For our World AIDS Day 2011 series on women and girls in HIV responses, NGO Delegate for North America, Ebony Johnson, calls for increased prioritization of and support for women-centric HIV prevention methods and asks the question of where to go from here in light of recent trials.
This past year has been a remarkable time for HIV prevention research. With the release of the Centre for the AIDS Programme of Research for South Africa (CAPRISA) microbicide trail results, we caught a glimpse of possibility: it was proof that a gel to prevent the transmission of both HIV and herpes simplex virus 2 was within view. I remember being there in Vienna on a hot summer day at the 2010 International AIDS Conference. It was standing room only. When the study results were announced, everyone’s eyes were full with tears; there was thanks and optimism for the new prevention revolution that appeared to be on the horizon. It was a glimmer of hope in achieving an AIDS-free world.
However, exactly a year later on another hot summer day at the 2011 International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention, we found ourselves left waiting, wondering and asking when. When will the microbicide be ready for non-trial use by women that desperately need new mechanisms of protection when male condoms are refused by husbands, boyfriends and male clients? When will a practical women-controlled gel be accessible for women living in countries where female condoms are expensive, stocked-out or just completely unavailable?
As such, a cadre of HIV advocates, women living with HIV, human rights champions and HIV researchers from across the globe took our questions to the public and held a press conference at the IAS conference to ask: “Where the hell is the gel!” We demanded answers and we called for action.
The gel offers new hope for many women as a chance to be able to have control over their sexual and reproductive health. This gel is a tool in HIV prevention that is long overdue, but the process to produce it is far too lengthy and under-funded. We can no longer stand and wait in silence as women and girls suffer in the pervasive wake of gender inequity which too often leaves women economically dependent, voiceless and without control over their sexual health. Women’s prevention needs must not be forgotten and must be prioritized.
Now, on the heels of the recent VOICE trial results, it feels as though we have taken two steps forward and one step back. In November 2011, the Microbicides Trial Network (MTN) released the following statement:
VOICE, an HIV prevention trial that has been evaluating two antiretroviral (ARV)-based approaches for preventing the sexual transmission of HIV in women – daily use of one of two different ARV tablets or of a vaginal gel – will be dropping the vaginal gel from the study. The decision to discontinue use of the gel, which contains the ARV Tenofovir, comes after a routine review of study data concluded that Tenofovir gel was not effective in preventing HIV in the women enrolled in the trial.
The oral tablet, Tenofovir, was discontinued from the study after a routine DSMB review in September determined that although the Tenofovir tablets were safe, they were no better than placebo in preventing HIV in the women assigned to that study group.
This news is heartbreaking, confusing and leads to many questions:
- How do we explain the disparity between the VOICE and CAPRISA trial results?
- Were all the participants well versed in English and clear on the trial goals and their participation?
- Was there a higher rate of condom usage in the CAPRISA trial?
- Why does the use of oral anti-retroviral tablets in VOICE differ from results seen in the Partners PrEP study?
- Did participants in both studies receive equal HIV prevention counselling and did any variance make an impact?
- What next? Will there be another microbicides trial?
- What does the qualitative data say?
- Are there other microbicide trials in the pipeline and what impacts will the VOICE results have on them?
With declining funds from the Global Fund, rising HIV rates in women and the shift from behavioural to bio-medical prevention in many parts of the world, we must continue to fight to see new options for women worldwide to live healthy and safe lives. We cannot afford to close the conversation on microbicides or other emerging new prevention technologies. We must be aggressive on all fronts to keep the HIV research agenda moving forward with women and girls as an integral part. We need the full package: microbicides, treatment as prevention, female and male condoms, vaccines, pre-exposure prophylaxis (PrEP) and other new and untapped means to save lives and to preserve their quality and longevity.
Now we must ask not only “where the hell is the gel?”, but also “why isn’t it working?” and “when will there be something for women?”
Now, we turn the pen over to you to share your thoughts here. Let’s keep this discussion empowering and as one that helps us chart a new way forward.