Global New HIV Infections: Do Young Females Surpass Males?

Globally, we have made great strides in HIV (human immunodeficiency virus) transmission prevention, resulting in a decline in AIDS-related deaths. The overall infection rates are falling with the advent of new and more effective pediatric and adult antiretroviral therapies, better testing methods, and education campaigns. However, especially in sub-Saharan Africa, young women and female teens may have a disproportionately high risk of contracting HIV. However, this statistic varies within individual countries, from continent to continent, references used, and data evaluated.

HIV: a very preventable disease

When first identified in the 1980s, the AIDS epidemic crippled the world. We had no means to thwart the disease, treatment options were limited, and there were significant barriers, including economics, access to care, and more. Fast forward to 2023, and we have come a long way.

Statistics show that we have successfully reduced the number of new people infected, continued to increase the number of people on antiretroviral therapy (ART), and even eliminated some forms of transmission in some parts of the world. This shows us that HIV can hopefully be stopped. However, we still have a long way to go. Though preventable, lack of education, lack of access to medical care, and other factors continue to permit this disease to take hold. However, continued education and intervention campaigns can improve the outcomes and hopefully reach the global 2025 goals of 95-95-95 discussed below.

What is HIV?

HIV is a retrovirus that infects humans and some non-human primates. Retroviruses attack a person’s immune system. In the case of HIV, the virus weakens the immune system by targeting an individual’s white blood cells. This results in immune system suppression and prevents the body from fighting routine infections. When untreated, the disease can progress to AIDS (acquired immunodeficiency syndrome), a life-threatening illness.

Once infected with a retrovirus, you remain infected for life. The infection cannot be cleared. However, in 2023, current scientific advances in ART help get the virus below detectable levels, thus helping to prevent transmission to others, including from mother to child and sexual partners.

Still, worldwide infections continue, and while treatable, this incurable disease still causes unnecessary amounts of disease, loss of quality of life, and deaths.

Data
In 2004, we lost 2 million people to AIDS globally, 1.3 million in 2010, and only 630,000 in 2022. We need to continue this downward trend.

Who is at the highest risk?

Risk factors for HIV infection include:

  • Any sexual activity (vaginal or anal)
  • Having multiple partners
  • Homosexual interactions, especially MSM (men having sex with men)
  • Sharing syringes, needles, and related materials
  • Incarceration
  • Those with other sexually transmitted infections (STIs)
  • Those who are pregnant — which, in turn, increases the risk of passing the disease on to offspring via direct transmission from mother to fetus in utero, during birth, or via breast milk

HIV transmission

HIV transmission occurs via two pathways, horizontal and vertical.

Horizontal transmission

Horizontal transmission refers to non-genetic means of disease spread. In other words, not from mother to child but from different means, including:

  • Injectable drug use and associated paraphernalia
  • Direct mucus membrane contact with bodily fluids*
  • Heterosexual and homosexual interactions (vaginal and anal sex)
  • Workplace exposures (e.g., contamination secondary to sharp objects, such as needles)

*Blood, semen, pre-seminal fluid, vaginal fluids, breast milk, or rectal fluids constitute bodily fluids. One or more of these fluids must make direct contact with one’s mucus membranes (present in the mouth, eyes, rectum, vagina, and penis) or gain direct access to the body via broken skin or bloodstream exposure.

Vertical transmission

When we talk about vertical disease transmission, this refers to the transmission of a disease, be it HIV or others, from mother to child. This could happen in utero, while the fetus develops, during the birthing process, or after birth through nursing and breast milk. With the advent of modern antiretrovirals, women with HIV can still carry a pregnancy to term while protecting the developing fetus from infection. Thus, this route of transmission can, ultimately, be eliminated.

According to the United Nations Children’s Fund, Thailand has become the first World Health Organization (WHO) certified country to fully eliminate the transmission of HIV vertically. In addition to Thailand, 14 territories and countries have also halted transmission from mother to child in utero, including Botswana, Namibia, Sri Lanka, Malaysia, and Bermuda.

Do new HIV infections occur more in females?

