4.8: HIV, Sex and Gender

Gender has been generally defined as shared expectations and norms held by society about appropriate male and female behavior, characteristics and roles.¹ Gender differs from the concept of sex in that it refers to socially prescribed gender-specific roles and expectations, whereas sex refers to biological sex differences.¹ Gender inequality refers to differential social opportunity and power, based on gender. Those with less social opportunity are more likely to have their needs overlooked or marginalized, have less access to social and health care systems and be at higher risk of contracting communicable diseases, including HIV.¹

While HIV affects women and men, a number of socio-economic factors, in addition to physiologic differences, place women at increased susceptibility to infection. Issues such as poverty, marginalization, gender power inequalities and violence increase the vulnerability of women to HIV infection.² In Canada, there are rising rates of infection among women, with racialized and Indigenous women comprising most of the new female HIV cases annually. Consultations with Canadian women living with HIV have identified three central characteristics of supportive women-centred HIV care, including: (i) coordinated and integrated services that address both HIV and women’s health care priorities, and protect against exclusion from care due to HIV-related stigma, (ii) care that recognizes and responds to structural barriers that limit women’s access to care, such as violence, poverty, motherhood, HIV-related stigma, and challenges to safe disclosure, and, (iii) care the fosters peer support and peer leadership in its design and delivery to honor the diversity of women’s experiences, overcome women’s isolation, and prioritize women’s ownership over the decisions that affect their lives.³

The needs of transgendered individuals living with HIV have also been explored. Factors associated with lower engagement in care included: depressive and post-traumatic stress disorder symptoms, barriers in access to care, transphobia, HIV-related stigma and housing insecurity.⁴