Hidden in Plain Sight: HIV Symptoms in Women That Shouldn’t Be Ignored

A silent storm was brewing. As a young, 30-year-old marketing executive in Mumbai, Meera* brushed off her fatigue, linking it to her hectic lifestyle. But as weeks turned into months, the symptoms intensified, accompanied by unexplained weight loss and recurrent infections.

As she sought answers, fear and confusion were Meera’s constant companions. It took an alarming decline in her health and an astute doctor to suspect HIV. The diagnosis hit her like a lightning bolt. Life, as she knew it, would never be the same. She was now forced to confront a disease shrouded in misconceptions and fear.

Meera's experience is not uncommon. Many face similar challenges in recognising the signs of HIV in women due to their often subtle nature and overlap with other common symptoms. Stigma and limited awareness further contribute to delayed diagnosis and inadequate care.

Women and girls remain mainly affected by the global HIV epidemic.

In 2022, over 20 million women and girls were living with HIV, which is more than 50% of all diagnosed cases. Teenage girls face an even higher risk, with new infections among them totalling 98,000 that year — more than double the rate for boys.

Despite progress, significant challenges persist. Stigma, discrimination, sexual violence, economic hardship, and limited healthcare access make things worse for women living with HIV.

The impact is profound: 69% experience stigma, nearly one million children and adolescents with HIV are untreated, and over half reside in Eastern and Southern Africa.

India mirrors these global trends. Stigma prevents many HIV-positive mothers from seeking care, impacting their children’s health. In 2021, nearly 5,000 children contracted HIV from their mothers, with the majority of transmissions occurring during pregnancy, childbirth, or breastfeeding. 

Join us as we explore the various ways HIV manifests in women, which could help with early intervention and improved health outcomes.

HIV stands for human immunodeficiency virus. It's a virus that attacks the body's immune system, specifically the CD4 cells that help fight off infections. When HIV damages enough CD4 cells, it can lead to AIDS (Acquired Immunodeficiency Syndrome), the most advanced stage of  HIV infection.

HIV is primarily spread through:

• Sexual contact: This includes vaginal, anal, and oral sex. Using condoms correctly every time reduces the risk of HIV transmission.
• Sharing needles or syringes: This practice is common among people who use illegal injectable drugs like heroin, methamphetamines, or cocaine. 
• Mother to child: HIV can be transmitted from a mother to her child through three ways — during pregnancy, childbirth, or through breastfeeding if the mother is infected. However, effective prevention methods like antiretroviral treatment for the mother can significantly reduce this risk.
• Blood transfusion: While extremely rare in countries with advanced blood screening systems, there's a risk of HIV transmission through contaminated blood products. However, rigorous testing and screening procedures have made this risk minimal.

It should be emphasised that HIV is not spread through simple physical interactions like hugs or kisses, using the same utensils, or from mosquito bites.

HIV symptoms in women can vary widely among individuals and often mimic other illnesses, making early detection challenging.

These can resemble flu-like symptoms and may include fever, chills, rashes, sore throat, fatigue, muscle aches, and swollen lymph nodes. However, many people don't experience any symptoms during this stage.

Some people may experience a brief period of acute HIV infection within 2-4 weeks after exposure. Symptoms during this phase can be more intense, including fever, rash, night sweats, and mouth ulcers.

As HIV progresses, symptoms may become more severe and include:

• Persistent fatigue
• Weight loss
• Fever
• Night sweats
• Swollen lymph nodes
• Diarrhoea
• Oral thrush
• Recurrent vaginal infections

Improved antiviral treatments have dramatically reduced AIDS-related deaths worldwide. Due to the effectiveness of these essential medications, the majority of individuals with HIV are now able to enjoy prolonged, healthy lives without progressing to AIDS.

However, without treatment, HIV typically progresses to AIDS within 8 to 10 years. The immune system is severely compromised at this stage, making the body highly susceptible to opportunistic infections and cancers. 

Symptoms include:

• Rapid weight loss
• Persistent fever
• Severe diarrhoea
• Shortness of breath
• Skin rashes and lesions

Identifying and treating HIV early on is crucial for controlling the virus and avoiding further health issues.

“HIV can manifest differently in women than in men. Symptoms like pelvic inflammatory disease, menstrual irregularities, and increased susceptibility to other infections can be indicators. Early detection is crucial, not just for the woman's health but also to prevent transmission to her children,” says Dr Miloni Gadoya, a gynaecologist in Mumbai. 

