Heading into December, many of us spend some time reflecting on the past year. But how many of us bother to take stock of our sexual health? The end of the year is really the perfect time to do this. Getting tested now for sexually-transmitted infections, including HIV, will help you go into the new year with peace of mind. 

HIV/AIDS awareness and prevention are particularly on our minds this month as the international community came together to observe World AIDS Day on December 1st. Since 1988, the day has been dedicated to raising awareness of the worldwide AIDS pandemic caused by the spread of HIV. 

In observance of World AIDS Day, we wanted to share the latest on HIV risk and prevention for women around the world. We talked to Marcel Curlin, M.D., an OHSU Associate Professor of Medicine who specializes in the treatment of HIV and conducts HIV vaccine research. 

Worldwide, women's risk of contracting HIV has changed quite a bit in the past decade. "The HIV epidemic used to primarily be among men," Dr. Curlin says. "Now, worldwide, about half of infections are in women." In the U.S., about 25 percent of infections are in women.  

The good news for women in the U.S. is that risk of HIV infection is decreasing. According to the Centers for Disease Control and Prevention, between 2005 and 2014 new diagnoses among U.S. women declined by 40 percent. That said, the risk is still very real, especially for black and Hispanic/Latina women who are disproportionately affected. Moreover, most new diagnoses occur in women in their twenties and young people are most likely to be unaware they're infected. 

In terms of contracting HIV, "vaginal intercourse is riskier for women than it is for men," Dr. Curlin says. Unlike men, who are at greatest risk when they have sex with other men or use IV drugs, nine out of 10 women who contract HIV get it via heterosexual sex with men. 

Here in the U.S. and around the world, there are many considerations when it comes to preventing HIV infection in women:

• Age of first sexual intercourse – Girls and young women are often infected by older men. These young women in asymmetrical relationships may feel uncomfortable or even powerless to ask their older partners to use a condom or get tested for HIV and other STDs. The older women are when they first start having sex, the lower their risk of HIV infection. 
• Access to education – Young women are also less likely to know how HIV is transmitted or to understand their risk and how to protect themselves. 
• Access to treatment – "We know that infected people who are receiving medical treatment are far less likely to transmit HIV to their sexual partners," Dr. Curlin says. 

So how can women protect themselves?  

The number one thing you can do is use a condom. "Using a condom every time you have sex reduces transmission by 70 percent or more," says Dr. Curlin. 

Knowing your HIV status, and the status of your sexual partners, is also important. Get tested, and discuss the issue with your partner, especially a new partner.  

For women at high risk, PrEP (Pre-Exposure Prophylaxis) is an important option. PrEP comes in several forms, the most common a pill that is taken daily. There is also a vaginal gel that is applied right before sexual intercourse, and a vaginal ring that is inserted monthly. PrEP must be prescribed by a doctor, and has been shown to reduce HIV transmission by 50 to 75 percent when used regularly. "The benefit of PrEP is that control is in the woman's hands," Dr. Curlin says. "She can protect herself even without cooperation from her partner." 

So, in honor of World AIDS Day this December, take the time to get tested for HIV and other sexually transmitted diseases. Ask your partner to get tested too. And spread the word to women you know about the risk of HIV infection. Prevention is possible.