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- Blood to Blood Contact
- Anal Sex
- Vaginal Sex
- Oral Sex
- Male/Female Transmission
- Substance Use/Abuse
- STI Increase Risk for HIV
- Mother to Infant
HCET Home > On-line Training > HIV Risk Assessment in Women > 3. HIV Risk Factors for Women
3. HIV Risk Factors for WomenOf new HIV infections among women, the CDC estimates that approximately 75% were infected heterosexually and 25% via injection drug use. (4) This percentage is an estimate because some women who become infected are categorized by risk as “other/not identified.” This category includes women who cannot identify risk, cannot identify a partner who is at risk or are not aware that they are having sex with someone who has risk factors for HIV.
The following slide shows the exposure categories for women. The pie on the left shows the distribution of exposure categories for cases diagnosed in 2000; the data depicted in the right pie are adjusted for delays in reporting and proportional re-distribution of cases initially reported without risk information.
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Figure 10:
formatBlood to Blood Contact
The highest risk for HIV transmission is via blood-to-blood contact.
- This can occur sexually, but sharing needles/syringes/”works” provides an excellent source of blood-to-blood contact. As of the of the year 2000, more than one-third (36%) of AIDS cases in the United States have been transmitted via injection drug use. (17)
- Most people are aware that HIV can be spread by injecting drugs or “shooting up,” however, sharing needles for tattooing, body piercing, injecting prescription medication like insulin or vitamins, can also readily spread HIV infection. +A tattoo done in a professional setting is much safer than ones that are “home made.” Many men who have been in prison have contracted HIV and/or hepatitis by sharing needles or ink to get tattoos while in jail.
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Prevention messages should focus on avoiding sharing any kind of needles or paraphernalia, not just injecting drugs! |
Anal Sex
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Anal sex carries a very high risk for HIV |
- Anal sex is often considered a behavior for only men who have sex with other men (MSMs).
- The fact is that 50% of MSMs do not have anal sex and some women do have anal sex!
- Women have anal sex to please themselves and/or their partner, to prevent pregnancy or preserve “virginity.”
- 32% of women reported anal sex in the past 6 months. (19)
- 20% of women have experienced anal sex. (20)
- The fact is that 50% of MSMs do not have anal sex and some women do have anal sex!
- Discussing ways to make anal sex safer with clients can be difficult for some clinicians/nurses/counselors. If we are unable to discuss anal sex in an open, non-judgmental way, our clients may not receive the testing, treatment or prevention messages they need. If this is difficult for you, try learning more about why people enjoy anal sex and techniques to talking with co-workers until it feels a little more comfortable.
Vaginal Sex
Vaginal sex is the most common way U.S. women become infected with HIV and is a risk factor for many family planning clients. Although not every woman who has vaginal sex is at high risk for HIV, many who are at high risk attend family planning clinics. This is the most compelling reason to address HIV within the context of family planning.
Hormone therapy is the method of choice for most women who choose to prevent pregnancy and does not provide protection from STI/HIV.
- Although more studies are needed, one study suggests that progesterone therapy may actually increase the risk of contracting HIV. (21) Women should not discontinue progesterone use, but clinicians should continue to provide risk reduction messages for at risk clients.
Oral Sex
Oral sex carries a very low risk for HIV infection
Although the risk is low, chances of spreading infection is increased;
- For the person giving oral sex and lower for the person receiving oral sex.
- If tears, cuts or STIs are present in the mouth, penis, vagina or rectum, the risk of transmission is increased.
- STIs such as, GC, chlamydia, HPV, syphilis, herpes and HIV can be spread through oral sex.
Prevention messages should include safer oral sex messages because many people do not consider oral sex as “sex.” Providers who work with teens, report that oral sex is extremely common and frequently not considered sex. A survey of adults published in the Journal of the American Medical Association (JAMA)
revealed that; Oral sex is not considered sex by 60% of surveyed persons, and
19% say anal sex is not sex (22).
Contributing Factors for HIV Risk in Women
When providing HIV counseling, testing and education it is important to consider factors that could contribute to an increased risk for HIV infection in women.
Male to Female Transmission
Male to female transmission is much more likely than female to male transmission. There are several possible reasons for this difference including:
- There are more men than women in the United States living with HIV; therefore, there is an increased likelihood that women will have an infected partner.
- HIV is more easily transmitted from men to women because of the greater exposed surface area in the female genital tract or rectum.
- HIV is found in greater concentrations in seminal fluid than in cervico-vaginal fluids.
- During unprotected vaginal intercourse, a larger volume of semen than cervico-vaginal fluids is exchanged (16).
Since heterosexual transmission is the most common way in which women are infected with HIV, it is important to consider the risk factors of their sex partners. Keep in mind that women may be unaware of their partner's risk because behaviors might have been concealed, or because HIV risk has not been discussed.
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Substance Use and Abuse
Injection drug use has directly or indirectly accounted for more than one-third (36%) of AIDS cases in the United States.
Since the epidemic began: 57% of all AIDS cases among women have been attributed to injection drug use or sex with partners who inject drugs, compared with 31% of cases among men.
Non-injection drugs also contribute to the spread of the epidemic. The connection between injecting drugs and HIV is well established, but non-injectible drugs can cause people to engage in risky sexual behaviors that they might not engage in when sober.
- One CDC study of more than 2,000 young adults, in three inner-city neighborhoods, found that crack smokers were three times more likely to be infected with HIV than non-smokers. (17)
- When discussing substance use with clients, it is important to recognize that occasional substance use can also contribute to increased risk. Not everyone who uses drugs or alcohol does so on a regular basis.
- Prevention messages should focus on how using substances such as alcohol or other drugs can lead to HIV infection. Often, people who use drugs occasionally may not respond to messages that discuss abuse.
Sexually Transmitted Infections (STI) Increase Risk for HIV
There is now strong evidence that other STIs increase the risk of HIV transmission and, conversely, that STI treatment reduces the spread of HIV.
- Studies have repeatedly demonstrated that people are 2-5 times more likely to become infected with HIV when other STIs are present.
- STIs that cause genital lesions can create a portal of entry for HIV.
- STIs without lesions increase the number of HIV target cells (CD4 cells) in cervical secretions, thereby likely increasing HIV susceptibility in women.
- Studies suggest that co-infection with HIV and other STIs results both in more shedding of HIV and in greater concentrations of HIV being shed. (18)
Mother to Infant
As discussed in Section 2: Perinatal Transmission of HIV (link to that section), women can pass HIV to their infants during pregnancy, labor and delivery or through breast feeding. The risk is greatly reduced if antiretroviral therapy is utilized.
For more information, go to:
- CAPS Fact Sheet - Is Mother-to-Child HIV Transmission Preventable?