The HIV symptoms in females include: 

How do gynaecological issues relate to HIV in women? Women who have HIV might go through changes in their menstrual cycle. Periods might become lighter, heavier, or irregular. Missed periods can occur, especially if there's rapid weight loss. Hormonal shifts can also worsen menstrual symptoms like cramps, breast tenderness, and fatigue.

HIV weakens the immune system, making women more susceptible to vaginal yeast infections. These infections cause symptoms like vaginal burning and itching, painful sex, painful urination, and thick, white discharge. Although yeast infections are common in women, they tend to be more frequent and severe in those with HIV due to a compromised immune system.

Women with HIV are at an increased risk for sexually transmitted diseases (STDs). In women with HIV, conditions such as genital herpes, pelvic inflammatory disease (PID), and bacterial vaginosis can be more prevalent, more severe, and harder to treat. Additionally, having both HIV and another STD can make it easier to spread HIV to sexual partners.

Women living with HIV are six times more likely to get cervical cancer compared to those without HIV. Most of the cervical cancer cases can be tied to the human papillomavirus (HPV). Fortunately, cervical cancer is largely preventable if the patient opts for regular screenings. Timely vaccination can also help prevent HPV infection in women with HIV.

Women with HIV may experience menopause earlier or with more severe symptoms. Osteoporosis, a condition marked by fragile and breakable bones, poses a worry for women living with HIV. Some HIV medications can contribute to reduced bone density.

Women with HIV are three times more likely to have heart disease. Research is ongoing to understand this heightened risk and develop appropriate interventions.

Women with HIV can have healthy pregnancies with proper care and medical management. However, it's crucial to discuss pregnancy planning with your healthcare provider, including HIV transmission prevention strategies if their partner is HIV-negative.

A mother may transmit HIV to her child during pregnancy, delivery, or through breastfeeding. Antiretroviral treatment of the mother significantly reduces this risk to less than 1%. However, decisions about infant feeding (breastfeeding or formula) should be made while considering the risks and benefits of each option.

Some HIV medications can reduce the effectiveness of hormonal contraceptives. Condoms remain crucial for preventing other STDs like gonorrhoea and syphilis.

HIV medications can cause different side effects in women compared to men with some of them leading to more nausea and vomiting in women. Moreover, the likelihood of accumulating fat and developing diseases of the pancreas is higher in women than in men when taking these drugs.

The only way to know for sure if you have HIV is to get tested. There’s no need to wait for symptoms, as many people with HIV don't experience any early signs. There are various diagnostic tests that your doctor may recommend.

HIV testing is available at several locations, including:

• Hospital or stand-alone laboratories 
• Clinics 
• Blood donation centres

The first question many people ask is: What happens if I am HIV positive? If you suspect that you have HIV, it's crucial to seek medical attention immediately. A healthcare provider can:

• Confirm your HIV status through testing
• Provide information about HIV, treatment options, and prevention
• Offer emotional support and counselling
• Connect you with resources and support groups

Living with HIV can significantly impact one’s emotional and mental well-being. 

“At first, I was terrified. It felt like my whole world had turned upside down. I mean, you hear about HIV, but you never think it'll happen to you, you know? There's this constant fear of getting sick, of the future. It's hard to explain, but it's like carrying a heavy burden in your chest all the time. And then there's the stigma. People looking at you differently, whispering. It makes you feel so alone, even when you’re surrounded by people,” says Meera. 

Like her, many women experience: 

• Fear of judgement, isolation, and discrimination, which can be overwhelming
• Worry about the future, disease progression, and treatment side effects can lead to anxiety
• Sadness, hopelessness, and a lack of interest in previously enjoyed activities may lead to depression
• Coping with the diagnosis and its implications can lead to anger and frustration
• Changes in physical appearance due to HIV or its treatment may affect self-esteem

Living with HIV presents unique challenges for women, from early symptoms to long-term health implications. While the journey may be tough, it's essential to remember that with proper care, support, and advancements in treatment, women with HIV can lead fulfilling lives.

Breaking the stigma surrounding HIV is paramount. By fostering open conversations, promoting education, and providing comprehensive support, we can create a society where women living with HIV feel empowered, respected, and cared for.