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HIV isn’t in the news as much anymore, but that doesn’t mean it’s gone away. The latest statistics show that about 1.2 million people in the United States have HIV – and about 13% of those people don’t know they have HIV. That’s about 156,000 people who don’t know they have the virus. There can be several reasons for this, from ignorance of HIV infection to lack of money or resources for testing. Some people choose not to get tested because they are afraid of the stigma and discrimination they might face if they are HIV positive.
Approximately 1 in 5 people newly diagnosed with HIV are women or are assigned female at birth (AFAB). Black women make up half of this group, while white women make up 24% and Hispanic/Latino women make up 20%.
When used as directed, antiretroviral (ART) HIV treatment can reduce the amount of virus in your body to the point where it is no longer detectable. This means your immune system stays strong and you stay healthy. We know that untreated or undertreated HIV can lead to AIDS, but what many people may not know is that as a woman or AFAB who is HIV positive and untreated or undertreated, you face unique challenges with your gynecological health.
The STI/HIV cycle
An untreated or progressive HIV infection will cause you to get more frequent, more severe, and more difficult-to-treat infections. These include sexually transmitted infections (STIs) and yeast infections.
STIs can lead to serious complications, such as:
- Pelvic inflammatory disease (PID), an infection of your upper reproductive organs
- Ectopic pregnancy due to scarring in the fallopian tubes
- Pregnancy complications such as premature birth and low birth weight
- Infertility caused by damage to the reproductive organs
- Increased risk of cancer, especially from HPV affecting the cervix, vulva, or vagina
STDs also increase inflammation, which makes it easier for HIV to multiply in your vaginal fluid. This means that despite ART, HIV is not as well controlled as it should be and that the virus spreads more easily through sexual activity.
In addition, antibiotics used to treat sexually transmitted diseases can reduce the effectiveness of ART and increase viral load. And ART can also make some antibiotics less effective, leading to antibiotic resistance, also known as antimicrobial resistance. This makes it difficult to treat infections such as sexually transmitted diseases and leads to the creation of superbugs.
Changes in menstrual health
Researchers don’t know why, but women living with HIV infections may notice changes in their menstrual cycles. Your period may be heavier or lighter than before, or you may miss it altogether. This is called amenorrhea. And if you have premenstrual syndrome, it could be more serious.
It’s possible that these changes have nothing to do with the infection but rather other problems, such as stress or perimenopause. However, some research shows that many women with HIV actually suffer from amenorrhea. One theory is that your hormones could be affected as the virus attacks your immune system. This, in turn, disrupts your menstrual cycle and can even lead to early menopause.
Lower genital tract and cervical cancer
We know that anyone who engages in sexual activity can get HPV and that certain types of HPV can increase the risk of cervical cancer. However, women with HIV who do not receive treatment are up to four to five times more likely to develop HPV and are less likely to clear the infection from their body on their own. They are also six times more likely to develop cervical cancer. This is important to know because many people living with HIV do not know they have HIV, and many with the virus are either untreated or receive inadequate treatment.
You can reduce your risk of cervical cancer by having regular Pap tests, a routine test performed as part of a pelvic exam. The results can show whether there are changes in the cells of your cervix before they develop into cervical cancer. Because women with HIV have a higher risk of cervical cancer, they should get the test more often. Guidelines vary, but a general recommendation for HIV-positive women is that you should have your first Pap test within one year of your first sexual activity or, if you are already sexually active, within the first year of your HIV diagnosis. After this initial test, a Pap test should be done every year when you are in your 20s and then every three years (along with the HPV test) until you are 65.
Living with HIV
HIV can affect your gynecological health, but knowing about this possibility will keep you one step ahead. Proper HIV treatment can keep your viral load low or undetectable, reducing your risk of infections, including sexually transmitted diseases. If you get an STI, early treatment increases the chances of successfully fighting off the infection. And regular Pap tests can help detect abnormal cells in your cervix, often before they become cancerous. Talk to your doctor about any concerns you have about your health at any stage of your life. Together you can make prevention a priority.
This educational resource was created with support from Merck.
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