Women in low- and middle-income countries still bear a disproportionate burden of HIV and AIDS, yet they lack practical tools they can use on their own without the involvement of a male partner.
This limited financial and social autonomy extends to their sexual lives, and women often have little say often over when — or even if — they have sex, especially when it comes to using a condom, Zeda Rosenberg, CEO of the product development nonprofit International Partnership for Microbicides, told Devex.
As women have increasingly become the face of HIV over the past decade, it has become more crucial to develop a diverse toolkit of HIV prevention products, she noted.
In early 2016, late-stage clinical trial results will reveal whether an innovative HIV prevention technology — the dapivirine vaginal ring — can help keep women safe from infection. If the monthly ring is found effective and safe for long-term use, it could help overcome
one of the greatest challenges of the AIDS epidemic: protecting women.
Devex caught up with Rosenberg to find out what key challenges remain concerning HIV prevention for women, and what’s next in terms of innovation in this field. Here are some excerpts from our conversation:
You mentioned the need for a diverse toolkit. What does the HIV prevention toolkit for women look like right now, and what will it look like in five years?
Right now the toolkit contains both male and female condoms, although male condoms require male partners to agree to wear it, and female condoms require the male partner to allow the female partner to wear it. Abstinence and behavioral change in the sense of trying to have mutual monogamy are also considered part of the toolkit, but these often aren’t under the woman’s control.
Some of the newer technology that we’re all very excited about is pre-exposure prophylaxis, or having people take daily antiretroviral pills for HIV prevention. It hasn’t yet been approved for prevention in developing countries, but it has been approved in the United States.
In the studies where women were a part of an acknowledged HIV-discordant couple, women found it quite easy to use, and it prevented infection. Studies were also done with women who were not in these kinds of relationships — where both people knew their status — and they found it very difficult to take pills every day. But if a woman, especially a young woman, can at some point — when it’s approved — get access to oral PrEP, that will be a very effective tool for her.
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As in family planning or contraception, we know that there is not one kind of approach that all people can — or want — to use. It’s going to be very important to develop a product that a woman can use vaginally that won’t have a lot of systemic effects, and the dapivirine vaginal ring seems to be an approach that women feel comfortable using in the studies ... They can put it in and keep it in place for 30 days and not have to carry it around with them.
We’re in phase three clinical trials with this product, and we’re hopeful that it will show that women can use it well — and that when it’s used, it’s effective.
How has the field of women’s HIV prevention changed in the past 10 years?
The HIV prevention field for women has worked much more closely in the past few years with women's groups and sexual and reproductive health groups to get the issue more into women's health overall.
Women face a whole range of issues — a lot of them because of gender inequality in the world. I think that in the early days of the HIV epidemic, these areas were more in silos. But a woman out here in the world isn't thinking of these things independently, she's thinking of them holistically: It’s all tied up in her identity and her role.
As scientists, health care providers and [nongovernmental organizations], we need to be responding to women’s needs. There needs to be a lot more coming together to help the woman regardless of the issue, whether its HIV, unplanned pregnancy or cervical cancer.
With microbicides, the technology came about by local civil society groups talking about what was needed for women. Unless you live in those communities, you really don’t know what could work. So ask them. And then design either technology or strategies and policies that could help.
I’ve seen an enormous amount of change occur in the past 30 years of the AIDS epidemic. The AIDS conference in 2016 is going to be in Durban, South Africa, and someone recently said to me: “Remember the AIDS conference in 2000?” It was amazing. There was suddenly this recognition and demand for antiretrovirals for people all over the world. To think now that people in 2000 hadn’t gotten access to ARVs and to think that in the past several years, more people have been put on ARV treatment than from 2000 to 2010, it’s amazing how much progress has been made in drug development, drug delivery and health care infrastructure.
All of that was innovation. Rather than starting by only considering challenges, think about the solutions ... It’s too easy to say that will be too difficult. With the capability of science and the Internet, anything is possible.
What’s next for HIV prevention — and IPM?
The product that we are developing next is both the antiretroviral and a contraceptive together. If a woman wants to get pregnant, she can use the antiretroviral ring, but if she also wants to limit or postpone pregnancy, she can use this new product. It would be very cost-effective as well.
One product alone is certainly not going to empower women. It will be important to try and change cultural norms. We need to keep women healthy, alive and uninfected so that this generation of women can work toward gains of autonomy, empowerment and equality.
The changes will be incremental. If the dapivirine vaginal ring is approved, it can be discussed in the context of what women’s rights are, including their right to sexual autonomy and protection. Even just having the conversations about HIV and risk really help women understand what they can and should aspire to.
Healthy Means is an online conversation hosted by Devex in partnership with Concern Worldwide, Gavi, GlaxoSmithKline, International Federation of Pharmaceutical Manufacturers & Associations, International Federation of Red Cross and Red Crescent Societies, Johnson & Johnson and the United Nations Population Fund to showcase new ideas and ways we can work together to expand health care and live better lives.