Dr Karris: I’d like to amplify Dr Gianella’s statements. Unfortunately we will not be able to answer these questions if women do not participate in HIV cure studies.

Along those lines, Dr Gianella and I also would love to see greater inclusion and involvement of HIV-infected trans women and men in HIV cure studies. Transgender men and women, especially those who use hormones, may have different biologic barriers to HIV cure than cisgender men and women. HIV interventions, including HIV cure strategies, need to be safe, culturally and socially appropriate, and effective for all affected populations.

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Conclusion/Clinical Implication

Dr Karris: The care for women living with HIV is complex from both a biologic and socioeconomic standpoint.  As providers, we should remember the unique challenges that women face so that we can intervene in small but impactful ways to improve linkage, engagement, and retention in care, as well as medication adherence.  For example, making a waiting room more kid-friendly, prioritizing regimen simplification, or referring a female or transgender patient to HIV research can positively impact outcomes for all women.

Dr Gianella: Specifically with regard to HIV research, sex-based analyses are imperative to understand the biological differences in HIV treatment, cure, and prevention.2 Clinical trial protocols should be written to include sex-based comparisons so that necessary information can be collected as trials are conducted. While it is not realistic to enforce a 50% recruitment of women into every HIV study (depending on epidemic characteristics and geographic location), a rate that matches the local population demographics should be a bare minimum. Specific efforts are needed to balance female and male participation at all phases of research (including basic research, cell cultures, and animal models). This will likely require adapting outreach procedures and commitment from funding agencies and sponsors to address the unique barriers to women’s participation.


Thank you to Katy Godfrey, Constance Benson, Jonathan Karn, and Liz Barr for their continuous support and inspiring dedication to this important topic.

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