Executive Summary: Exploring Reproductive Aging in Women Living with HIV

Overview

At the U.S. Conference on HIV/AIDS (USCHA) in September 2025, the National Institutes of Health (NIH) and its partners convened an event to explore the latest research on how HIV and antiretroviral therapy impact ovarian aging. The session aimed to:

• Enhance understanding of the biological, clinical, and psychosocial aspects of ovarian aging in women with HIV; and
• Provide a platform for researchers, community-based organizations, women with HIV, and public health professionals to share insights and lived experiences and to identify critical knowledge gaps related to reproductive aging in women with HIV.

The workshop was hosted by the NIH Office of AIDS Research, Office of Research on Women’s Health, and the National Institute on Aging, in collaboration with the Emory University Center for AIDS Research (CFAR), Ribbon, and The Well Project.

Speakers

The two-hour event featured presentations from experts in women’s health and ovarian aging, including:

• Presenter: Jennifer Garrison, Ph.D., University of Southern California
  • Topic: Reframing Health and Aging
• Presenter: Rebecca Abelman, M.D., University of California, San Francisco
  • Topic: Effects of Reproductive Transition in Women Aging with HIV
• Presenter: Sara Looby, Ph.D., Massachusetts General Hospital
  • Topic: Menopausal Hormone Therapy for Women Living with HIV
• Presenter: Linda Scruggs, Ribbon
  • Topic: Navigating Reproductive Aging with HIV
• Moderator: Alexis Bender, Ph.D., Emory University CFAR
• Moderator: Molly Perkins, Ph.D., Emory University CFAR

Following the presentations, Bridgette Picou, LVN, ACLPN, of The Well Project facilitated exploration of a case study through small group breakouts and a broader group discussion.

Themes

Several major discussion points arose through the conversation. These included:

• A critical need for more research and proactive, coordinated care to understand and address the unique—and often earlier—menopausal changes experienced by women with HIV, including health impacts, counseling needs, and potential interactions between HIV treatment, hormonal changes, and menopausal hormone therapy (MHT).
• The need to expand research and communication to address how ovarian aging and menopause affect multiple body systems beyond reproduction.
• The importance of clear, accurate language and culturally aware communication to help women understand ovarian aging, distinguish menopause from the menopausal transition, and recognize how ageism, sexism, and HIV stigma shape their experiences and access to care.
• An urgent need for dissemination and implementation research to help overcome stigma, misinformation, and fragmented care around MHT and menopause in women with HIV. This work should ensure that clinicians across disciplines receive and apply current science, engage women effectively, and coordinate care to meet the complex needs of women aging with HIV. Related needs include building health system capacity and workforce development across the entire research continuum.
• The value of intentional, well-supported spaces to empower women—honoring elders, meeting women where they are, and fostering equal partnerships among scientists, clinicians, and women themselves—to ensure shared understanding, informed advocacy, and meaningful dialogue around aging and health.
• The critical importance of cross-discipline and cross-community information sharing. Community members charged researchers and research institutions to continue disseminating findings with cultural humility and a strong focus on health literacy.

Conclusion

The presentations and discussion underscored major gaps in understanding the impacts of ovarian aging in menopause for women with HIV. Although menopause is a universal biological transition, women with HIV face unique vulnerabilities—earlier onset, more intense symptoms, and potential interactions between MHT and HIV treatment—yet population-specific research remains limited, constraining evidence-based care. These gaps are compounded by lack of access to and parity in care; stigma; fragmented services split between gynecology and infectious disease providers; and widespread misinformation around MHT. These factors undermine access to informed, coordinated, and culturally sensitive care and—among other impacts—force women to rely on peer networks, rather than clinicians, for essential information.

Addressing these challenges requires intentional, sustained efforts to bridge research, clinical practice, and community needs. Priorities include expanding research across the continuum, from basic science through dissemination and implementation; building a trained and responsive workforce; strengthening communication and coordination across disciplines; and centering the voices and lived experience of women, particularly older women, with HIV. Creating supportive spaces and using clear language accessible to all populations can help women advocate for themselves and ensure that the benefits of scientific advances reach clinicians and communities.

Fully addressing the processes and impacts of ovarian aging in women with HIV will require coordinated, interdisciplinary, community-engaged action backed by long-term investment from NIH and its partners to improve the health of women aging with HIV.