1 HIV/AIDS among Women, November 2004

HIV/AIDS among Women

Early in the epidemic, HIV infection and AIDS 

were diagnosed for relatively few women. Today, 

the HIV/AIDS epidemic represents a growing and 

persistent health threat to women in the United 

States, especially young women and women 

of color. In 2001, HIV infection was the leading cause of death for African American women 

aged 25–34 years and was among the four leading causes of death for African American women 

aged 20–24 and 35–44 years, as well as Hispanic 

women aged 35–44 years [1]. Overall, in the same 

year, HIV infection was the 6th leading cause of 

death among all women aged 25–34 years and the 

4th leading cause of death among all women aged 

35–44 years.

STATISTICS

Cumulative Effects of HIV Infection 

and AIDS (through 2003)

• Through 2003, 170,679 women were given a 

diagnosis of AIDS, a number that represents 

about one fi fth of the total 929,985 AIDS 

diagnoses [2].

• An estimated 81,864 women with AIDS died. 

These women account for 16% of the 524,060 

deaths of persons with AIDS [2].

• Women with AIDS made up an increasing part 

of the epidemic. In 1992, women accounted 

for an estimated 14% of adults and adolescents 

living with AIDS [3]. By the end of 2003, this 

percentage had grown to 22% [2].

• From 1999 through 2003, the annual number 

of estimated AIDS diagnoses increased 15% 

among women and increased 1% among men 

[2].

• According to a recent CDC study of more than 

19,500 patients in 10 US cities, HIV-infected 

women were 12% less likely than infected men 

to receive prescriptions for the most effective 

treatments for HIV infection [4].

AIDS in 2003

• An estimated 11,498 women had a diagnosis 

of AIDS, a number that represents 27% of the 

43,171 AIDS diagnoses [2]. 

• The rate of AIDS diagnoses for African American women (50.2/100,000 women) was approximately 25 times the rate for white women 

(2.0/100,000) and 4 times the rate for Hispanic 

women (12.4/100,000) [2].

• African American and Hispanic women together represented about 25% of all US women [5], 

yet they account for 83% of AIDS diagnoses 

reported in 2003 [2]. 

• An estimated 88,815 women were living with 

AIDS, representing 22% of the estimated 

405,926 people living with AIDS [2].

• An estimated 4,736 women with AIDS died, 

representing 26% of the 18,017 deaths of persons with AIDS [2].

Diagnoses of AIDS in women, by race/ethnicity, 2003
 2 HIV/AIDS among Women, November 2004

HIV/AIDS in 2003

• Data from 33 areas (32 states and the US 

Virgin Islands) with confi dential name-based 

HIV reporting indicate that an estimated 8,733 

women were given a diagnosis of HIV infection [2]. 

• Heterosexual contact was the source of almost 

80% of these HIV infections [2].

• Women accounted for 27% of the estimated 

32,048 diagnoses of HIV infection [2]. 

• The number of estimated HIV diagnoses for 

women remained stable during 2000–2003 [2].

RISK FACTORS AND BARRIERS TO 

PREVENTION

Young Age

According to a 1998 CDC study of Job Corps 

entrants aged 16–21 years, HIV prevalence 

among young women (2.8 per 1,000) was higher 

than among young men (2.0 per 1,000). African 

American women in the study were 7 times as 

likely as white women and 8 times as likely as 

Hispanic women to be HIV-positive [6]. Another 

study found that even though overall HIV diagnoses among women decreased slightly from 1984 

through 1998, as the youngest group of women 

(aged 15–19) reached the age at which they initiated risk behaviors, the number of HIV cases caused 

by injection drug use increased, and the number 

acquired through heterosexual contact more than 

doubled [7]. 

Lack of Recognition of 

Partners’ Risk

Some women may be unaware of their male 

partners’ risk for HIV infection (such as unprotected sex with multiple partners, sex with men, or 

injection drug use) [8]. Men who engage in sex 

both with men and women can acquire HIV from 

a male partner and can then transmit the virus to 

female partners. In a recent study of HIV-infected 

people (5,156 men and 3,139 women), 34% of 

African American men who have sex with men 

(MSM), 26% of Hispanic MSM, and 13% of 

white MSM reported having had sex with women. 

