IDSE Review
Women and HIV: Gaps in Care BY JACOB BOUDREAUX, MD,
T
AND
JULIA GARCIA-DIAZ, MD, MSC, FACP, FIDSA, CPI
he first cases of the US HIV epidemic were recognized in 1981, primarily among men who have sex with men (MSM). By 1988, the incidence of men living with HIV was nearly 15 times the rate of women.1 At the time, HIV affected the MSM community, as well as racial and ethnic minorities, at disproportionally higher rates. In the decades since then, research into HIV treatment protocols, HIV-related disease, comorbidities, and outcomes has been heavily focused on these groups. However, the incidence of HIV among these subgroups has changed significantly in the last 40 years in relation to the incidence of women living with HIV. By 2010, a shift was seen among women who comprised 21% of total HIV cases in the United States, while the incidence rate for men dropped to 3 times the rate seen in women.1
At the end of 2016, women accounted for 23.7% of all people living with HIV in the United States, and as of 2020, women represent one-fourth of all HIV cases nationally.2 In 2017, women represented a larger percentage of people living with HIV globally, accounting for 52% of total cases, or 18.2 million women. This trend has remained stable, as women continue to represent nearly half of all cases globally each year.3 Despite being equally represented in total global cases of HIV, women continue to be underrepresented in HIV research. This gap in representation is especially shocking as HIV and HIVrelated disease are the leading causes of death among women of reproductive age (ie, 15-49 years).4 In 2019, the Department of Health and Human Services announced a new goal to reduce the incidence of HIV infections by 90% within the decade.5 To achieve this goal, the importance of addressing the health care needs of women living with HIV—both diagnosed and undiagnosed—needs a sharper focus. This review serves as an update to information published in 2019 in Infectious Disease Special
INFECTIOUS DISEASE SPECIAL EDITION • SUMMER 2021
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