HIV clinician perspectives on menopause care delivery: a qualitative study

Menopausal symptom burden disproportionately affects cisgender women living with HIV (WWH), but WWH receive treatment for symptoms less often than women without HIV. This gap in care is likely due to a lack of menopause-specific training for HIV care providers and the structural challenges WWH face. We conducted a cross-sectional qualitative study to understand how these providers work with patients going through the menopausal transition. From May-September 2024, we conducted in-depth interviews with N = 15 HIV care providers in the San Francisco Bay Area. Interviews lasted approximately 40 minutes, and data were analyzed thematically. Providers in our study had minimal training on menopause and no training on the intersection of menopause and HIV. They gained competence working with patients and through personal experience, but conversations about menopause were often initiated by patients. These conversations required trust and nuance, particularly with patients who had experienced trauma. Most prescribing providers felt comfortable offering Menopause Hormone Therapy to their patients, but rapid changes in the evidence made care challenging. We recommend more menopause-specific continuing medical education opportunities for HIV care providers. We also recommend that provider-initiated, trauma-informed conversations about menopause should be part of standard care for WWH over age 35.