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One in four people living with HIV in the United States is a woman. While any woman can be HIV-positive or get HIV, there are ages, ethnic groups and behaviors that can put a woman more at risk of spreading or contracting HIV. If you are HIV-positive or in one of a few high-risk groups, it's important that you are aware and educated so you can take the precautions necessary to either not spread or not contract HIV.

Higher Risk Activities and Groups

Women Who Have Sex With Men
According to the U. S. Department of Health and Human Services, a woman is more likely to get HIV during vaginal sex when these factors are present:

-You are unaware of your partner's risk factors for HIV. Some men, for example, have sex with men as well as women but do not tell their female partners.
- Your male partner was recently infected. During this time, the amount of HIV in his semen is higher. Exposure during early infection may cause up to half of all HIV transmissions in the United States.
- Your partners do not use male latex condoms or you do not use female condoms correctly every time you have sex.
- You have a history of sexual abuse, which can lead to riskier future behavior.
- You have sex with multiple partners or have sex with someone who is having sex with multiple partners.
- You have sex in exchange for money or drugs.
- You misuse drugs or alcohol before or during sex.
- Have injected illegal drugs, either now or in the past.
- Have another sexually transmitted infection (STI).
- Had a blood transfusion between 1978 and 1985.

Women Who Have Sex With Women
In women who have sex only with women, HIV transmission is rare. If you are a woman and your female partner has HIV, you can get it if you have cuts, bleeding gums, or sores in your mouth and you give oral sex. It is also possible to spread HIV through menstrual blood and shared sex toys.

As a woman who has sex with women, it is also possible to get HIV if:

- You inject or your partner injects drugs with someone who has HIV
- You have or your partner has sex with a man who has HIV
- You are trying to get pregnant and use semen that has not been tested for HIV or sexually transmitted infections (STIs)

You can lower your risk of getting HIV or passing it to your partner by:

- Knowing your HIV status and your partner's HIV status.
- Taking steps to protect yourself and others from HIV.
- Use latex condoms correctly and every time if you have sex with men.
- Use dental dams correctly.
- Never share sex toys.

Younger Women
Young women are at risk for HIV because:
According to a 2013 DHHS survey, only half of female high school students used a condom the last time they had sex and only one in eight female high school students in the study had ever been tested for HIV.

Younger women are more likely to have a sexually transmitted infection (STI). Having an untreated STI makes HIV transmission more likely. An untreated vaginal yeast or bacterial infection can also increase the risk of transmission. This is because the infection brings white blood cells (and therefore CD4 cells that can be infected with HIV) into the area. This is especially true for women, because small cuts on the skin of the vagina are hard to notice but may allow HIV to pass into your body.

Teen girls and younger women are at higher risk for HIV infection than adult women, because their reproductive tract is still developing.

Older Women
Women over 50 are still at risk for HIV. Older women are more likely than younger women to be diagnosed with HIV much later after they are first infected.
This may be because older women may think they do not need condoms, because they do not worry about getting pregnant. They may not talk about safe sex with their doctors or partner or get tested regularly for HIV and other sexually transmitted infections (STIs). Their doctors may also not suspect their symptoms could be caused by HIV. A later diagnosis can mean a later start to treatment and possibly more damage to your immune system. It can also raise the risk of spreading HIV to other people.

You can get HIV at any age. In fact, the decrease in hormone levels during and after menopause means your vagina will probably not be as lubricated as it used to be. This means that you have a greater risk for tiny cuts in your vagina during sex that can make it easier for HIV to get in.

Other health concerns
Older women with HIV also need to think about other health problems, such as heart disease and osteoporosis. If you have HIV, talk to your doctor about steps you can take to lower your risk of these problems.

African American and Hispanic Women
African-American and Hispanic women, are disproportionately affected by HIV.

African-American women made up more than 61% of new HIV infections among women in 2015 but are only 14% of the female population in the United States. African-American women face the highest risk of HIV and other sexually transmitted infections (STIs) compared with women of other groups. However, many African-American women do not know their HIV status. Poverty, stigma, and fear of discrimination may prevent women from getting tested or seeking care if infected.

