The Biological and Social Dimensions of HIV in Women: A Multidisciplinary Perspective

HIV infection in women presents a complex interplay of biological, social, and behavioral factors that demand a multidisciplinary approach to understanding and addressing the epidemic. While significant progress has been made in HIV prevention and treatment, women—particularly those in marginalized communities—continue to face disproportionate rates of infection. This article synthesizes current research on the biological vulnerabilities and social determinants that influence HIV acquisition and progression in women, with the aim of informing more targeted and effective public health interventions.

Biological factors play a crucial role in women's susceptibility to HIV. Anatomically, the vaginal mucosa provides a larger surface area for potential viral entry compared to men, and hormonal fluctuations during the menstrual cycle can alter mucosal integrity and immune response. Additionally, sexually transmitted infections (STIs) such as herpes simplex virus type 2 (HSV-2) and bacterial vaginosis can increase the risk of HIV acquisition by disrupting the mucosal barrier and promoting inflammation. Research has also highlighted the role of microbial diversity in the vaginal microbiome, with certain bacterial compositions being associated with increased susceptibility to HIV.

Beyond biological factors, social determinants significantly influence HIV risk among women. Poverty, gender-based violence, and limited access to education and healthcare are among the key drivers of HIV infection. Women in low-income settings often face economic disparities that force them into transactional sex or relationships with older, potentially HIV-positive partners. Gender-based violence further exacerbates vulnerability, as women in abusive relationships may have limited autonomy over sexual decision-making. Additionally, cultural norms and stigma surrounding HIV can deter women from seeking testing and treatment, further perpetuating the cycle of infection.

The intersection of biological and social factors creates a compounded risk for HIV in women. For example, a woman living in poverty may engage in sex work to survive, increasing her exposure to HIV, while biological factors such as untreated STIs further elevate her risk. Similarly, a woman experiencing intimate partner violence may be unable to negotiate condom use or seek healthcare, placing her at higher risk of infection. Understanding these intersections is critical for developing holistic interventions that address both the immediate biological risks and the underlying social determinants.

Current interventions to reduce HIV in women include pre-exposure prophylaxis (PrEP), which has shown promise in preventing infection when taken consistently. However, adherence to PrEP remains a challenge, particularly among women in resource-limited settings. Community-based approaches, such as peer education and support groups, have also been effective in increasing HIV awareness and promoting safer behaviors. Additionally, integrating sexual and reproductive health services with HIV care can improve access to comprehensive healthcare for women.

Future research should focus on developing targeted interventions that address the unique biological and social vulnerabilities of women. This includes advancing research on vaginal microbicides and long-acting injectable PrEP to improve adherence. Additionally, addressing the social determinants of HIV through policy changes, economic empowerment programs, and gender-based violence prevention initiatives is essential. By adopting a multidisciplinary approach, we can better understand and mitigate the complex factors contributing to HIV in women, ultimately reducing the burden of the epidemic.