Over the past 15 years, the world has seen a change in the trajectory of the AIDS epidemic. Through enormous global prevention and treatment efforts, new infections have fallen by nearly 40 percent, and increased access to treatment has enabled millions more with HIV to live productively.
But the advances we have made have not benefited everyone equally. We are still failing in one crucial area: preventing HIV infections in young women.
Women and girls become infected at disproportionately higher rates than men and boys. In sub-Saharan Africa, where the epidemic has taken the greatest toll, young women are twice as likely to be infected as young men. HIV robs women of their lives, children of their mothers, families of their caretakers and communities of their workforce. Around the world, nearly 2,500 women are infected by HIV every day, and it remains the leading killer of women ages 15 to 44 worldwide.
The evidence is clear: We cannot win the fight against HIV without focusing on the young women who are the highest risk of acquiring HIV.
Sunday is the 105th International Women’s Day, an opportunity for leaders around the world to celebrate the progress that women have made over the last century and to focus attention on the inequalities and challenges that remain. This year’s global theme, “Make it Happen,” reminds us that we must continue to take action to ensure women have options that can protect them from the threat of HIV and AIDS.
Preventing HIV in women has always been both a scientific and a social challenge. First, women are biologically more susceptible to contracting the virus during heterosexual sex than men. Second, deep-rooted gender inequities and economic inequality too often stand between women and safe sex. Condoms, for instance, are highly effective when used consistently and properly, but many women are unable to negotiate condom use with their partners.
To close the gap and lower women’s risk of acquiring HIV, we need more female-initiated options that can work for and meet the needs of different women at different times of their lives. The past decade has seen amazing breakthroughs in HIV prevention. All of the major advances in HIV prevention — voluntary medical male circumcision, treatment-as-prevention, prevention of mother-to-child transmission, and most recently, the use of ARV pills in healthy people to prevent infection known as PrEP, or pre-exposure prophylaxis — are scaling up to reach people in their communities. Unfortunately, oral PrEP has not proven to be a workable intervention among young high-risk women in Africa. This means they still lack a method they can use to protect themselves from HIV.
For more than a decade, scientists have worked hard to develop HIV prevention tools designed specifically for women, but the process has proved challenging. Vaginal gel products containing the ARV tenofovir have been evaluated. Just last month, a clinical trial of a vaginal gel found the product was not effective, largely because the young women in the trial had challenges using the gel before and after sex. Similarly, another trial found that daily use of the gel was not the right approach for the women in that study. While the results were disappointing, the lesson learned was clear: Women need options they can and will use that fit within the context of their lives.
Fortunately, scientists around the world are continuing to develop a range of new products that are easier to use.
For example, by early next year, we will have results from two late-stage clinical trials of a promising new product, a monthly vaginal ring that slowly releases the ARV drug dapivirine. The ring is designed to be long-acting so that women can insert it and leave it in place for up to a month at a time. Because of its discreet nature, women could choose whether to discuss its use with their partners.
The nonprofit International Partnership for Microbicides developed the ring with a variety of public and private partners, and is leading one of these phase III trials, while the U.S. National Institutes of Health-funded Microbicide Trials Network has partnered in leading the other. Conducting these “sister studies” simultaneously will potentially shorten the time from results to regulatory approval and ultimately, to women. If the dapivirine ring is found to be effective, it could mark the beginning of a new era in women’s HIV prevention.
While we are optimistic that the ring will be a useful option for millions of women, there will be no single solution to stopping HIV. We are encouraged by other promising products in earlier stages of development, including long-acting injectable ARVs, products that combine ARVs with a contraceptive, new vaginal and rectal products, and vaccines.
The progress we have made to date was possible because communities and governments joined with donors and researchers in a global effort to stop HIV. That work must continue. Empowering women by giving them new HIV prevention options will have a profound impact on their health, their families and their communities. If we can offer women practical and effective prevention options, we not only enable them to protect their own well-being — we protect their children and future generations.
On International Women’s Day, let us remember that we cannot end AIDS without giving women new options they can use to keep themselves healthy and safe.
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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.
Dr. Sharon Hillier is professor and vice chair for faculty affairs, and director of reproductive infectious disease research in the department of obstetrics, gynecology and reproductive sciences at the University of Pittsburgh School of Medicine. In addition, she is a senior investigator at the University of Pittsburgh-affiliated Magee-Womens Research Institute. As co-principal investigator of the Microbicide Trials Network funded by the U.S. National Institutes of Health, Hillier oversees an expansive portfolio of clinical trials focused on evaluating a range of HIV prevention products for different high-risk populations.
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