High-Risk HIV Behaviors - Women in Maryland

Maryland

The human immunodeficiency virus (HIV) attacks the body’s immune system and, if left untreated, can progress to the most severe stage of HIV infection, known as acquired immunodeficiency syndrome (AIDS). While the human body can get rid of some viruses, it can't completely get rid of HIV. Currently, there is no cure for HIV or AIDS, but there are medical therapies that can help manage it. In the United States, there are an estimated 263,900 women living with HIV, with 6,400 new cases among women in 2019. 

HIV is spread when certain bodily fluids of an HIV-positive person enter the bloodstream of someone without HIV, regardless of age, gender, sexual orientation or race/ethnicity. The most common ways that HIV is spread to women are unprotected vaginal or anal sex with a person who has HIV and sharing needles with a person who has HIV. People who live in communities with a higher prevalence of HIV or exchange sex for money or nonmonetary items are at greater risk of becoming infected.

HIV presents unique challenges for women, including an increased risk of cervical cancer and heart disease. Some HIV medicines can interact with hormonal birth control, making it less effective at preventing pregnancy. Women who are pregnant or are planning on becoming pregnant should get tested for HIV. While the transmission of HIV from mother to child can happen at any time during pregnancy, childbirth and breastfeeding, there are effective ways to prevent it. 

People who are HIV-positive can also experience HIV-related stigma. Nearly 8 in 10 HIV patients reported feeling internalized HIV-related stigma, meaning they experienced negative feelings such as shame, guilt or worthlessness. Experiencing HIV-related stigma is associated with negative health outcomes, such as depression. People who are HIV-positive can also experience discrimination, such as being denied care by a health professional.

The prevalence of engaging in high-risk HIV behaviors is higher among:

• Women ages 18-24, whose prevalence is three times higher than that of women ages 35-44.
• Multiracial and Black women compared with non-Hispanic white, Hispanic and Asian women. 
• Women with an annual household income of less than $25,000 compared with those with a household income of $75,000 or more.

There are steps people can take to lower their risk of being infected with HIV. To reduce the risk of being infected with HIV people can: 

• Abstain from sex or have fewer sexual partners.
• Use a condom (male or female condom) correctly every time they engage in sexual activity. Combining condom use with medication is recommended when a sexual partner is HIV-positive, as condoms do not eliminate all risk even when used correctly. 
• Take medications such as pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP) if they are at high risk of getting HIV through sex or injection drug use. 

Not engaging in injection drug use is the best way to avoid HIV infection from drug use, but if that is not possible, the risk of infection can be lowered by:

• Using only clean, sterile needles and not sharing needles with anyone.
• Avoiding coming into contact with other people’s blood.
• Disposing of needles appropriately after every use. 

Many communities have started implementing syringe service programs, such as needle exchanges. These programs provide access to sterile needles, safe disposal of used syringes and connections to other resources, such as treatment programs for substance use disorder and treatment care for HIV. Studies have indicated that needle and syringe programs have been effective at reducing new cases of HIV.

People who are diagnosed with HIV should start taking medicine to treat it as soon as possible. The treatment is called antiretroviral therapy (ART) and it works by reducing the amount of HIV in the body. Antiretroviral therapy can decrease the amount of HIV in the body so much that it becomes undetectable. At that point, the person has effectively no risk of transmitting HIV to someone who is HIV-negative through sex. 

The Centers for Disease Control and Prevention (CDC) has a tool to help people find HIV prevention services, including condoms, HIV testing, PrEP and PEP in their area.

Healthy People 2030 has several HIV-related goals, including reducing the number of new HIV infections and increasing the proportion of people living with HIV who know their status. The U.S. Department of Health and Human Services is working on an initiative to reduce new HIV infections by 90% by 2030.

Abdul-Quader, Abu S., Jonathan Feelemyer, Shilpa Modi, Ellen S. Stein, Alya Briceno, Salaam Semaan, Tara Horvath, Gail E. Kennedy, and Don C. Des Jarlais. “Effectiveness of Structural-Level Needle/Syringe Programs to Reduce HCV and HIV Infection Among People Who Inject Drugs: A Systematic Review.” AIDS and Behavior 17, no. 9 (November 2013): 2878–92. https://doi.org/10.1007/s10461-013-0593-y.

Bosh, Karin A., H. Irene Hall, Laura Eastham, Demetre C. Daskalakis, and Jonathan H. Mermin. “Estimated Annual Number of HIV Infections - United States, 1981–2019.” MMWR. Morbidity and Mortality Weekly Report 70, no. 22 (June 4, 2021): 801–6. https://doi.org/10.15585/mmwr.mm7022a1.

Centers for Disease Control and Prevention. “Estimated HIV Incidence and Prevalence in the United States, 2015-2019.” HIV Surveillance Supplemental Report 26, no. 1 (May 2021). https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-supplemental-report-vol-26-1.pdf#page=39.

Rueda, Sergio, Sanjana Mitra, Shiyi Chen, David Gogolishvili, Jason Globerman, Lori Chambers, Mike Wilson, et al. “Examining the Associations between HIV-Related Stigma and Health Outcomes in People Living with HIV/AIDS: A Series of Meta-Analyses.” BMJ Open 6, no. 7 (July 2016): e011453. https://doi.org/10.1136/bmjopen-2016-011453.