HIV Prevention Research for Women: Cocktails for Success

1. HIV Prevention Research for Women: Cocktails for Success Hadiyah Charles, Community HIV/AIDS Mobilization Project Naina Khanna, WORLD/U.S. Positive Women’s Network HIV Research Catalyst Forum April 21, 2010

2. Goals • 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

3. What we Know • 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

4. What we know (cont’d) For women, “risky behavior”  risk for HIV infection

5. What we don’t know • 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?

6. What we don’t know (cont’d) • 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?

7. The Future of Prevention Behavioral Biomedical Structural

8. Behavioral: Current 1. (D)EBIs - (Diffused) Effective Behavioral Interventions • 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.

9. Behavioral: Current Models • Focus is individual or group level • Promote increased use of condom, fewer partners Limitations: • Numbers reached are relatively small • May not be reaching women at highest risk • Asks women to change behaviors that may not be up to them: male condom; reduced number of partners • Limited cultural relevance

10. Biomedical (cont’d) • 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?

11. Biomedical (cont’d) 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

12. Bio-medical 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

13. Vaccines 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

14. Female-Controlled Prevention Vaginal and Anal Microbicides (currently in development) • Microbocide is a substance that would reduce risk of contracting HIV when applied vaginally or rectally • Over a dozen trails are ongoing in ten countries • Results are expected in mid 2010

15. Female-Controlled Prevention • 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.comwww.fc2femalecondom.com

16. Structural Interventions • Intervene further “upstream” - on factors other than behavior and biology which influence risk • Change balance of power • Economic, policy, social, physical Examples: • IMAGE project - South Africa • 2 currently funded pilot CDC projects in Florida • Housing (CHHC)

17. Structural Interventions What about… • Health care access (over 50% of HIV+ women not in care in U.S.) • Violence prevention • Economic opportunity for women • Comprehensive Sex Education throughout lifetime?

18. Key Questions • 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?

19. Some existing advocacy efforts • 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)

20. What are some next steps?