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Women and HIV: Questions Answered |
 
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| August 2007 Issue No. 14 |
The INFO Project • Johns Hopkins Bloomberg School of Public Health • Center for Communication Programs • 111 Market Place, Suite 310 • Baltimore, Maryland 21202, USA • 410-659-6300 • 410-659-6266 (fax) • www.infoforhealth.org • infoproject@jhuccp.org | |
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Basic Facts About HIV
How do people get HIV infections?
Most adult women and men with HIV become infected through unprotected vaginal intercourse. Women and men also can get HIV during anal sex and, very rarely, oral sex. The virus also can be passed in infected blood that enters another person’s body. This could happen through sharing injection needles used for taking intravenous drugs, for example. Infected mothers can transmit HIV to their infants during pregnancy and childbirth and through breastfeeding (see “Mother-to-Child Transmission of HIV). HIV cannot be passed by ordinary day-to-day contact such as shaking hands, hugging, or using public toilets.
Are women more likely to get HIV than men?
Yes. Because of physical differences between women and men, women are generally more likely to acquire HIV infection than men if they come into contact with HIV through unprotected penile-vaginal intercourse. Women have a greater area of exposed tissue (the cervix and the vagina) than men. Also, small tears may occur in the vaginal tissue during sex. These tears are an easy pathway for infection (44, 69).
If a person already has an infection of the reproductive tract, is contact with HIV more likely to lead to infection?
Yes. HIV infection is more likely to occur if a woman or man has another sexually transmitted infection (STI) when she or he is exposed to the virus. Infection with the herpes simplex virus (HSV) (even without sores) is especially risky. Also, for women, bacterial vaginosis and candidiasis (yeast infection) can increase a woman’s chances of getting HIV infection if she comes into contact with the virus. Vaginosis and candidiasis are two common infections of the vagina that are not usually sexually transmitted (37, 45, 92).
Is a woman more likely to develop HIV infection while she is pregnant?
It is not certain. The scientific evidence conflicts. A large study in Uganda found that women who were pregnant were more than twice as likely to become infected with HIV as women who were not pregnant. Another large study, in Uganda and Zimbabwe, did not find any difference. All women, including those who are pregnant, need to protect themselves if they might be exposed to HIV (29, 55).
Is a woman able to get pregnant if she has HIV?
Yes. In general, a woman with HIV is able to become pregnant. Her ability to become pregnant and carry a pregnancy to term is somewhat reduced, however. Women who have the most difficulty getting pregnant are women who have more advanced HIV disease. Also, some HIV-related infections (called opportunistic infections) can reduce fertility. Having certain other STIs, along with HIV, also can reduce fertility. Still, any woman with HIV who wants to avoid pregnancy needs to use contraception. If there is a risk of transmitting STIs or infecting an uninfected partner with HIV, she needs to use condoms or else condoms and another contraceptive method (5, 16, 30, 60, 62, 75, 78).
Can a man get a woman pregnant if he has HIV?
Yes. A man with HIV can get a woman pregnant. A man’s ability to cause pregnancy may be somewhat reduced if he has HIV. Still, a couple that wants to avoid pregnancy needs to use family planning. If there is a risk of transmitting STIs or infecting an uninfected partner with HIV, they need to use condoms or else condoms and another contraceptive method (18, 61).
When a man has HIV and his partner does not, can a couple safely have a child without risk of the woman becoming infected with HIV?
No, not usually. Usually, she will risk HIV infection while trying to become pregnant. The couple can limit her contact with HIV by having sex without condoms only on a woman’s most fertile days—between days 8 and 15 for a woman with a 28-day cycle. Also, antiretroviral (ARV) treatment of either partner reduces the risk that the man will infect his partner (4, 76).
In the opposite situation—if the woman has HIV and her partner does not—this same approach can be used. Alternatively, a couple could try artificial insemination instead of having unprotected sexual intercourse. Artificial insemination involves using a simple tool such as a syringe to place a man’s fresh semen into the woman’s vagina. Using this approach would protect the man from exposure to HIV. The success of artificial insemination at home has not been studied, however.
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