However, their female partners may not know of 

their bisexual activity: only 14% of white women, 

6% of African American women, and 6% of Hispanic women in this study acknowledged having a 

bisexual partner [9]. In a recent CDC survey, 65% 

of the men who have ever had sex with men also 

had sex with women [10]. 

Sexual Inequality in Relationships 

with Men

Some women may not insist on condom use out of 

fear that their partners will physically abuse them 

or leave them [11]. Sexual inequality is a major issue in relationships between teenaged girls 

and older men. In one CDC study of urban high 

schools, more than one third of African American and Hispanic female teenagers had their fi rst 

sexual encounter with an older man [12]. These 

teenagers, compared with teenagers whose partners were also teenagers, were younger at fi rst 

sexual intercourse, were less likely to have used 

a condom during fi rst and most recently reported 

intercourse, or were less likely to have used condoms consistently. 

Biologic Vulnerability and Sexually 

Transmitted Diseases

A woman is approximately twice as likely as a 

man to contract HIV infection during vaginal 

intercourse [13]. Additionally, the presence of a 

sexually transmitted disease greatly increases the 

likelihood of acquiring or transmitting HIV infection [14]. The rates of gonorrhea and syphilis are 

higher among women of color than among white 

women. These higher rates are especially marked 

in the younger age groups (15–24 years) [15]. 

Diagnoses of HIV infection in women, by risk, 2003
 3 HIV/AIDS among Women, November 2004

Substance Abuse

An estimated 1 in 5 new HIV diagnoses for 

women is related to injection drug use [2]. Sharing injection equipment contaminated with HIV 

is not the only risk associated with substance use. 

Women who smoke or snort crack cocaine or other 

noninjection drugs may also be at high risk for 

sexual transmission of HIV if they sell or trade sex 

for drugs [16]. Also, both casual and chronic substance users are more likely to engage in high-risk 

behaviors, such as unprotected sex, when they are 

under the infl uence of drugs or alcohol [17].

Socioeconomic and Other 

Societal Factors

Nearly 1 in 4 African Americans and 1 in 5 Hispanics live in poverty [18]. Socioeconomic 

problems associated with poverty, including 

limited access to high-quality health care and higher levels of substance use, can directly or indirectly increase HIV risks [19]. Research has shown 

that women are less likely than men to receive 

highly active antiretroviral therapy and preventive 

therapy for opportunistic infections [20].

PREVENTION 

The annual number of new HIV infections among 

all people in the United States has declined from a 

peak of more than 150,000 cases in the mid-1980s 

and stabilized at approximately 40,000 cases annually since the late 1990s. Minority populations are 

disproportionately affected by the HIV epidemic. 

To reduce further the incidence of HIV, CDC announced a new initiative, Advancing HIV Prevention (http://www.cdc.gov/hiv/partners/AHP.htm), 

in 2003. This initiative comprises 4 strategies: 

making HIV testing a routine part of medical care, 

implementing new models for diagnosing HIV infections outside medical settings, preventing new 

infections by working with HIV-infected persons 

and their partners, and further decreasing perinatal 

HIV transmission.

In the United States, women, particularly 

women of color, are at risk for HIV infection. CDC, through the Department of Health 

and Human Services Minority AIDS Initiative 

(http://www.cdc.gov/programs/hiv09.htm) explores the disparities in minority communities 

at high risk for HIV and what can be done to 

reduce these disparities. CDC is also conducting 

demonstration projects on using women’s social 

networks to reach high-risk persons in communities of color and doing outreach and testing for 

partners of HIV-infected men.

