Feminization of HIV & Macroeconomic Policies

The Appignani Bioethics Center, Guttmacher Institute and Population Council are co-sponsoring a panel discussion on "Feminization of HIV & Macroeconomic Policies." under the auspices of the fifty-third session of the Commission on the Status of Women, at the United Nations headquarters in New York, from 2 to 13 March 2009.

Date & Place: Tuesday, March 10, 2009, 6.00-8.00 PM, 777 UN Plaza, 10th floor - Conference Room, NY 10017

The feminization of HIV relates to gender discrimination and social restrictions. These result in women's lacking access to education and employment as well as decision-making power. Victims of gender violence, women are deprived of sexual and reproductive rights. International agreements and decisions on gender equality must be translated into national legal frameworks and action plans. The focus of this panel is the social, economic, cultural and legal aspects of the epidemic, but to truly understand its feminization we need to consider how macroeconomic policies might improve women's access to resources and political influence.

Our very own Sean Philpott (blogger extraordinaire and Science and Ethics Officer for the Global Campaign for Microbicides, based at PATH) will be presenting on a panel with Helen Epstein (author of the recent book AIDS in Africa: The Invisible Cure), Heather Boonstra (our colleague from the Guttmacher Institute), and Anrudh Jain (from the Population Council).

He'll be talking about research and development of new user-controlled HIV prevention technologies that women can use to protect themselves, focusing on the need for sustained economic investment and ways to increase private industry involvement through novel licensing agreements, priority review vouchers, and advance market commitments. Kudos and thanks!

Finally, some good news for women at risk of HIV

Women and girls are the new face of HIV/AIDS. Globally, there are twelve HIV-positive women for every ten HIV-positive men. In the hardest hit countries of sub-Saharan Africa, young women are three times more likely than their male peers to become infected.

The disproportionate impact of HIV on women is due to a variety of biological and socioeconomic factors, factors that also make current HIV prevention tools – including condoms and mutual monogamy – inaccessible to those most at risk. For example, many women do not have the social or economic power necessary to insist on condom use and fidelity, or to abandon partnerships that put them at risk.

Thus, there is a desperate need to develop new user-controlled tools to enable women to protect themselves, such as vaginal microbicides. Over the past two years, a series of flat findings and trial closures have shaken public confidence in research to develop safe and effective microbicides. But now there’s a glimmer of hope.

Yesterday, at the 16^th Conference on Retroviruses and Opportunistic Infections in Montreal, a team of researchers funded the US National Institutes of Health announced the results of HPTN 035, a clinical trial of PRO2000 and BufferGel, two candidate vaginal microbicides.

This study enrolled over 3000 at-risk women in Malawi, South Africa, United States, Zambia and Zimbabwe. In addition to showing that these products were safe to use, the study found that women used PRO2000 (as a topically-applied gel) plus condoms had 30% fewer HIV infections than those who used only condoms or condoms plus a placebo gel.

Although the decrease in HIV infections among women using PRO2000 did not quite achieve statistical significance, this is first large-scale clinical trial showing that a candidate microbicide might actually work in women. A second trial of PRO2000, enrolling more than 9000 at-risk women in Southern Africa, is currently underway. The results of that study – known as MDP201 – will be available in November. If the data from the MDP201 trial also show that PRO2000 is safe and effective, it is expected that this gel will be submitted for regulatory review and approval, hopefully giving women worldwide access to a new and sorely needed HIV prevention tool.

HIV Preventative Significant Boost for Women

Researchers at the University of Alabama (UAB) and the University of Pittsburgh School of Medicine say an experimental anti-HIV gel being tested in Phase II trial studies is safe for women to use on a daily basis. The gel, called tenofovir, was successfully applied by non-HIV infected women patients, daily, over 6 months, as a prevention for HIV infection. The drug is being tested in trials conducted under the authority of a consortium of researchers, exploring and evaluating anti-HIV microbicides. The researchers are a part of the U.S. National Institutes of Health-funded Microbicide Trials Network.
200 sexually active HIV-negative women were included in the study. Participants were age 19 to 50, and 64 percent were married. The goal was to determine the drug's safety if used daily, and the woman's willingness to apply it according to directions.

Results from the tenofovir study comes as welcome news to this segment of the HIV/AIDs prevention research community, following on the heels of unsuccessful late-stage trial testing of other drugs, including another gel, carraguard, (which our blogger Sean Philpott had blogged about earlier this month) which failed to prevent HIV infection in 6,000 South African women tested. That study ended in 134 new HIV infections in the carraguard group, and 151 new infections in the placebo group. A year ago, two other late-stage drug trials for similar preventative gels were stopped due to fears the drugs would accelerate a women's chances of infection instead of decreasing it. Researchers acknowledged that low use of the gel by participants may have played a role in adversely affecting the results.

In South Africa, some 8,000 women develop HIV infection each day.

Sign on to the Microbicide Development Act of 2007

Women and girls are the new face of HIV/AIDS worldwide. As of 2005, 17.3 million women aged 15 years and older were living with HIV – 48% of the global total. In the hardest hit region of the world, sub-Saharan Africa, women comprise 59% of all adults living with HIV/AIDS.

There are a myriad of effective HIV prevention tools – condoms, mutual monogamy, and STI treatment – but these are not available to most women. In many countries, women do not have the social or economic power necessary to insist on condom use and fidelity, or to abandon partnerships that put them at risk.

Microbicides are a class of products currently under development that women (and men) could apply topically to prevent HIV and other sexually-transmitted infections. These user-controlled prevention technologies were hailed as one of the world’s most promising new HIV-prevention technologies at the 2006 Toronto AIDS Conference, and were named in a survey of 28 eminent international scientists and experts as one of the "10 most promising biotechnologies for improving global health."

Right now, a mere 3% of the US budget for AIDS research is spent on developing microbicides. Many public health experts believe that, with increased funding and coordination, an effective microbicide could be available in five to ten years. The longer it takes to develop an effective microbicide, the more people who will be infected needlessly with HIV.

The Microbicide Development Act of 2007 (S. 823 and H.R. 1420) was introduced simultaneously in the House of Representatives and the Senate on 8 March 2007, International Women’s Day. The Act would:

1. Establish a unit dedicated to microbicide research and development within the NIH, and creating a single line of administrative accountability and funding coordination;
2. Authorize funding increases, as needed, at the NIH, the CDC and USAID for the development of microbicidal products; and
3. Require increased coordination between the NIH and other Federal agencies supporting microbicide development.

Please help put the power of HIV prevention in women’s hands by contacting your Senator and Representative … if they are one of the 14 Senate and 26 House co-sponsors, thank them for their support. If they are not a co-sponsor, ask them why.