According to the most recent global snapshot of HIV infections worldwide, 2022 statistics suggest that while kids 10–19 years old represent only 4% of those living with HIV, that age group represents 10% of all new infections. Further, of those new infections, 71%, according to the United Nations, occur in women of that age group.

According to HIV.gov 2022, global AIDS statistics showed that of the 39 million people with HIV, 1.5 million were kids < 15, and 53% were women and girls.

According to UNAIDS, a critical player in the worldwide HIV/AIDS epidemic response, girls and women represented 46% of all new HIV infections globally in 2022. However, in sub-Saharan Africa, females age 15–24 represented over 77% of new infections.

Data
According to our latest HIV data, females aged 15–24 in sub-Saharan Africa are more than three times more likely to contract new infections compared to boys of the same age.

However, while the majority of the global HIV burden occurs in sub-Saharan Africa, and these results hold true in this region, this isn’t always the case. In some areas in the same age group, boys are at higher risk of new infections than girls. Further, overall infection rates are declining in sub-Saharan Africa while remaining high in other parts of the world.

In countries where HIV transmission occurs more commonly in homosexual populations (most widely MSM) rather than heterosexual (e.g., the Pacific, East Asia, and Latin America), infection rates are higher among males aged 10–19.

Why the higher HIV rates in females?

Thankfully, overall, HIV rates in most regions are declining worldwide, with the largest reduction in transmission occurring in sub-Saharan Africa.

However, several factors play a role in areas where we see higher rates among young females vs. males. This is happening for many reasons in countries where women have more new HIV infections than men, which disproportionately affects pregnant women above all others. This puts not just women but their unborn children at risk as well.

Reasons we may see higher rates in young women include:

  • Poor quality of care in numerous countries and rural areas
  • Insufficient testing
  • Failure to link women with ART
  • Lack of follow-up to ensure compliance and continued medication access
  • Lack of proper education about modes of transmission and prevention methods
  • Lack of education on and availability of PrEP (pre-exposure prophylaxis)
  • Discrepancies of overall education and access to education for females vs. males and related gender inequality factors

Additional reasons we may see higher rates of infections in females and women, particularly 15–24 years of age, include social factors, lack of awareness, and risky sexual practices.

Global target: 95-95-95

While we still have a long way to go to reach global HIV targets for 2025, we have made great strides. The 95-95-95 target goal aims to ensure that:

  • At least 95% of people know their HIV status.
  • 95% are on ART, and
  • Of those on ART, 95% reach the appropriate viral load suppression level.

This 95-95-95 target, as of the UNAIDs 2023 report, hasn’t been fully met, but we are much closer than we were just 10 years ago. For all age groups, we are currently at 86-89-93 globally. Continued education and intervention campaigns, funding, affordable PrEP and antiretrovirals, and improved access to care can improve outcomes, and we can hopefully reach our global 2025 goals ahead of schedule. However, strategies must be geared toward each region and the individual groups of concern. One strategy won’t fit all, with gender differences and exposure risks varying across nations.

HIV is preventable!

Prevention strategies apply no matter where one resides. They are globally applicable and include:

  • Engage in safe sex practices. Wearing a condom and knowing your partner’s HIV status can go a long way.
  • Avoid illicit drug use. If drugs are used, never share needles or other equipment.
  • Take PrEP when warranted.
  • Regular testing for those at high risk. Know your HIV status.
  • Be in the know. Education goes a long way. Understand HIV transmission, prevention methods, and resources available.

In terms of bettering outcomes for people with HIV, we have achieved tremendous progress. Furthermore, our efforts have avoided innumerable infections and improved millions of people's quality of life and life expectancy.

The road to HIV elimination: addressing gender inequality

AIDS deaths have been dramatically reduced in the past 10 years. Some countries, through education programs and interventions, and with the successful use of PrEP and effective ARTs, have eliminated vertical disease transmission. By continuing to address gender inequalities and lack of access to drugs and education, we can continue to limit this epidemic’s reach and continue to prevent transmission and subsequent disease and deaths.

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