CDC funds prevention programs in state and local 

health departments and community-based organizations. The following are some of CDC’s programs that focus on women:

• In Maryland, providing rapid HIV testing 

and implementing SISTA (Sisters Informing 

Sisters About Topics on AIDS ), a program 

designed to increase the number of African 

American women who can negotiate condom 

use with their male partners

• In Illinois, focusing on African American 

women through prevention case management, 

SISTA, and Safety Counts, which is an HIV 

prevention intervention for active injection 

drug and crack cocaine users

• In California, offering counseling, rapid testing 

services, referral and other services to minority 

women 13 years of age and older to decrease 

the transmission of HIV and to increase awareness of serostatus and linkages to prevention 

and treatment services

CDC also funds research on interventions to 

reduce HIV-related risk behavior or biologic 

outcomes. For example, the Women and Infants 

Demonstration Projects were focused on lowincome, inner-city sexually active women to 

measure injection drug use, sexual behaviors, and 

HIV testing behaviors, as well as sexually transmitted diseases and pregnancy. The demonstration 

projects increased condom use and resulted in an 

intervention package called Real AIDS Prevention Project, which is available, with training and 

technical assistance, from CDC. 

To prevent mother to child transmission, since 

1999, CDC has distributed $10 million annually 

to 16 states with high HIV/AIDS rates to carry out 

prevention programs for pregnant women, to 10 

states for enhanced surveillance for infected moth-
 4 HIV/AIDS among Women, November 2004

REFERENCES

1. Anderson RN, Smith BL. Deaths: leading 

causes for 2001. National Vital Statistics 

Reports 2003;52(9):32–33,53–54. Available 

at http://www.cdc.gov/nchs/data/nvsr/nvsr52/

nvsr09.pdf. Accessed November 9, 2004.

2. CDC. HIV/AIDS Surveillance Report 2003; 

(Vol. 15). Atlanta: US Department of Health 

and Human Services, CDC. In press.

3. CDC. HIV/AIDS Surveillance Report 

1998;10(No. 2):1–43. Also available at http:

//www.cdc.gov/hiv/stats/hasrlink.htm. Accessed August 26, 2004.

4. McNaghten AD, Hanson DL, Aponte Z, Sullivan P, Wolfe MI. Gender disparity in HIV 

treatment and AIDS opportunistic illnesses 

(OI). XV International Conference on AIDS; 

July 2004; Bangkok, Thailand. Abstract 

MoOrC1032.

5. US Census Bureau. Census Brief: Women 

in the United States: a profi le. March 2000. 

Available at http://www.census.gov/prod/

2000pubs/cenbr001.pdf. Accessed August 27, 

2004.

Understanding HIV and AIDS Data

AIDS surveillance: Through a uniform system, CDC 

receives reports of AIDS cases from all US states and 

territories. Since the beginning of the epidemic, these 

data have been used to monitor trends because they 

are representative of all areas. The data are statistically 

adjusted for reporting delays and for the redistribution 

of cases initially reported without risk. As treatment has 

become more available, trends in new AIDS diagnoses 

no longer accurately represent trends in new HIV infections; these data now represent persons who are tested 

late in the course of HIV infection, who have limited 

access to care, or in whom treatment has failed.

HIV surveillance: Monitoring trends in the HIV 

epidemic today requires collecting information on HIV 

cases that have not progressed to AIDS. Areas with 

confi dential name-based HIV infection reporting requirements use the same uniform system for data collection on 

HIV cases as for AIDS cases. The US Virgin Islands and 

32 states (Alabama, Alaska, Arizona, Arkansas, Colorado, 

Florida, Idaho, Indiana, Iowa, Kansas, Louisiana, Michigan, 

Minnesota, Mississippi, Missouri, Nebraska, Nevada, New 

Jersey, New Mexico, North Carolina, North Dakota, Ohio, 

Oklahoma, South Carolina, South Dakota, Tennessee, Utah, 

Texas, Virginia, West Virginia, Wisconsin, Wyoming) have 

collected these data for at least 5 years, providing suffi cient 

data to monitor HIV trends and estimate risk behaviors for 

HIV infection. 

HIV/AIDS: This term includes persons with a diagnosis of 

HIV infection (not AIDS), a diagnosis of HIV infection and 

a later diagnosis of AIDS, or concurrent diagnoses of HIV 

infection and AIDS.

