As the United Nations convenes its High-Level Meeting on Ending AIDS in New York this week, world leaders are discussing a critical question: How can we end the 35-year-old crisis within the next generation, and also reap the many benefits that will follow for sustainable development?
To bring us closer to the end of HIV and AIDS, multiple priorities must be addressed. Stopping its spread among women is one of the most vital — and often overlooked. Ending AIDS must start with women because they bear the greatest burden. HIV and AIDS is the leading cause of death in women of reproductive age, 15-44, globally, and in sub-Saharan Africa where the epidemic is greatest, 56 percent of new adult HIV infections occur among women.
Young women are at especially high risk in sub-Saharan Africa, where twice as many young women live with HIV as young men. While significant progress has been achieved in reducing HIV and AIDS overall, this progress has largely failed to reach women.
One major reason is the lack of prevention options that women can use on their own to stay HIV free. Many women are unable to negotiate condom use with their partners, and for women who are married or want children, abstinence may not be a viable option.
Developing new HIV prevention tools
Fortunately, recent scientific innovations offer hope. New HIV prevention tools specifically designed to meet women’s unique needs and different life situations are advancing through research and development. Continued investment in these promising tools could have enormous payoff.
One new HIV prevention option moving forward is microbicides — products, including vaginal rings, films and tablets that prevent sexual transmission of the virus. Earlier this year, the International Partnership for Microbicides announced that its monthly vaginal ring safely helped reduce HIV risk in women in two large late-stage clinical trials. The ring slowly releases an antiretroviral drug called dapivirine to help reduce a woman’s risk of HIV infection. One key feature is that the ring is discreet and easy for women to replace themselves monthly.*
IPM plans to file for regulatory approval of the dapivirine ring, and if approved, the monthly vaginal ring could be an additional tool for women to prevent HIV.
Beyond these new tools, there is more work to do to translate a promising innovation into a real impact on women’s health. For one, further research is needed to overcome challenges to consistent product use, or adherence, especially among the youngest women.
In one of the clinical trials of the monthly ring, little to no protection was seen among women ages 18-21 while greater protection was seen for women over age 21, who also appeared to use the product more consistently. Similar adherence challenges among women, including young women, have been seen with clinical trials of daily oral ARV pills taken to prevent HIV, known as pre-exposure prophylaxis or PrEP.
Preparations are underway to conduct follow-on studies to explore how women will use the ring in their daily lives now that its safety and efficacy are known. Another study will assess the safety of and adherence to the ring and PrEP among young women and adolescent females.
Findings from these studies will help identify new ways to support consistent product use, which is key to achieving protection.
Further research is also needed to develop a diverse pipeline of self-initiated products, since no single product will fit into every woman’s life. A safety trial is set to begin later this year of a three-month vaginal ring designed to protect against both HIV and unintended pregnancy. Multipurpose prevention may encourage consistent use and close important gaps in meeting women’s sexual and reproductive health needs.
Investing in women’s health
Getting to a point where women may soon have a discreet and long-acting HIV prevention tool like the dapivirine ring took the resources and foresight of a global network of partners. Key funding for the monthly ring’s development was provided by many European governments, including Belgium, Denmark, France, Germany, Ireland, the Netherlands, Norway, Spain, Sweden and the United Kingdom as well as the Bill & Melinda Gates Foundation and the U.S. Agency for International Development.
These governments and foundations have invested in HIV prevention for women both because it is the right thing to do and because it promises a substantial return: Preventing HIV in women will lower future treatment costs, and drive sustainable development by ensuring women are healthy enough to attend school, work and care for their families. And it will give women the chance to realize the futures they envision for themselves.
If the world wants to get serious about ending AIDS, we must get serious about improving women’s sexual and reproductive health. Continued investment in scientific innovation for women is an essential step toward a future free of HIV and AIDS — one where women thrive and their communities and nations prosper.
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* Update, June 10, 2016: This article has been updated to further explain International Partnership for Microbicides’monthly vaginal ring.
Zeda Rosenberg is CEO of IPM, a nonprofit working to develop new HIV prevention and sexual and reproductive health products for women. Previously, she served as scientific director for the HIV Prevention Trials Network at Family Health International, and senior scientist at the U.S. National Institute of Allergy and Infectious Diseases at NIH. She received her master's in epidemiology and a doctorate in microbiology from Harvard University.
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