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You don’t hear about HIV in the news anymore, but that doesn’t mean it doesn’t exist anymore. The most recent statistics show that about 1.2 million people in the United States have HIV and about 13% of those people do not know they have HIV. That’s about 156,000 people who don’t know they have the virus. There are a few reasons that could explain why this happens, from ignorance of HIV infection to lack of money or resources to get tested. Some people choose not to get tested because they fear they will be stigmatized and discriminated against if they have HIV.
Approximately one in five people who receive a new HIV diagnosis are women or assigned female at birth (AFAB). Half of this group are black women, while 24% are white women and 20% are Hispanic or Latino women.
When used as directed, HIV antiretroviral therapies (ART) can reduce the level of the virus in your body to undetectable levels. This means your immune system continues to be strong and keeps you healthy. We know that HIV, if untreated or inadequately treated, can cause AIDS, but what many people may not know is that as a woman or AFAB with HIV and untreated or poorly managed, you will face unique challenges to your gynecological health.
The STI and HIV cycle
When HIV is untreated or ongoing, it causes infections to become more frequent, more serious, and more difficult to treat. These include sexually transmitted infections (STIs) and candidiasis.
STIs can lead to serious complications, such as:
- Pelvic inflammatory disease (PID), which is infection of your upper reproductive organs
- Ectopic pregnancies due to scarring in the fallopian tubes
- Complications during pregnancy, such as premature birth and low body weight
- Infertility caused by injuries to the reproductive organs
- An increased risk of cancer, especially from HPV affecting the cervix, vulva, or vagina
Sexually transmitted diseases can also cause inflammation, which makes it easier for HIV to spread in your vaginal discharge. This means that despite ART, HIV is not as well controlled as it should be and the virus spreads more easily during sexual activity.
Additionally, antibiotics used to treat sexually transmitted diseases can reduce the effectiveness of ART and increase your viral load. And ART can also reduce the effectiveness of some antibiotics and cause antibiotic resistance, also called antimicrobial resistance. This makes it more difficult to treat infections, such as sexually transmitted diseases, and also leads to the proliferation of resistant germs.
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 not have a period at all. This is called amenorrhea. And if you have PMS, it could become more severe.
These changes may have nothing to do with the infection, but rather other issues such as stress or perimenopause. However, some research suggests that many women with HIV experience amenorrhea. One theory is that your hormones could be affected if the virus attacks your immune system. This, in turn, disrupts your menstrual cycle and can even lead to early menopause.
Cancers of the cervix and lower genital tract
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 become infected with HPV and are less likely to clear the infection from their body without treatment. They also have a six-fold increased risk of developing cervical cancer. This is important to know because many people infected with HIV do not know they have the virus, and many who are infected with the virus are untreated or receive poor treatment.
You can reduce your risk of developing cervical cancer by having regular Pap smears, routine pelvic exams. The results can reveal whether there are changes in the cells of your cervix before they turn into cervical cancer. Because women with HIV have a higher risk of cervical cancer, they should get tested more often. Guidelines vary, but a general recommendation for women with HIV is that they should have their first Pap smear within the first year of their first sexual activity or, if you are already sexually active, within the first year of your HIV diagnosis. After this initial test, Pap tests should be done every year if you are between the ages of 20 and 30, and every three years thereafter (along with HPV testing) until age 65.
Living with HIV
HIV can affect your gynecological health, but knowing about this possibility will help you be prepared in advance. Proper HIV treatment can keep your viral load at low or undetectable levels, reducing your risk of infections, including sexually transmitted diseases. If you contract a sexually transmitted disease, early treatment increases your chances of successfully fighting the infection. And regular Pap tests can be helpful in detecting 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 prioritize prevention.
This educational resource was created with support from Merck.
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