Looking to a New Era for Women's HIV Prevention

While there is much progress to celebrate in HIV treatment and prevention, protecting women remains a major challenge. AIDS is the number-one killer of women ages 15 to 44 worldwide.
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This World AIDS Day, global resolve to end the AIDS epidemic has never been stronger. With its new Fast-Track strategy, UNAIDS has set ambitious goals for accelerated action in the fight against HIV. As Michel Sidibé, executive director of UNAIDS, said in launching the strategy, we have bent the trajectory of the epidemic and now have a five-year window of opportunity to break it for good.

Preventing HIV among women must be central to this effort.

While there is much progress to celebrate in HIV treatment and prevention, protecting women remains a major challenge. AIDS is the number-one killer of women ages 15 to 44 worldwide. Women are biologically more vulnerable to infection and face deep-rooted gender inequities that increase their risk. In sub-Saharan Africa, where the epidemic has taken the greatest toll, young women are at least twice as likely to contract HIV as young men.

Existing prevention methods such as male and female condoms are not always realistic options for women. They need tools they can use easily and discreetly.

Promising new products such as microbicides could soon transform how women protect themselves. These products are vaginal gels, rings, films and tablets that deliver the same types of antiretroviral (ARV) drugs used to successfully treat those already infected with HIV.

Two microbicides - a gel used around the time of sex and a monthly ring - are now being tested in late-stage clinical trials in Africa. We could know as soon as next year whether these products are effective in preventing HIV in women. The gel, developed by CONRAD, delivers the ARV tenofovir to protect against infection. The monthly ring, developed by the International Partnership for Microbicides (IPM), releases the ARV dapivirine and could be the first long-acting, female-controlled prevention method.

If effective, these products would expand women's choices and revolutionize their HIV prevention options. A range of options gives women more control over their health: some may want to use an on-demand gel, others may prefer a daily pill and still others may choose a ring that provides sustained protection. To capture the promise of these technologies, we need to be ready for results.

Getting an effective product approved so women can use it can take several years in some countries, but the work to integrate microbicides into the broader HIV prevention toolkit must start now. Successful microbicide introduction will require continued conversations with the women who will use them, well-funded and supportive policies, trained health workers, effective supply chains and strong partnerships.

At IPM, efforts are underway to prepare for future studies that would give women who participated in the current trials early access to the ring once its safety and efficacy have been determined. We are also engaging stakeholders in African countries to help advance the approval process in places where women are at highest risk for HIV.

Even if both the gel and the ring are effective, research must continue. No single product will be right for everyone. We must keep investing in research to develop different prevention technologies that fit women's individual lifestyles and preferences and help us stay one step ahead of the ever-evolving HIV virus.

As we enter 2015, the global community has an unprecedented opportunity to stem the spread of the AIDS epidemic. This will not be possible if we leave women behind. Together, let's make this the start of a new era for women's HIV prevention.

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