Hispanic women made up 15% of new HIV infections among women in 2015. Cultural challenges may raise Hispanic women's risk for HIV. Hispanic women may avoid seeking testing, counseling, or treatment if infected because of their immigration status, stigma, or fear of discrimination. Poverty may also prevent Hispanic women from getting care.

Prevention
Get PrEP Educated! In 2014 The CDC recommended new guidelines for the use of Pre-Exposure Prophylaxis or PrEP in HIV prevention. The guidelines requested that health care providers consider advising the use of anti-HIV drugs by uninfected patients who are at substantial risk of infection.

The recommendations states that PrEP can reduce HIV infection rates. When taken daily as directed, PrEP can reduce the risk of HIV infection by more than 90 percent.

The guidelines say PrEP should be considered for HIV-uninfected patients with any of the following indications:

-Anyone who is in an ongoing sexual relationship with an HIV-infected partner.

-A gay or bisexual man who has had sex without a condom or has been diagnosed with a sexually transmitted infection within the past six months, and is not in a mutually-monogamous relationship with a partner who recently tested HIV-negative.

-A heterosexual man or woman who does not always use condoms when having sex with partners known to be at risk for HIV (for example, injection drug users or bisexual male partners of unknown HIV status), and is not in a mutually-monogamous relationship with a partner who recently tested HIV-negative.

-Anyone who has, within the past six months, injected illicit drugs and shared equipment or been in a treatment program for injection drug use.

Of course, many recommend that you are best protected by using both PrEP and a condom for the most protection if you are engaging in high-risk sexual behavior.

PrEP is a single pill (single tablet HIV regimen) branded Truvada. Because it is so important and deserves much more space than we can give it here, please visit https://start.truvada.com for more information and possible financial assistance.

Pregnancy
If you are HIV-positive and live in the United States, the chances your baby will be born HIV-positive is less than 2%.

Currently, there are fewer than 250 infants born each year in the United States with HIV, and in almost every case, it was the result of failure to follow established guidelines—often because the mother was non-compliant because of addiction to drugs.

Here are the procedures that have cut down the rate of mother-to-child transmission of HIV so dramatically:

1. Universal prenatal HIV counseling and testing.

In the United States today, expectant mothers are offered the opportunity to have an HIV test. Obviously, doctors can’t do anything to keep your baby from being born with HIV if they don’t know you have it yourself. So this is the universal first step.

2. Antiretroviral prophylaxis.

A complicated way of saying: Treating the mother with combination HIV therapy. Studies show that mothers who are taking HIV medications and have an undetectable viral load have a very low risk of passing along HIV to their babies. So doctors will often recommend that expectant women start HIV therapy to protect their babies. The higher your viral load, the greater the chance that you will pass on HIV to your child. The lower your viral load, the lower the danger of transmission.

3. Scheduled Cesarean Delivery.

A C-Section can protect your baby from exposure to your genital tract virus during passage through the birth canal. This is generally recommended for women who have a viral load greater than 1,000. Women who have viral loads below 1,000 have very low rates of infected babies, and a C-section doesn’t seem to make any difference.

4. Avoidance of breastfeeding.

A woman can give HIV to a baby who was born healthy through her breast milk. So, in the United States—where bottle-feeding is a safe and practical alternative—women with HIV (even those on HAART), are advised to avoid breastfeeding their children.

Is there anything else you can do to protect your child? Yes! Give up smoking, drinking and drugs—all of these can have a negative impact on your child. And take vitamins prescribed by your doctor that contain folic acid and calcium, which can reduce the rates of certain birth defects.

Of course, there is no absolute guarantee that you will have a healthy child—not for a woman with HIV or a woman who does not have the virus. But, if you follow your doctor’s orders, the odds are good.

Get Tested
If you fall into one of the high-risk groups mentioned or recently engaged in high-risk behavior -- GET TESTED! The tests are fast, easy and in some cases free. The sooner you know your status or begin treatment, the better off you'll be.

Copyright 2018, Positive Health Publications, Inc.

This magazine is intended to enhance your relationship with your doctor - not replace it! Medical treatments and products should always be discussed with a licensed physician who has experience treating HIV and AIDS!