In 2021, 25.4% of Ryan White HIV/AIDS Program (RWHAP) clients were female (HRSA, 2022). Twenty-three percent (23%) of people with HIV (CDC, 2019) and 19% of new HIV diagnoses (CDC, 2022) are female.
Viral suppression rates for all RWHAP client populations, including women, have steadily improved over the years. Women and Girls HIV/AIDS Awareness Day is March 10. The 2023 theme: Prevention and Testing at Every Age. Care and Treatment at Every Stage.
This blog summarizes data on women getting HIV care from HRSA's RWHAP and various initiatives and insights on service delivery targeting women with HIV. See also HRSA Recognizes National Women and Girls HIV/AIDS Awareness Day.
Viral Suppression Trends
From 2010 through 2021, viral suppression increased from 66.3% to 89.9% among female RWHAP clients receiving HIV medical care. In comparison, rates increased from 69.5% to 89.7% for all RWHAP clients (RWHAP Annual Client-Level Data Report, 2021, HRSA, 2022). In greater detail:
- Viral suppression among Black/African American women receiving RWHAP care was 89.0%--slightly lower compared to all RWHAP female clients (89.9%) and all RWHAP clients (89.7%).
- Viral suppression among Latinas receiving RHWAP care was 91.5% in 2021, higher than the RWHAP average. Rates were lower among Latinas aged 20–24 years (80.8%) and 25–29 years (80.4%); those with perinatal HIV (78.4%); and those with temporary (85.3%) and unstable (79.6%) housing.
- The rate of viral suppression among transgender women has steadily increased from 2016 to 2021 (79.0% to 84.8%), but remains the lowest across gender groupings.
Data Focus: African American Women
Lower income African American and other minority women comprised 83.3% of RWHAP female clients (HRSA, 2022). This heavy burden is driven by an environment of poverty, inadequate housing, limited healthcare access, and other challenges. According to the Overview of Clients Served by RWHAP, 2021, PPTX (HRSA, Feb. 2023), among female RWHAP clients: 67.8% were living below the federal poverty level; 5.7% had temporary housing and 3.7% had unstable housing; and 62.4% were over 45 years old.
Women and HIV Care Interventions
HRSA has funded and number of TA and training projects that focus on engaging and retaining women with HIV in care. Interventions developed by these projects, with demonstrated effectiveness at improving client HIV outcomes, are included in the Best Practices Compilation. Here are examples from the Compilation, which is continuously updated.
- Peer Engagement to Improve Linkage to Care and Retention in Care for Women and Youth uses peers and patient navigators to provide support, reduce barriers, and improve linkage and retention to care for women and youth with HIV.
- Peer Linkage and Re-engagement of Women of Color with HIV is a peer linkage and reengagement intervention for women of color with HIV.
- Postpartum Retention and Engagement Quality Improvement Initiative uses a combination of care coordination, printed materials, case management services, and improved collaboration between a clinic and a perinatal program.
- Healthy Divas, T.W.E.E.T. and Text Me Girl! are among the Best Practices HIV interventions that focus on transgender women.
More innovations in HIV care can be found in HIV Care Innovations: Replication Resources. Many are catalogued in the Best Practices Compilation, after undergoing extensive review. Examples follow.
Peer Engagement to Improve Linkage to Care and Retention in Care for Youth, Women, Infants, and Children is a San Antonio project that utilized peers and patient navigators. Features of success included an outreach specialist job description; and a dedicated social media and marketing strategy,
This project was identified as an "emerging intervention" in the Best Practices Compilation.
Enhanced Patient Navigation for Women of Color with HIV materials are for programs to utilize patient navigators, "non-medical staff in clinical settings" who work "to reduce barriers to health care and optimize care." The implementation manual covers such activities as hiring, training, supervision, integrating patient navigators within the clinical team. The manual also covers identifying clients to match with patient navigators. Materials were developed under the HRSA project, Dissemination of Evidence-Informed Interventions (DEII).
Peer Linkage and Re-engagement of Women of Color with HIV resources support the use of peers who help engage cis and transgender women of color in HIV care. Resources include an implementation manual for program staff (e.g.,implementation activities, a client care plan) and training materials, also developed under DEII.
Healthy Divas and TWEET are the names of two evidence-informed interventions designed for transgender women with HIV. Resources (e.g., implementation guides, videos, brochures, learning modules, brochures) were developed by HRSA's E2i.
The HRSA-funded Center for Quality Improvement and Innovation (CQII) has various training tools for program staff on incorporating quality improvement within their RWHAP programs. Among their many initiatives is the HIV Disparity Interventions, which were tested and implemented by agencies that took part in the CQII's end+disparities ECHO Collaborative. Women Like Me Support Group is one of the project's interventions. The focus was on HIV-positive pre- and post-natal mothers that covers varied topics, with support by a mental health coordinator and medical director.
HIV Clinical Care
The National HIV Curriculum (NHC), developed by HRSA's RWHAP Part F AETC Program and the University of Washington, is continuously updated and offers continuing education credits and a robust online learning experience. Their HIV in Women topic covers contraception, conception, and other key issues. The HIV in Sexual and Gender Minority Populations chapter reviews epidemiology and care issues for cis- and transgender women.
Ryan White Conference Presentations: Women
Access our Conference Presentations database for sessions from recent Ryan White Conferences, like the session at the 2022 National Ryan White Conference on HIV Care & Treatment: 101: Adapting Evidence Informed Interventions to Address Barriers to Care for Black Women with HIV and Turning Toward Technology: Integrating Digital Health Tools into HIV Care Programs for Black Women.
RWHAP Part D: A Focus on Women
While all aspects of RWHAP deliver care to women with HIV, Part D is focused on HIV services for women, infants, children, and youth. See the RWHAP Part D WICY Fact Sheet (August 2019).