Transcript Hadiyah Charles, Community HIV/AIDS Mobilization Project Naina Khanna, WORLD/U.S. Positive Women’s Network HIV Research Catalyst Forum April 21, 2010

Hadiyah Charles, Community HIV/AIDS
Mobilization Project
Naina Khanna, WORLD/U.S. Positive
Women’s Network
HIV Research Catalyst Forum
April 21, 2010
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Increase understanding of current landscape
of Prevention Research for women
Discuss emerging trends and key issues in
prevention research
Identify opportunities for advocacy and
further collaboration to improve prevention
research for women
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Over 80% of women in U.S. are infected
through heterosexual contact
Globally, women are more than 50% of all
infections
For women, acquiring HIV is not primarily
correlated with having a lot of sex partners or
using injection drugs
Factors that correlate with a woman’s risk for
acquiring HIV include: poverty; violence;
housing instability; food insecurity; and power
dynamics in relationships
For women, “risky behavior”
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risk for HIV infection
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Why do some women seem to have innate
immunity to HIV and others don’t (including
genetic markers - HLA)?
How does homophobia impact the epidemic
among women?
What kinds of sex are serodiscordant
heterosexual couples having; and has it
changed since the release of the Swiss study
data?
What are the prevention needs of heterosexual
men?
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What motivates women or men to use a
condom?
Why is seroprevalence higher among WSW
than among women who have sex with only
men?
What, if any, role does anal sex play in
women’s risk for acquiring HIV?
What percentage of women testing positive
suspected they were at risk for acquiring HIV?
Behavioral
Biomedical
Structural
1. (D)EBIs - (Diffused) Effective
Behavioral Interventions
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compendium of prevention interventions
that showed “positive behavioral and/or
health outcomes”
Funded by CDC (Centers for Disease
Control & Prevention)
17 DEBIs specifically target women
2. Homegrown Interventions: e.g. Healthy
Love Workshop by SisterLove, Inc.
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Focus is individual or group level
Promote increased use of condom, fewer partners
Limitations:
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Numbers reached are relatively small
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May not be reaching women at highest risk
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Asks women to change behaviors that may not be
up to them: male condom; reduced number of
partners
Limited cultural relevance
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PreP // pre-exposure prophylaxis (take it before
you think you may be exposed) This strategy uses
antiretrovirals to reduce the risk of HIV infection
in HIV-negative people
Currently in trials – nearly 20,000 people are enrolled
 How does this apply to women, especially in a U.S.
context, who usually don’t perceive themselves as being
at risk?
 What role does violence PreP play in women’s motivation
to use a mechanism like PreP?
 Will women utilize PreP?
 What impact might MSMW taking PreP have on their
female partners?
 What happens when PreP becomes PEP?
PEP // post-exposure prophylaxis (take it after
you think you may have been exposed: rape;
unplanned unprotected sex)
Access, affordability, coverage, implications for
health insurance, etc
 Limited options during pregnancy
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Treatment as Prevention/TLC+
Studies show if viral load is suppressed to
undetectable the likelihood of transmission is low.
- ARV treatment of people living with HIV may
reduce their infectiousness and improve their
outcomes
Questions:
- What are long term effects of starting treatment
earlier?
- Does this overemphasize burden of prevention on
HIV-positive partner and minimize responsibility of
negative partner?
- Human rights implications
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Currently in development
Special considerations for women:
 Sex differences in effectiveness
 Pregnant women
 Women of reproductive potential
 Breastfeeding women
 Girls and adolescents
 Women are under-enrolled
Vaginal and Anal Microbicides
(currently in development)
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Microbocide is a substance that would reduce
risk of contracting HIV when applied vaginally
or rectally
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Over a dozen trails are ongoing in ten countries
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Results are expected in mid 2010
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FC1- female condom 1 was approved by the
FDA for use in the US since 1993
FC2 - Female Condom 2 was approved by the
FDA for use in the US in March 2009
FC2 offers women a choice, that they can initiate,
to provide dual protection against unintended
pregnancy and sexually transmitted infection
including HIV.
The Female Health Company
www.femalehealth.com www.fc2femalecondom.com
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Intervene further “upstream” - on factors other than
behavior and biology which influence risk
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Change balance of power
Economic, policy, social, physical
Examples:
 IMAGE project - South Africa
 2 currently funded pilot CDC projects in Florida
 Housing (CHHC)
What about…
 Health care access (over 50% of HIV+ women
not in care in U.S.)
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Violence prevention
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Economic opportunity for women
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Comprehensive Sex Education throughout
lifetime?
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How can we most effectively target testing
resources for women?
What structural interventions could work in
the U.S. and how?
How can structural interventions be integrated
with biomedical and behavioral interventions?
How do women want to use PreP?
Are there ways (nutritional, other) to enhance
innate immunity for women vulnerable to HIV
infection in areas with generalized epidemics?
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AIDS Vaccine Advocacy Coalition
Global Campaign for Microbicides
Prevention Justice Alliance
www.preventionjustice.net
National Women and AIDS Collective
Chicago Female Condom Campaign – Put a
ring on it www.ringonit.org
Prevention Now! www.preventionnow.org
Happiness and Satisfaction - facebook (FC2)