The aunties and elder women are cringing right now…how she could publish such a topic. These things are private and only to be discussed amongst women—they are saying. I disagree.
Menstruation/periods is something that women experience as part of life—why are we brought up thinking this is something shameful that we should hide. The culture surrounding menstruation must be changed, and it takes both women and men to make that happen. It starts with open, honest conversation, and continues with education that empowers women to feel aware of and comfortable with their bodies and flows. It is time to smash taboos, remove shame, and create communities of support.
There is evidence to suggest that women living with HIV are more likely to experience missed periods (amenorrhea). The exact reasons for this continue to be debated. It remains unclear if amenorrhea is a complication of HIV infection itself or due to other risk factors that were more common among women with HIV, such as low body weight, immune suppression, or a combination of factors. Further research among women on antiretrovirals (ARVs) may help to answer these questions. A single missed period is not a sign of HIV. The symptoms of recent HIV infection are the same in men and women, with the most common being fever, swollen glands, muscle aches and tiredness.
Menstrual blood touching intact skin poses no HIV transmission risk. If it comes into contact with broken skin or is swallowed, then HIV transmission is possible but still unlikely. Due to the effectiveness of HIV treatment, the menstrual blood of someone living with HIV who is adherent to their antiretroviral medication could well have no detectable virus.
If a person living with HIV is not taking antiretroviral treatment, levels of HIV in their vaginal fluid are likely to be higher during menstruation. Several studies have shown that viral load in the female genital tract can vary during the menstrual cycle. Condoms, dental dams and PrEP are all options that reduce the risk of HIV infection during sex with a person living with HIV who is menstruating.
The menstrual bleeding during a period itself does not increase the risk of acquiring HIV. However, hormonal changes during menstrual cycles are believed to place women at greater risk than at other times. Since more research is needed to establish clarity on when women are most at risk, women should always consider using barrier methods such as male and female condoms to provide the best protection from STIs including HIV, regardless of the stage of their menstrual cycle.
Women living with HIV can use hormonal contraception to regulate or suppress their periods, whether or not they are seeking to prevent pregnancy. However, it is important to take HIV treatment into account when choosing such options, as there are possible interactions between anti-HIV drugs and hormonal contraceptives that mean the contraception may not work.
By all of us—men and women—speaking openly about menstruation—I hope we can normalise it as a healthy, positive part of the female life cycle.