Breaking Silos in HIV and Menopause Care: Bridgette Picou, LVN, ACLPN

During the “Hot Topic: Menopause and HIV” mini symposia at the 2025 Conference on Retroviruses and Opportunistic Infections, Bridgette J. Picou, LVN, ACLPN, stakeholder liaison, The Well Project, Brooklyn, New York, emphasized the need for more inclusive research on how these 2 aspects of health intersect in women. She spoke to that in part 1 of this interview.

Here in part 2, she continues the discussion by emphasizing that multidisciplinary care for these women encompasses care that is often delivered in silos, but that this care instead needs to be tailored to women as a whole and then to each woman as an individual.

“No 2 women are the same,” Picou says, “and the fact that we need to engage in care from a standpoint of shared decision-making is really, really important.”

This transcript was lightly edited for clarity; captions were auto-generated.

Transcript

How do menopause-related challenges differ between women who are and are not living with HIV?

I always say that HIV adds a little layer onto life. Sometimes that layer is pancake thin, and sometimes it's the size of a king-size mattress. The difference is that added aspect of HIV. Let me explain it like this. If I am a woman living with HIV, I have an infectious disease [ID] doctor that I go to. Sometimes that doctor is both my HIV clinician and he may act or she may act as my main clinician as well. But if I have all of these separate silos where I'm seeing one clinician for IDs and another clinician for my general care and another clinician for my OB GYN [obstetric/gynecologic] health, there's all of these other little intersections that come into play. The one right in the middle is life with HIV, and unfortunately, clinicians are not as versed on HIV, and they don't want to necessarily maybe treat me with HRT [hormone replacement therapy] because maybe they're worried about not understanding how it's going to interact with my HIV medications. That's the added layer, the extra intersections that come into play.

How can HIV care be tailored to the unique needs of menopausal women?

I am so glad you asked that. It is important to tailor not only the individual needs of women living with HIV to their care, but also women as individuals. No 2 women are the same, and the fact that we need to engage in care from a standpoint of shared decision-making is really, really important. For me, I think that anytime a clinician, whether they are an ID clinician or just a general care practitioner, approaches a woman living with HIV, having the conversations to understand where that particular woman is within the journey of her diagnosis. Because we all have some type of relationship with our HIV, and sometimes if we're in the very beginning of it, we don't even really understand what's happening, let alone what might be best for us vs I'm 12 years in or someone who is 40 years in has a better understanding and a better relationship with their HIV, but they still need to understand clinically what's happening with their body.