AIDS 2012: Time for Women to take control of HIV prevention

Women are more likely to be infected with HIV than men due to a combination of culture and biology. And yet women have had little control over most prevention methods.

Women are more likely to be infected with HIV than men due to a combination of culture and biology. And yet women have had little control over most prevention methods. Condom use, abstinence, fidelity and male circumcision are all excellent methods, but they rely on a male partner’s cooperation or action, which is not always possible. Unfortunately, current methods have not done enough to stem the epidemic among women.

Women already make up half of the 34.2 million people worldwide living with HIV. According to UNAIDS figures, 1.3 million women and girls became HIV positive last year and 63% of those are young women between 15-24 living with the virus. In Sub-Saharan Africa, 60% of those with HIV are women and girls.

First Lady Laura Bush speaking at the International AIDS Conference (AIDS 2012) last week (23-27 July) stressed that women continue to play a crucial role in the global fight against HIV and AIDS. She noted, “the health of women affects families, communities and whole countries. Healthy mothers make healthy families.” The First Lady highlighted how the rates of cervical cancer are nearly five times higher among women with HIV. Nobel Peace Prize recipient and Burmese opposition leader Aung San Suu Kyi, in a videotaped message, spoke about the need to end stigma against those with HIV.

Also discussed was the need to explore multipurpose prevention technologies for women who face the dual risks of HIV and unintended pregnancy.

Two large clinical trials in Africa are ramping up to test the effectiveness of a vaginal ring that releases a the antiretroviral drug dapivirine for around a month, offering women at high risk a discreet way to protect themselves from HIV. The studies will test the effectiveness of the vaginal ring in thousands of women in several African countries to evaluate its ability to prevent new HIV infections and its long-term safety.

Developed by the nonprofit organisation International Partnership for Microbicides (IPM), the rings being tested do not currently contain birth control; the focus is on HIV prevention only. If effective, the ring will add “a long-acting, female-initiated technology to the existing toolkit of HIV prevention options”, said Dr Zeda Rosenberg, chief executive officer of IPM.

Developing microbicides has proved difficult. Previous research on an experimental anti-AIDS vaginal gel offered partial protection but fell down due to the fact that women had to remember or be able to use it every time they have sex. Because it only needs to be replaced once a month, the ring may help address this problem.

The trials form part of research into “the next generation of women-focused prevention tools”, Dr. Carl Dieffenbach of the National Institutes of Health (NIH) said in a speech at AIDS 2012 to announce the new research.

“We need options that fit readily into women’s lives,” added Dr. Sharon Hillier of the University of Pittsburgh and the Microbicide Trials Network, which is conducting the NIH-funded study.

Early-stage studies suggested the ring could work, and women said they liked using it better than a gel, reported Dr. Saidi Kapiga of the London School of Hygiene and Tropical Medicine.

Giving women tools to protect themselves when their partners won’t use a condom is crucial for battling the HIV epidemic. Women worldwide are asking for prevention options that better meet their needs. A grassroots movement in Zimbabwe convinced the government to add the female condom to national family planning programs. Women elsewhere have articulated the need for prevention methods over which they have control. In spite of these efforts, prevention options for women have been a marginalized issue among policy makers, programmers, and donors. This may be due to long-standing provider bias against barrier methods in family planning programs, or a general discomfort with interventions that specifically focus on sexuality. There is a general perception that women living in conservative societies will not use vaginal methods, though this assumption has been disputed by research.

It is clear that female controlled methods for HIV prevention are urgently needed and any viable option to protect the health of women and girls must be pursued. It is time that women take control of HIV prevention and with this change the course of the epidemic.

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