Evolving Mechanisms for Combating HIV/AIDS: the Social Development Dimensions
By Zingisa Ngqongwa
Women are disproportionately affected by the Acquired Immunodeficiency Syndrome (AIDS) epidemic in Africa, which is also the region that accounts for 70% of the global burden of the Human Immunodeficiency Virus (HIV) infection. Current HIV prevention behavioural messages on abstinence, be faithful and condom use (ABC) promotion have had limited impact on HIV incidence rates in women, especially in sub-Saharan Africa, where young women bear the greatest HIV burden. The search for new technologies to prevent sexually transmitted HIV infection over the past decades has had limited success.
Evolving mechanisms for combating HIV/AIDS this year indicate that a new vaginal gel could reduce a woman’s risk for HIV infection by half when used regularly. The gel, one of the first designed to contain an antiretroviral drug, was tested in a trial involving women from the KwaZulu-Natal province of South Africa. The trial’s success has been great news in sub-Saharan Africa, where the number of women living with HIV/AIDS now exceeds the number of infected men.
The new gel, which has been a groundbreaking development, was found to reduce the risk of HIV infection by 39% in women who used it in about three quarters of their sexual encounters and by 54% in women who used it consistently. The findings carry particular significance given the discouraging results of earlier trials involving other gels—among the most notable recent failures are the 2007 trial of a gel known as Ushercell and the 2009 trial of PRO 2000.
Unlike some of the first-generation vaginal gels developed, including Ushercell and PRO 2000, which were formulated with substances intended to block HIV binding to epithelial cells in the vagina, the new gel contains tenofovir, a drug capable of inhibiting HIV replication. It is the first of several antiretroviral-containing gels to be tested in women.
In sub-Saharan Africa, the primary methods of HIV/AIDS prevention (ABC) have only marginally reduced a woman’s risk of infection. Thus, if the gel proves successful in larger trials, it could mark a major breakthrough in HIV prevention, giving women the independent ability to protect themselves against infection.
“Tenofovir gel could fill an important HIV prevention gap by empowering women who are unable to successfully negotiate mutual faithfulness or condom use with their male partners,” said study co-principal investigator, Dr Quarraisha Abdool Karim, Associate Director of CAPRISA and Associate Professor of Epidemiology at Columbia University. “This new technology has the potential to alter the course of the HIV epidemic, especially in Southern Africa where young women bear the brunt of this devastating disease.”
The results still need to be confirmed in another study according to the researchers, and the level of protection may not be enough to win approval of the microbicide gel in countries like the United States. But they are optimistic it can be improved. It's the first time we've ever seen any microbicide give a positive result that scientists agree is true evidence of protection.
It is said that for a gel or cream to be licensed in the US to prevent HIV infection, it may need to be at least 80% effective. That percentage might be achieved by adding more tenofovir or getting women to use the gel more consistently. In the study that was conducted here in South Africa, women used the gel only 60 percent of the time; those who used it more often had higher rates of protection. The gel also cut in half the chances of getting HSV-2, the herpes virus that causes genital warts. Even partial protection is a huge victory that could be a good bonus, not just in poor countries, but for couples anywhere when one partner has HIV and the other does not have the virus.
However, while the gel is an important pharmaceutical advancement that studies show could protect four out of ten women from contracting HIV, by no means is it the panacea for a complex problem rooted not only in sexual behaviours, but also in social and political structures that fail to protect women, particularly young women, from victimisation. While others are positive about the new improvements, others are not very pleased with the results of the gel, especially those who got infected with HIV while using the gel. Reason for this may be the high risk people are still faced with, for the gel is not a hundred percent cure for the virus and condom use is still emphasised, while quite a number of people are still not making use of it. The gel, like other preventive methods (ABC), is still targeting women.
Domestically and abroad, social conditions persist that make women more susceptible than their male counterparts to infectious disease. The power dynamics that relegate women to increased vulnerability still play a role. In South Africa, it might take the form of the young girl who gets raped because it is believed that her purity will "cure" an older male of infection. In the United States, it may be the sexually exploited minor who was "turned out" at the age of ten, and who will not be seen by a physician until she finally comes into contact with the juvenile justice system. In both of these cases, and others like them, a vaginal gel alone won't decrease her risk of infection.
The ability to know one's status and exercise a full empowerment to protect one's body from victimisation is a human rights issue that is persistently violated in many communities around the world. This is one of the reasons the ratification of the convention on the elimination of all forms of discrimination against Women remains so important. Economic and political empowerment, as well as education and adequate health care, are still key protective factors and human rights that when observed, will aid in the effort to reduce the physical and mental health disparities that may be associated with or exacerbated by the virus not just in Africa, but throughout the world. Let’s make informed decisions.
References
• www.capisa.org
• UNAIDS, WHO, AIDS Epidemic Update (Joint United Nations Programme on HIV/AIDS and World Health Organization, Geneva, 2009).