6. Valleroy L, MacKellar D, Karon J, et al. 

HIV infection in disadvantaged out-ofschool youth: prevalence for U.S. Job Corps 

entrants, 1990 through 1996. Journal of 

Acquired Immune Defi ciency Syndromes 

1998;19:67–73.

7. Lee LM, Fleming PL. Trends in human 

immunodefi ciency virus diagnoses among 

women in the United States, 1994–1998. 

Journal of the American Medical Women’s 

Association 2001;56(3):94–99.

8. Hader S, Smith DK, Moore JS, Holmberg 

SD. HIV infection in women in the United 

States: status at the millennium. JAMA 2001; 

285:1186–1192.

9. Montgomery JP, Mokotoff ED, Gentry AC, 

Blair JM. The extent of bisexual behaviour in 

HIV-infected men and implications for transmission to their female partners. AIDS Care 

2003;15:829–837.

10. Valleroy LA, MacKellar DA, Behel SK, et 

al. The bridge for HIV transmission to women from 23- to 29-year-old men who have 

sex with men in 6 U.S. cities. National HIV 

ers and babies, and to 5 national organizations to 

develop and distribute training and educational 

materials for women and prenatal care providers. These programs are successful: AIDS cases in 

children have dropped by 90% in the past decade, 

from 952 cases in 1992 to 59 cases in 2003. 
 5 HIV/AIDS among Women, November 2004

16. Edlin BR, Irwin KL, Faruque S, et al. Intersecting epidemics—crack cocaine use and 

HIV infection among inner-city young adults. 

New England Journal of Medicine 1994;331:

1422–1427. 

17. Leigh B, Stall R. Substance use and risky 

sexual behavior for exposure to HIV: issues in 

methodology, interpretation and prevention. 

American Psychologist 1993;48:1035–1045.

18. US Census Bureau. Poverty: 1999. Census 

2000 Brief. Issued May 2003. Available 

at http://www.census.gov/prod/2003pubs/ 

c2kbr-19.pdf. Accessed September 16, 2004.

19. Diaz T, Chu S, Buehler J, et al. Socioeconomic differences among people with AIDS: 

results from a multistate surveillance project. 

American Journal of Preventive Medicine

1994;10:217–222.

20. Shapiro MF, Morton SC, McCaffrey DF, et al. 

Variations in the care of HIV-infected adults 

in the United States: results from the HIV 

cost and utilization study. JAMA 1999;281:

2305–2315. 

For more information . . .

CDC National STD & AIDS Hotlines

1-800-342-AIDS

Spanish: 1-800-344-SIDA

Deaf: 1-800-243-7889

CDC National Prevention

Information Net work

P.O. Box 6003

Rockville, MD 20849-6003

1-800-458-5231

Web Resources

NCHSTP: http://www.cdc.gov/nchstp/od/

nchstp.html

DHAP: http://www.cdc.gov/hiv

NPIN: http://www.cdcnpin.org

Prevention Conference; July 2003; Atlanta, 

Georgia. Abstract M2-B0902.

11. Suarez-Al-Adam M, Raffealli M, O’Leary 

A. Infl uence of abuse and partner hypermasculinity on the sexual behavior of Latinas. 

AIDS Education and Prevention 2000;12:

263–274.

12. Miller KS, Clark LF, Moore JS. Sexual initiation with older male partners and subsequent 

HIV risk behavior among female adolescents. 

Family Planning Perspectives 1997;29:

212–214.

13. European Study Group. Comparison of female 

to male and male to female transmission of 

HIV in 563 stable couples. British Medical 

Journal 1992;304:809–813.

14. Fleming D, Wasserheit J. From epidemiological synergy to public health policy and 

practice: the contribution of other sexually 

transmitted diseases to sexual transmission of 

HIV infection. Sexually Transmitted Infections

1999;75:3–17.

15. CDC. Sexually Transmitted Disease Surveillance, 2003. Atlanta: US Department 

of Health and Human Services, September 

2004. Also available at http://www.cdc.gov/

std/stats/toc2003.htm. Accessed November 

30, 2004.