Women are at risk of HIV

About 25 percent of people living with HIV infection in the United States are women. It can be hard for women to prevent HIV or to take care of themselves if they have it. There are several things that can put you at higher risk of being infected with HIV:

• Having unprotected sex with more than one partner
• Injecting drugs, either now or in the past
• Having sex with someone to get money or drugs in return, or having sex with someone who has traded sex for money or drugs
• Having sex, now or in the past, with someone who has HIV, is bisexual, or injects drugs
• Having another sexually transmitted infection (STI)
• If you had a blood transfusion between 1978 and 1985

Of course, these are not the only ways to get HIV. Some women have a higher risk than others. This section explores many reasons why women are at risk of HIV infection.

Women have a higher risk of getting HIV from vaginal sex

Women are more likely to get HIV during vaginal sex than men are for several reasons.

• The vagina has a larger area (compared to the penis), that can be exposed to HIV-infected semen.
• Semen can stay in the vagina for days after sex, while men are only exposed to HIV-infected fluids during sex. Semen left in the vagina means a longer exposure to the virus for women.
• Having untreated sexually transmitted infections (STIs) makes it more likely for a person to get HIV. This is especially true for women. Small cuts on the skin of the vagina are hard to notice but may allow HIV to pass into a woman's body.

Women can pass HIV to their partners

Many HIV-positive women with HIV-negative partners worry about passing HIV. Research shows in the United States, men pass HIV more easily than women do. But women can still pass HIV to uninfected partners — both male and female — through all kinds of sex. This is because HIV is in blood (including menstrual blood), vaginal fluids, and in cells in the vaginal and anal walls.

If you are HIV-positive, you can pass the virus at any time, even if you are getting treatment. But you may be more likely to pass the virus if:

• You have a vaginal yeast infection or STIs
• You have recently been treated for a vaginal yeast infection or STIs
• You were recently infected with HIV
• Your partner has an infection or inflammation

The surest way to avoid passing any STI, including HIV, is to not have sex. If you do have sex, it's important to always use a male condom correctly and every time you have sex.

Women who have sex with women

Women who only have sex with women (lesbians) might think they are safe from HIV. To get HIV in this way would be very rare. But it is possible for a woman to get HIV through sexual contact with an HIV-positive woman. Experts think this could happen if soft tissues, such as those in the mouth, come in contact with the vaginal fluid or menstrual blood of a woman infected with HIV. Women who have sex with women also can get infected with HIV by injecting drugs or by having sex with a man who has HIV.

A lesbian or bisexual woman should know her HIV status as well as her partner's. That way, she can take steps to protect herself or others from HIV. You can lower your risk of getting HIV by using condoms correctly and every time you have sex with men, or when using sex toys. Experts suggest using dental dams to lower the risk of getting or spreading HIV through oral sex. However, not much research has been done to prove that they are effective.

Men on the "down low"

The term "down low" or "DL" means to keep something private. Being "on the down low," "on the DL," or "on the low low," are terms often used to describe men who have sex with men as well as with women. However, these men do not call themselves gay or bisexual. Female partners of men who are "on the down low" do not know that their partner is also having sex with one or more men. These women have a higher risk of getting HIV, especially if the male partner had unprotected sex with HIV-positive men.

The term "DL" has most often been used among African-American men , but it also describes the lives of some white and Latino men. Yet because being on the DL is defined by secrecy, very little is known about these men. It is not known how many of these men:

• Have HIV or AIDS
• Practice unsafe sex with any partner
• Do other actions that put them at risk of HIV, such as injecting drugs

Women of all races and ethnicities can get HIV

HIV can touch the lives of all American women, no matter what their background. However, research shows that women of color are more likely to be infected with HIV.

Some risks of HIV infection may be higher in some communities.

• Sexually transmitted infections (STIs). Women of color have high rates of some STIs. Having an STI can make women more likely to be infected with HIV.
• Risky sexual behavior. Unprotected sex with multiple partners, with a partner who has other sex partners, or with people at high risk of HIV infection can be common in some communities. In some communities men may not live with their regular sex partner due to jail, immigration issues, or other social forces. This can result in female partners being at greater risk of HIV.
• Drug use. All drug users may be more likely to have unprotected sex under the influence of drugs or alcohol. Women who use intravenous (IV) drugs may share needles or have sex with others who use IV drugs. Sharing needles to inject IV drugs is the second most common way of getting HIV.
• Lack of basic necessities. Women who cannot afford the basics in life such as quality health care and housing are indirectly at higher risk of HIV. Having to care for others such as children or family may place additional strain on women's resources.

African-American women and Latinas have the highest rates of HIV. HIV diagnoses in black women are nearly 15 times higher than in white women. HIV diagnoses in Hispanic or Latina women are four times higher than in white women.

