Global Burden and Economic Impact of HIV/AIDS and Other Sexually Transmitted Infections in Women of Childbearing Age, 1990–2021: Insights From the GBD 2021 Study

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Abstract
Sexually transmitted infections (STIs), including HIV/AIDS, remain a major global public health issue for women of childbearing age (WCBA). However, comprehensive data on their epidemiological and economic burden and long‐term trends in this population are limited. This study aims to systematically assess the global, regional, and national burden and temporal trends of HIV/AIDS and other significant STIs among WCBA from 1990 to 2021, and to evaluate the associated economic burden in 2021. Data were obtained from the Global Burden of Disease Study 2021 to estimate the incidence, prevalence, mortality, and disability‐adjusted life years (DALYs) for HIV/AIDS and other STIs across 204 countries or territories. Temporal trends were assessed using estimated annual percentage change (EAPC). An age‐period‐cohort model was applied to estimate relative risks, and frontier analysis was used to determine efficiency in resource utilization. The economic burden in 2021 was estimated using an indirect cost approach. In 2021, an estimated 287 million incident cases of HIV/AIDS and other STIs occurred globally. Since 1990, new HIV/AIDS cases have declined by 25.1%, and the age‐standardized incidence rate (ASIR) decreased by 46.5%, while the age‐standardized prevalence rate (ASPR), age‐standardized mortality rate (ASMR), and age‐standardized DALYs rate (ASDR) increased. In contrast, other STIs saw a 54.3% rise in incident cases, with slight increases in ASIR and ASPR, and decreases in ASMR and ASDR. The burden was highest in low sociodemographic index (SDI) regions and declined with increasing SDI. Sub‐Saharan Africa remained the most affected region. Global direct healthcare spending on HIV/AIDS and other STIs among WCBA reached $2.46 billion in 2021, with high‐SDI countries accounting for the majority. Low‐SDI countries, despite high disease burdens, contributed minimally to global spending. From 1990 to 2021, the burden of HIV/AIDS and other STIs among WCBA increased significantly, with notable regional disparities. Sub‐Saharan Africa carries a disproportionately high burden of HIV/AIDS and other STIs yet receives insufficient global attention. Low‐SDI populations face greater disease burdens but benefit from less healthcare investment, underscoring the urgent need to strengthen STIs‐specific prevention, treatment, and health education in these regions.

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