- More than half of the world’s new HIV infections occur in Sub-Saharan Africa, and women and adolescent girls account for the majority of those. Accessing this vulnerable population remains a major challenge in the global effort to eradicate HIV/AIDS, due to cultural stigma, behavioral choice, and limited medical prevention options to date.
- Dr. Roy Baynes initiated the discussion with an announcement regarding the advancement of Merck’s Islatravir drug, a once-monthly oral PrEP, which is moving onto Phase 3 clinical trials. The trials, conducted in partnership with the Bill & Melinda Gates Foundation and the International Clinical Research Center, will begin in Africa and—while time horizons are contingent on a trial conduct made uncertain due to COVID-19 challenges—point to a promising antiviral option for women and adolescent girls. A monthly oral option like Merck’s Islatravir provides a preferable treatment option that will contribute to a reduction in new HIV infections.
“You could imagine that it would not be too much of a reach to put the contraception with the antiviral into the implantable…and that’s a project that’s in its early form but offers great promise,” Dr. Roy Baynes
- There is a gap between where the burden of infection is (i.e. women and adolescent girls) and what is available. The use of antivirals prophylactically opened the path for gender-based progress and the design, development, and market readiness of women-initiated technologies. As Dr. Linda-Gail Bekker referenced, greater choice and availability of options will support adoption and uptick in prevention methods, as humans demonstrate great variability in lifestyle and preferences and one treatment option will not work for everyone. As more preventative treatments become available, doctors can better prescribe treatments based on the user profile, factoring in gender, lifestyle, and dosage frequencies, for differentiated care. With the progress achieved by an increasing variety of treatment comes the challenge of utilizing the most appropriate distribution channels, based on who is being reached and what treatment option is being used.
- Both treatment and biomedical technology, as well as behavioral interventions, will be required to fully address the outbreak. On the behavioral side, the panel spoke of the reluctance of women and girls to seek out HIV/AIDS-specific testing and treatment. Thus, education, prevention, and treatment interventions need to be integrated into already sought-after service delivery, like general and reproductive health examinations. Treatments also need to factor in behavioral patterns; a monthly oral option like Merck’s Islatravir, in comparison to a daily pill, provides a preferable treatment option. Finally, solutions need to account for age-disparate relationships. This includes creating tools that support women and girls’ self agency, and policies that address sexual education, gender power imbalances, and gender-based violence.
“Prevention is a mosaic, and we’re filling in the various pieces because our lives are diverse […] different people have different needs,” Dr. Linda-Gail Bekker
- Understanding the nexus of science, advocacy, and policy is essential to meaningful progress in HIV/AIDS eradication. Dr. Quarraisha Abdool Karim spoke of the importance of evidence-based advocacy, and the role of activism in shaping policy and investment in the public health space.
- Technology shows promise, and experts looked towards the future, where scientists might co-locate medicinal agents geared towards contraception, sexual health needs, and HIV prevention through a ring or injection. The next three to five years could yield a tremendously different outlook for young women and adolescent girls and, as Dr. Elizabeth Bukusi convincingly closed the session, this is a commitment we must make to the next generation, as we don’t have another option.
“If you do provide education to empower a woman, you’re empowering a whole village. It’s not even just a family,” Dr. Elizabeth Bukusi