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Health-related issues for women living with and vulnerable to HIV in Ontario

October 4, 2011 - The HIV epidemic has changed from the early years-from one that affected mostly gay men and other men who have sex with men to one that increasingly affects other groups, including people who use injection drugs and heterosexual men and women.

As a result, the burden of HIV among women is increasing. Social and economic conditions (such as poverty, gender inequalities and violence) that fuel the HIV/AIDS epidemic may increase the vulnerability of women to HIV infection and may make it more difficult for them to access care, treatment and support. As a result, there may be important differences in how HIV affects men and women. Recently, an Ontario-based study, called POWER (Project for an Ontario Women's Health Evidence-Based Report), released the results of a gender-based analysis of health and access to healthcare for women living with and vulnerable to HIV.

Study details

With the help of service providers and people living with HIV, researchers selected a list of important HIV-related health outcomes. They then used existing data sources (such as cohort studies and health services data) to see what could be learned about gender differences in behavioural and health outcomes.

Key findings

1. Women account for a rising number of new HIV infections in Ontario

Women accounted for 1,190 new HIV infections between 2006 and 2008, representing one quarter of the 4,735 new HIV infections in Ontario (incidence). The percentage of new infections among women has increased from 3% prior to 2001 to 25% from 2002 to 2008. Heterosexual contact accounted for the vast majority of new infections (93%). The remaining 7% were in women who inject drugs.

2. Women account for 18% of all people living with HIV in Ontario

An estimated 26,630 people were living with HIV in Ontario at the end of 2008 (prevalence). Women accounted for 4,750 (18%) of infections. In women, 87% of all infections were attributed to heterosexual sex and 13% attributed to injection drug use. Women who came to Canada from a country where HIV is endemic accounted for 58% of all new infections in women.

3. Women, more so than men, report engaging in activities that place them at risk for HIV infection

Unprotected sex and sharing of needles and equipment used to prepare drugs for injection place people at risk for HIV. Forty-seven percent of women aged 15 to 49 who had multiple sex partners in the past 12 months did not use a condom during their last sexual encounter, compared to only 35% of men. Twenty-five percent of women who inject drugs reported injecting with previously used needles and 44% reported using previously used equipment, compared to only 14% and 30% of men respectively.

4. Women who inject drugs and Aboriginal women have the lowest HIV treatment rates during pregnancy

Ninety-five percent of pregnant women in Ontario who received prenatal care were tested for HIV in 2009. Twenty-eight cases of HIV were identified. Between 2005 and 2009, 91% of pregnant women who knew they were HIV-positive took HIV medications, which prevent the vast majority of transmissions of HIV from mother to child. Women whose HIV infection was attributable to injection drug use had the lowest treatment rates during pregnancy at 75%. Compared to other ethnocultural groups, Aboriginal women were less likely to be on HIV medications during pregnancy.

5. HIV-positive women who inject drugs report poorer mental health compared to HIV-positive men who inject drugs

In a standard survey used to assess quality of life (SF-12), HIV-positive women who use injection drugs reported greater mental health issues compared to HIV-positive men who use injection drugs.

6. Women living with HIV report more bothersome symptoms of HIV than men living with HIV

In a standard survey used to assess symptom burden (ACTG symptom index), women reported a greater symptom burden than men. On average, women reported 4.5 symptoms that bothered them compared to only 3.7 reported by men. The most commonly reported issues were fatigue or loss of energy (34%); nervousness or anxiety (25%); pain, numbness or tingling in the hands and feet (21%); and feeling sad, down or depressed (34%). Women were more likely than men to report feelings of sadness.

7. HIV-positive women are less likely than HIV-positive men to consistently have undetectable viral loads

Of the HIV-positive people who underwent a viral load test in Ontario in 2008, 63% had an undetectable viral load. Fewer women had an undetectable viral load than men (58% vs. 64%). It should be noted that this viral load data included both people on treatment and those not on treatment. People may not be on treatment for a variety of reasons, including personal preference, access to care issues, the practice of their physician, etc.

Where to go from here?

The results of the POWER Study suggest that there are many areas for improvement in HIV prevention, care, treatment and support for women in Ontario. These include:

  • HIV prevention campaigns aimed specifically at women to promote safer sex and safer injection drug use
  • Programs to encourage HIV-positive women, particularly Aboriginal women and women who inject drugs, to consider HIV treatment during pregnancy
  • Screening for mental health issues of HIV-positive women who currently inject or who have injected drugs
  • HIV-positive women have a higher symptom burden which needs to be addressed within the healthcare environment
  • HIV-positive women who currently inject drugs and desire drug treatment should be referred to drug treatment programs
  • A multi-pronged approach to treatment and care, which could include such initiatives as treatment education for women and initiatives aimed at increasing women's access to care

-Laurel Challacombe


Bayoumi AM, Degani N, Remis RS et al. HIV Infection. In: Bierman AS, editor. Project for an Ontario Women's Health Evidence-Based Report : Volume 2 : Toronto; 2011.


CATIE-News is written by Sean Hosein, with the collaboration of other members of the Canadian AIDS Treatment Information Exchange, in Toronto.

From Canadian AIDS Treatment Information Exchange (CATIE). For more information visit CATIE's Information Network at


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