• www.britannica.com/blogs/2010/07/vaginal-gel-renews-hope-for-hivaids-prevention-in-women
Women are disproportionately affected by the Acquired Immunodeficiency Syndrome (AIDS) epidemic in Africa, which is also the region that accounts for 70% of the global burden of the Human Immunodeficiency Virus (HIV) infection. Current HIV prevention behavioural messages on abstinence, be faithful and condom use (ABC) promotion have had limited impact on HIV incidence rates in women, especially in sub-Saharan Africa, where young women bear the greatest HIV burden. The search for new technologies to prevent sexually transmitted HIV infection over the past decades has had limited success.
Evolving mechanisms for combating HIV/AIDS this year indicate that a new vaginal gel could reduce a woman’s risk for HIV infection by half when used regularly. The gel, one of the first designed to contain an antiretroviral drug, was tested in a trial involving women from the KwaZulu-Natal province of South Africa. The trial’s success has been great news in sub-Saharan Africa, where the number of women living with HIV/AIDS now exceeds the number of infected men.
The new gel, which has been a groundbreaking development, was found to reduce the risk of HIV infection by 39% in women who used it in about three quarters of their sexual encounters and by 54% in women who used it consistently. The findings carry particular significance given the discouraging results of earlier trials involving other gels—among the most notable recent failures are the 2007 trial of a gel known as Ushercell and the 2009 trial of PRO 2000.
Unlike some of the first-generation vaginal gels developed, including Ushercell and PRO 2000, which were formulated with substances intended to block HIV binding to epithelial cells in the vagina, the new gel contains tenofovir, a drug capable of inhibiting HIV replication. It is the first of several antiretroviral-containing gels to be tested in women.
In sub-Saharan Africa, the primary methods of HIV/AIDS prevention (ABC) have only marginally reduced a woman’s risk of infection. Thus, if the gel proves successful in larger trials, it could mark a major breakthrough in HIV prevention, giving women the independent ability to protect themselves against infection.
“Tenofovir gel could fill an important HIV prevention gap by empowering women who are unable to successfully negotiate mutual faithfulness or condom use with their male partners,” said study co-principal investigator, Dr Quarraisha Abdool Karim, Associate Director of CAPRISA and Associate Professor of Epidemiology at Columbia University. “This new technology has the potential to alter the course of the HIV epidemic, especially in Southern Africa where young women bear the brunt of this devastating disease.”
The results still need to be confirmed in another study according to the researchers, and the level of protection may not be enough to win approval of the microbicide gel in countries like the United States. But they are optimistic it can be improved. It's the first time we've ever seen any microbicide give a positive result that scientists agree is true evidence of protection.
It is said that for a gel or cream to be licensed in the US to prevent HIV infection, it may need to be at least 80% effective. That percentage might be achieved by adding more tenofovir or getting women to use the gel more consistently. In the study that was conducted here in South Africa, women used the gel only 60 percent of the time; those who used it more often had higher rates of protection. The gel also cut in half the chances of getting HSV-2, the herpes virus that causes genital warts. Even partial protection is a huge victory that could be a good bonus, not just in poor countries, but for couples anywhere when one partner has HIV and the other does not have the virus.
However, while the gel is an important pharmaceutical advancement that studies show could protect four out of ten women from contracting HIV, by no means is it the panacea for a complex problem rooted not only in sexual behaviours, but also in social and political structures that fail to protect women, particularly young women, from victimisation. While others are positive about the new improvements, others are not very pleased with the results of the gel, especially those who got infected with HIV while using the gel. Reason for this may be the high risk people are still faced with, for the gel is not a hundred percent cure for the virus and condom use is still emphasised, while quite a number of people are still not making use of it. The gel, like other preventive methods (ABC), is still targeting women.
Domestically and abroad, social conditions persist that make women more susceptible than their male counterparts to infectious disease. The power dynamics that relegate women to increased vulnerability still play a role. In South Africa, it might take the form of the young girl who gets raped because it is believed that her purity will "cure" an older male of infection. In the United States, it may be the sexually exploited minor who was "turned out" at the age of ten, and who will not be seen by a physician until she finally comes into contact with the juvenile justice system. In both of these cases, and others like them, a vaginal gel alone won't decrease her risk of infection.
The ability to know one's status and exercise a full empowerment to protect one's body from victimisation is a human rights issue that is persistently violated in many communities around the world. This is one of the reasons the ratification of the convention on the elimination of all forms of discrimination against Women remains so important. Economic and political empowerment, as well as education and adequate health care, are still key protective factors and human rights that when observed, will aid in the effort to reduce the physical and mental health disparities that may be associated with or exacerbated by the virus not just in Africa, but throughout the world. Let’s make informed decisions.
References
• www.capisa.org
• UNAIDS, WHO, AIDS Epidemic Update (Joint United Nations Programme on HIV/AIDS and World Health Organization, Geneva, 2009).
• www.britannica.com/blogs/2010/07/vaginal-gel-renews-hope-for-hivaids-prevention-in-women