Transcript Slide 1

HIV Prevention : Why we
need more options for
women
Wanjiku Kamau
Consultant: International AIDS Vaccine Initiative
Consultant: International Partnership for Microbicides
July 6th 2007
1
HIV Prevention – a neglected area
Global HIV Prevention Working Group estimated that
only 1 in 5 people at risk of HIV infection in developing
countries had access to prevention services and
commodities
 Urgent need to scale up existing HIV treatment and
prevention to reduce transmission rates and save lives.
 However, even when scaled up, current treatments can
prolong life, but they are not a cure. Present prevention
options can reduce rates of HIV incidence but will not
end the epidemic.
 With existing technologies and approaches, the global
HIV/AIDS epidemic may be slowed but will continue to
grow

Women’s greater risk and urgent
need for improved HIV prevention

Biological: male-to-female transmission is
easier than female-to-male

Economic: financial dependence on male
partners

Cultural: early marriage, intergenerational
sex and marital infidelity

Sexual exploitation and violence
Current prevention is failing us all but
particularly women – why?

Current approaches rely on individuals recognising and
understanding their risk and on personal agency or
ability to control or limit risk

Relies on individuals being empowered to employ various
prevention strategies

Is increasingly based on morality as a guiding principle
The world’s main HIV prevention
technology is over 3000 years old
The Case for New Preventive Technologies
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One size does not fit all!
Combination prevention is the future
If you increase the number of options available, the overall
protection increases (lessons from family planning)
We are not meeting people’s sexual and reproductive health
needs. Ever rising number of infections confirm that we need
to do things differently – including providing a wider range of
tools.
Female Barrier Methods

Female condoms
– Contraception and STI prevention
– High initial acceptability
– Large programs in Brazil, Ghana, Namibia, South
Africa, Zambia
– Slow uptake

Diaphragms
– Contraceptive; STI prevention under study
– Use currently low—0.3% of reproductive-age women
in the US
What are cervical barriers (CBs)?
Diaphragms
Cervical Caps
Why cover the cervix?

The cervix is fragile
– Entrance lined with delicate columnar
epithelial cells
– This layer is only 1 cell thick

Preferential site of infection for many STIs
– Bacterial pathogens (gonorrhea, chlamydia)
– Human papilloma virus
Concentration of HIV receptor sites
 Protection of the upper genital tract

Cervical barriers - summary
Cervical barriers are long-standing, safe,
effective female-controlled contraceptives.
 Cervical barriers are currently being
studied as potential STI/HIV prevention
methods.
 New cervical barriers are under
development.
 May be a useful preventive method for
women who do not wish to conceive.

Microbicides

Vaginal product to prevent or reduce HIV
transmission

Could potentially be delivered in many
forms
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A woman could initiate use independently
to protect her health

Ideally safe, effective, low-cost and userfriendly
Why do we need a microbicide?
Women are increasingly at risk of HIV globally
and yet currently have no option that can be
used without male consent or knowledge
 Behavioural approaches are gender-blind
 Women have practical HIV prevention needs
which must be met while gender equality is
striven for
 Even a partially effective microbicide could
have a huge impact on number of lives saved

Early generation microbicides

Non-specifically block HIV from interacting with
target cells
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In most advanced stage of clinical trials
(Carraguard, PRO2000, BufferGel)
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Partial, low or no effectiveness
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Short-acting (used near time of sex)
Next generation microbicides

Based on antiretroviral drugs (ARVs) with
known efficacy in humans
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Long half-life or can be formulated for
sustained release

Products may contain a combination of
drugs that act at different stages of HIV
replication
Delivery – offering choice
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Semisolids/Solids
–
–
–
–
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Gels
Vaginal Tablets
Films
Emulsions
Devices
– Vaginal Ring
– Sponge
– Diaphragm
Why we need a vaccine
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Vaccines are essential in the prevention of
epidemics
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Vaccines are the only intervention
historically to have eradicated
communicable disease
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Increased personal control over
vulnerability to infection
New Prevention Technologies
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Microbicides and vaccines will give people
additional choices that better meet their
needs in preventing HIV transmission.
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In both cases, women can initiate use, and
may be able to do so discretely, providing an
essential benefit over existing prevention
options.
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Microbicide designs aim to address issues of
intimacy and to provide choice over
contraceptive function, which currently hinder
greater condom uptake.
New Preventive Technologies
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A vaccine would not interfere with sex itself at all.

Microbicides may offer the potential for efficacy against a
range of other STIs

HIV vaccines hold out the promise of an HIV prevention
option not dependant on repeat use for every sexual or
injecting drug use act.

A future vaccine could protect individuals from HIV
infection before they become sexually active or begin
other potentially high risk activities including intravenous
drug use
We need a comprehensive and
integrated HIV/AIDS toolkit
Prior to exposure
• Education &
Behavior change
• Preventive
Vaccines
• Pre-exposure
prophylaxis
(PREP)
4
Point of
transmission
After infection
• Male and female
condoms
• Anti-retroviral
therapy
• Anti-retroviral
therapy (mother-tochild)
• Care
• Post exposure
prophylaxis (PEP)
• Male circumcision
• Microbicides
• HSV2 suppression
• Diaphragm &
other cervical
barrier
• Education &
Behavioral change
• Therapeutic
vaccines