The latest estimates from the CDC show almost 300,000 women living with HIV in the U.S. A study of 40 U.S. states and territories shows that 66 percent of the women who were diagnosed with HIV in 2009 were African-American, 17 percent were white, and 14 percent were Hispanic or Latina.

Violence against women and HIV risk

If you are currently in an abusive relationship, you are more likely to get HIV. That's partly because abusive men are more likely to have sexual partners other than their wife. Women in violent relationships often lack any control. Either partner may have other sexual relationships going on at the same time.

Fear of violence keeps some women from insisting on condom use. Fear of violence also keeps some women from seeking treatment for HIV or other STIs. Women may delay being tested for HIV or not get the results because they are afraid that sharing their HIV-positive status may result in physical violence.

Women with HIV may be at risk of violence when they tell a partner about their HIV status. If you have HIV, take these steps to lower the risk that your partner will react violently when you tell your status:

• Tell your partner that you have HIV before you get sexually involved.
• Break the news in a semi-public place. A public park is a good place because it gives you some privacy, but make sure other people are around in case you need help.
• If you feel at all threatened by your partner's reaction, stop seeing him or her. If you must meet, do so only in public.
• Find a domestic violence service in your community and ask for help.

Alcohol and substance abuse and HIV risk

Women who abuse drugs and alcohol are more likely to get HIV. One main reason for this is that anyone who uses drugs and alcohol is more likely to have risky sex. Risky sex can include:

• Having sex without a condom. Women who are intoxicated are less likely to convince a partner to practice safer sex.
• Having sex with someone when you don't know their HIV status

Women who use intravenous (IV) drugs may share needles, which, after sex, is the main way HIV is spread. Also, women who drink alcohol or use drugs may be at higher risk of sexual assault or rape. Forced sex with any partner puts you at risk of HIV. If you are raped, you need to see a doctor immediately.

Young women

Young women in the United States are at risk of getting HIV. The Centers for Disease Control and Prevention (CDC) estimates that more than half of 13- to 24-year-olds living with HIV infection are undiagnosed. Some factors put young women at higher risk of HIV than older women. They include:

• Biological reasons, such as how the title="click for glossary definition">vagina has a large area through which HIV can pass from semen. Also, young women and adolescents have immature reproductive systems, which may be more likely to receive HIV. Researchers are still studying the reasons that younger women get HIV easily.
• You may not know about HIV or how to prevent it
• You may have less power in your relationships. It may be hard to convince your partners to use condoms.
• You may not know your partners' risk factors, such as a history of unprotected sex or injection drug use
• You are more likely than older women to have a sexually transmitted infection (STI). Having an STI can make someone more likely to get HIV. Small cuts on the skin of the vagina are hard to notice but may allow HIV to pass into a woman's body.

Many young people don't worry about becoming infected. HIV prevention efforts, including programs on abstinence, safer sex, and HIV screening, are key to stopping the spread of HIV in young people. The U.S. government tries to bring this information to both schools and communities. For instance, the "Healthy Youth" program from the CDC helps schools offer education and services to prevent HIV in students. On the state and local level, health departments might provide one of these CDC-tested programs for youth:

Women over 50

Twenty-four percent of people living with HIV are age 50 or older. If you are over 50, you may think that you are not at risk of HIV infection for some of these reasons:

• You may not realize what HIV is or that it is still a health risk in the United States.
• You may not know the term "sexually transmitted infections" or STIs. You were taught about "venereal diseases" or VD.
• You may not know how to prevent HIV.
• You may think you don't need to use condoms because you don't worry about getting pregnant. Or, you may be dating again after many years and don't know how to talk to your partner about using condoms.
• You may think that only younger people are at risk of HIV infection. You might assume that your older sexual partners couldn't possibly have it.
• Your doctor does not talk to you about your HIV risk.
• You are uncomfortable talking about sex or HIV risk.
• You don't know your partners' risk factors, such as a history of unprotected sex or injection drug use.

But anyone at any age can get HIV. In fact, if you are nearing or post-menopause, your vagina will not be as lubricated as normal. This means that you have a greater risk for tiny tears in your vagina during sex. These can make it easier for HIV to get in. If you have not been tested for HIV, don't wait. Get tested now. You might be at risk of HIV if:

• You are sexually active and do not use condoms.
• You have sex of any kind and do not know yours or your partner's HIV status.
• You do not know your partner's drug and sexual history.
• You have had a blood transfusion or operation in a developing country at any time.
• You had a blood transfusion in the United States between 1978 and 1985.

You can lower your risk of HIV if both you and your partner know your HIV status, are faithful to each other, and do not inject drugs. Using condoms correctly and every time you have sex also lowers your risk. Learn more about steps you can take to protect yourself from HIV no matter what your age.