FREQUENTLY ASKED QUESTIONS Let’s start with the basics. What is sex at birth? What is gender? Identity? Expression? Orientation? Below we offer definitions to these terms since they often come up in our conversations about women and research. It is important for all to understand the meanings of these terms because they matter in HIV-cure directed (and other) research. Sex: Sometimes this term is referred to as biological sex. We recommend using the term, “sex assigned at birth.” It refers to the assignment and classification of people as female, male, intersex, or another sex based on a combination of anatomy, chromosomes, and hormones. Sex assigned at birth can also be understood as a spectrum. There is no reason for sex and gender identity to be the same. Gender: We recommend using the term, gender identity. Everyone has a gender identity, which refers to one’s internal sense of being female, male, both of these, neither of these, or another gender or genders. Gender expression or presentation: These terms refer to the way a person presents herself to the world (or himself or theirself). Sometimes these terms refer to physical and social manifestation of one’s gender identity through clothing, voice, hairstyle, body shape, etc. Like sex and gender, gender expression is a spectrum and refers to a diverse range of expressions and presentations of what is commonly referred to masculinity and femininity. Sexual orientation: The term often refers to physical and sexual attraction. Sexual orientation may have little to do with how someone expresses their gender or the gender or sex of their physical and/or romantic partner(s). Sexual orientation lies along a spectrum as well. Why is sex and gender equity important in HIV cure-directed research? The balance of women (cis- or trans-) and men (cis- or trans-), is important in HIV-cure directed research because women and men experience HIV differently. Biological factors, pharmacokinetics (PK) of ART (how drugs move within the body), and social factors experienced by women living with HIV could alter how different cure strategies impact a woman’s body or could render a treatment more or less effective. Depending on how a particular cure strategy is delivered and due to the historical systemic economic oppression of women, access may be limited for large segments of the population of PLWHA. Recall the global and national statistics of HIV, that across the world, women represent 52% of adults living with HIV (WHO, 2018). In the US, women make up 19% of new HIV diagnoses; of those, African American women account for 57% of new infections (CDC, 2018). These factors must be taken into account as studies and trials are developed, so that all women benefit when a cure strategy is developed. We know that HIV affects the cis-female body differently than the male body (Scully, 2018), and, it is only recently that studies that have begun exploring the effects of HIV and HIV treatments in trans people (C. Chung, Kalra, McBride, Roebuck, & Sprague, 2016; C. Chung, Kalra, Sprague, & Campbell, 2016; Herbst et al., 2008; Klein, Psihopaidas, Xavier, & Cohen, 2020; Wansom, Guadamuz, & Vasan, 2016). Studies to date have shown several biological differences of HIV in the cis-female body:
1. Anatomical
2. Genetic and Hormonal (This is mainly related to the X chromosome, and estrogen being predominant in women.) BEAT-HIV Position Paper / Version 1.0 (2020)
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