In 2012, half of the estimated 35.3 million people living with HIV were women and girls. Today, adolescent girls in sub-Saharan Africa are at especially high risk, and they are seven times more likely to get infected than their male counterparts.
This population is highly vulnerable to HIV for a number of reasons, including underlying social norms that affect gender roles that can increase vulnerability to HIV infection. Women and girls may be unable to safely insist their partners use a condom—or reticent about independently reaching out for health information and care. Poverty, lack of education, and food insecurity also increase women’s and girl’s risk for HIV infection.
In sub-Saharan Africa, adolescent girls are roughly seven times more likely to contract HIV than boys. Photo: PATH/Eric Becker.
In search of solutions that women and girls control
Several developments hold great promise for female-controlled technologies that can be used discreetly and without requiring a partner’s permission or knowledge.
There are pre-exposure prophylaxis (PrEP) drugs that, if taken on a regular basis, reduce the risk of HIV infection for both men and women. Several studies have shown that young women may not take the drugs frequently enough to protect themselves, indicating a need for better tools to help young women adhere to PrEP regimens. PATH, along with the HIV Prevention Trials Network, pharmaceutical company Janssen, and the Division of AIDS at the National Institutes of Health is working on the development of a long-acting injection as a potential PrEP agent. It’s hoped that someday such injections will provide protection for HIV infection over a period of months, similar to injectable forms of contraception.
PATH has long advocated for low-cost delivery options for microbicides, products which could prevent or reduce the possibility of sexually transmitted infections, including HIV/AIDs, when applied intravaginally (watch our video In Our Own Hands: A Social Movement for Women-Initiated HIV prevention Options). PATH is currently partnering with colleagues at CONRAD and the Centre for the AIDS Programme of Research in South Africa (CAPRISA) to test paper applicators for delivering tenofovir gel—a candidate microbicide for HIV prevention. If acceptable to women, paper applicators will be less expensive to manufacture, allowing the gel to be more widely available in low-resource areas around the world. PATH will help design the study and analyze the results with its research partners.
We also led development of the “one-size fits most” SILCS diaphragm, which recently received market clearance from the United States Food and Drug Administration. The SILCS diaphragm is a comfortable, easy-to-use device that doesn’t require a pelvic exam to be fitted. Next steps for this innovation include plans to study the SILCS diaphragm as a possible delivery method for a microbicide gel. If effective, the SILCS diaphragm could be used as a multipurpose prevention system to protect women from both HIV and pregnancy.
A combination approach
PATH supports a combination approach to meet the HIV prevention needs of women and girls – including HIV testing, use of male and female condoms, providing oral PrEP to high-risk populations, and treating infected partners with lifesaving antiretroviral therapy.
Along with these methods, we also need to go more “upstream” to address the multitude of structural issues that put women and girls at greater risk for HIV, such as addressing the underlying economic and power inequalities that are often the root causes of gender disparities. Empowering women to take control of their reproductive health is an important step in that direction.