/ethnicities, age groups, geographic location, socioeconomic status, and access to care. In the United States, 37,966 people were diagnosed with HIV in 2022, underscoring the need to continue expanding the use of PrEP and other comprehensive HIV prevention strategies.

Among all PrEP users in the U.S., 92% were male and only 8% were female, despite the fact that women comprised 19% of new HIV diagnoses.

Transgender Women and HIV

Transgender is an umbrella term for persons whose gender identity or expression (masculine, feminine, other) is different from their sex (male, female) at birth. Transgender people have long been subjected to stigma and discrimination. In the United States, the discrimination against people in the transgender community extends into the healthcare system, leading to disparate outcomes in medical care and preventive services, including HIV prevention and care.

Because most medical providers don’t systematically collect information on both sex at birth and current gender identity, HIV surveillance data systematically undercount HIV cases among trans people. Existing data suggests that transgender men and women are disproportionately impacted by HIV, especially Black transgender men and women. According to CDC, in 2020,

• 610 transgender women and 40 transgender men were diagnosed with HIV
• 88% of transgender women and 77% of transgender men living with HIV were from racial/ethnic minority populations
• Black transgender men represented 54% of all transgender men living with HIV and Black transgender women represented 52% of transgender women living with HIV

Transgender women of color are disproportionately impacted compared to their White counterparts. In 2020, Black and Hispanic/Latina transgender women represented 79% of transgender women newly diagnosed with HIV.

Transgender Data on AIDSVu

AIDSVu currently has limited transgender data exclusively at the city level. That data is likely an undercount, but AIDSVu strives to provide as much up-to-date data as is publicly available at this time and is working to encourage the gathering of more in-depth surveillance data for this population. In addition, AIDSVu participates every year in Transgender HIV Testing Day on April 18, conducting interviews with experts and producing updated infographics on available data.

Health Disparities among Women

Health equity is the state in which everyone has a fair and just opportunity to attain their highest level of health. Achieving this requires ongoing societal efforts to:

• Address historical and contemporary injustices;
• Overcome economic, social, and other obstacles to health and health care; and
• Eliminate preventable health disparities. 

Because HIV disproportionately impacts gay and bisexual men, women with HIV are often underrepresented in the HIV conversation, despite representing 23% of all people living with HIV in 2022. Women are also less likely to perceive themselves as at risk for HIV. They often do not receive HIV and prevention-related information from health care providers and their communities adequate to their risk.

Many women living with HIV face significant financial burdens, as living with HIV and the ensuing stigma often lead to loss of income and financial support. Living in low-income areas can also greatly impact the risk and outcomes of HIV in women. For example, having fewer employment opportunities and less access to education, healthcare services, and HIV prevention all contribute to an environment where HIV is harder to stop.

In addition, much of the existing HIV research in the U.S. focuses on men, and more studies are needed to understand the interpersonal, cultural, financial, and structural factors that place women at high risk.

Finally, HIV-related stigma varies by gender, with women and transgender individuals with HIV reporting higher levels of stigma than men in 2021.

Perinatal

Perinatal transmission of HIV is when HIV is passed from a person with HIV to their child during pregnancy, childbirth, or breastfeeding (through breast milk). Perinatal transmission of HIV is also called mother-to-child transmission of HIV and vertical transmission of HIV.

Advances in HIV research, prevention, and treatment have made it possible for people with HIV to give birth to babies who are free of HIV. The annual number of diagnoses of perinatal HIV in the United States and dependent areas has declined by more than 95% since the early 1990s.

The use of HIV medicines (ART) and other strategies have helped to lower the rate of perinatal transmission of HIV to 1% or less in the United States and Europe.