About 264,000 women in the United States were living with HIV as of 2019, making up roughly 22% of all people with the virus in the country. In 2023, women accounted for 19% of all new HIV diagnoses. While those numbers represent a meaningful share of the epidemic, the burden is not spread evenly: race, age, geography, and access to testing all shape a woman’s actual risk.
New Diagnoses in Women Each Year
In 2023, about 7,350 of the roughly 39,000 new HIV diagnoses in the U.S. were among women. The vast majority of those infections, around 83%, came through heterosexual contact. In 2022, women reporting heterosexual contact accounted for an estimated 4,900 new infections, while women who inject drugs accounted for about 1,000. The overall trend has been slowly declining: estimated new infections among women dropped from 6,800 in 2015 to 6,400 in 2019, though the change was modest enough that researchers called it statistically nonsignificant.
Racial Disparities Are Stark
The single most important number in understanding HIV risk among women in the U.S. is this: Black women accounted for half of all new female HIV diagnoses in 2023, despite making up only 13% of the female population. Their diagnosis rate was 19.6 per 100,000, compared to 6.7 for Hispanic/Latina women and 1.8 for white women. That means a Black woman was roughly 11 times more likely to be diagnosed than a white woman in the same year.
These gaps are not explained by individual behavior. They reflect decades of structural inequities in healthcare access, economic opportunity, housing stability, and rates of incarceration in communities, all of which concentrate HIV transmission in specific populations and make prevention and treatment harder to reach.
Why Women Are Biologically More Vulnerable
During vaginal sex, women face a higher per-act risk of acquiring HIV than their male partners. The reason is anatomical. The vaginal and cervical lining covers a large surface area and, in some regions of the reproductive tract, is only a single cell layer thick. This tissue is rich in the immune cells that HIV targets. Any disruption to that lining, whether from another sexually transmitted infection, a herpes ulcer, or even normal micro-tears during sex, gives the virus easier access to those vulnerable cells beneath the surface.
Herpes simplex virus type 2 is especially significant. The ulcerations it causes break down the physical barrier of the genital lining and recruit exactly the types of immune cells HIV needs to establish infection. Other STIs do the same, which is why untreated infections compound a woman’s risk substantially.
The Global Picture
Worldwide, the gender balance looks different than in the U.S. Women and girls make up 53% of all people living with HIV globally, and they accounted for 45% of all new infections in 2024. Sub-Saharan Africa drives much of this disparity, where young women are infected at rates far exceeding young men. In the U.S., men (particularly men who have sex with men) account for the majority of cases, but globally, HIV is very much a women’s epidemic.
Older Women Face Unique Risks
HIV in women over 50 is more common than most people realize. Over 50,000 women in this age group were living with HIV as of 2009, and that number has likely grown as people with HIV live longer on treatment. The infection rate for women over 50 held steady around 4.2 per 100,000 between 2007 and 2010. One troubling finding: older women saw a 32% increase in deaths due to HIV over a period when men saw an 18% increase, suggesting that later diagnosis and delayed treatment may hit older women harder.
Doctors are less likely to test older women because they assume lower risk. Older women themselves may not consider HIV a realistic concern, and postmenopausal changes to vaginal tissue can actually increase susceptibility to the virus by thinning the protective lining.
Many Women Don’t Know Their Status
Approximately 18% of all people with HIV in the U.S. are unaware they carry it. For women specifically, several barriers make this problem worse. Providers often skip testing because they perceive their female patients as low-risk. Language barriers, late entry into prenatal care, and the time required for pre-test counseling all reduce the chances a woman gets screened. In many cases, the first test a woman receives happens during pregnancy, meaning non-pregnant women may go years without being offered one.
The CDC recommends that all people aged 13 to 64 be tested at least once as a routine part of healthcare, and that women at higher risk be tested annually. Yet implementation of that recommendation remains inconsistent, particularly outside of prenatal settings.
Prevention With PrEP Takes Longer for Women
Pre-exposure prophylaxis (PrEP), the daily pill that prevents HIV, works for women, but it takes longer to reach full effectiveness in vaginal tissue than in rectal tissue. For receptive vaginal sex, oral PrEP requires about 21 days of daily use to build up to maximum protective drug levels. For receptive anal sex, that window is about 7 days. This means consistent daily use matters even more for women relying on PrEP for protection during vaginal sex. Missing doses has a bigger impact on protection.
Newer injectable PrEP, given every two months, removes the daily adherence challenge entirely and has been shown to be highly effective for women. It represents a significant shift in prevention options for women who find daily pills difficult to maintain.
Pregnancy and Transmission to Babies
For women living with HIV who become pregnant, the risk of passing the virus to their baby during pregnancy, delivery, or breastfeeding drops to less than 1% when they take antiretroviral therapy as prescribed throughout the process. The key is maintaining an undetectable viral load, meaning the amount of virus in the blood is so low that standard tests cannot detect it. At that level, transmission to a child is extremely unlikely. Without treatment, the risk of perinatal transmission ranges from 15% to 45%, making early diagnosis and consistent treatment one of the clearest success stories in HIV prevention.