Women at risk for HIV: What is on the horizon?

In the United States, women and teen girls accounted for more than one-fourth of all new HIV/AIDS diagnoses in 2007 and more than 93,900 cumulative deaths from AIDS.1 Black women are at heightened risk. The incidence rate of new diagnoses in black women is almost 15 times higher than that of white women, according to statistics compiled by the Centers for Disease Control and Prevention.1

Why are black women at increased risk? According to authors of a recent editorial in The New England Journal of Medicine, the increase in risk might be due more to vulnerable social and economic situations and sexual networks than women's own risky behaviors.2

"Socioeconomic disadvantage and instability of partnerships due to high rates of incarceration among men in their communities may lead women to engage in concurrent relationships or serial monogamy," the editorial states. "In addition, they may be unaware of their partners' HIV status or may be involved in abusive or economically dependent relationships and thus be unable to negotiate safer sex with their partners."

The National Alliance of State and Territorial AIDS Directors (NASTAD) has issued a new issue brief in its ongoing efforts to reduce racial and ethnic health disparities in the HIV/AIDS and viral hepatitis epidemics.3 The release of the brief is part of the organization's efforts to draw attention to the impact of HIV/AIDS on women and the need to increase support for science-based, effective HIV and STD prevention programs for them. (Download a copy of the brief at the organization's web site, www.nastad.org. Under "Highlights," click on "Black Women and HIV/AIDS: Findings from the Southeast Regional Consumer and Provider Focus Group Interviews.")

NASTAD will continue to advocate for increased awareness and services for women impacted by HIV/AIDS, says Michelle Batchelor, MA, senior manager of racial and ethnic health disparities. While strides have been made, the collective response to women's needs have not been met at the level that the crisis deserves, she states.

Put a ring on it

One way to help women protect themselves against HIV/AIDS to boost female-controlled prevention methods. The Female Health Co. (FHC), manufacturers of the FC2 Female Condom, are supporting a new social marketing campaign in Chicago designed to educate women about HIV/AIDS and boost awareness, availability, and access to the FC2 condom.

The Chicago Female Condom Campaign includes a coalition of 20 HIV/AIDS, reproductive justice, and women's and men's health organizations that are mobilizing outreach to women and men living at risk of HIV in Chicago. The campaign was launched on March 10, the 2010 observance of National Women and Girls HIV/AIDS Awareness Day.

The campaign is conducting a multifaceted communications and marketing effort to promote the female condom as an acceptable and affordable HIV prevention option for women and men. With funding and technical support provided by FHC and other partners, it is sponsoring in-person trainings to equip Chicago-area service organizations with the skills to promote female condoms. Those skills include knowledge of correct use and strategies for negotiating female condom use with partners. Many of the community-based partners serve African American and Latino women, who are disproportionately impacted by the city's HIV/AIDS epidemic. The campaign is launching a mixture of social media channels to spread awareness including a female condom web site (www.ringonit.org), a Facebook fan page, and a Twitter account (twitter.com/ChiFemaleCondom).

Science eyes prevention

Women might have another option when it comes to HIV prevention if a current large-scale clinical trial proves successful. The Vaginal and Oral Interventions to Control the Epidemic (VOICE) study is examining whether antiretroviral medications normally used to treat HIV infection also can prevent HIV infection in women when applied as a vaginal gel or taken as once-daily oral tablets.

The study, launched in 2009, looks to enroll some 5,000 HIV-uninfected women at risk for HIV infection in multiple sites in Africa. Scientists are enrolling participants at sites in Zimbabwe, Uganda, and South Africa, with additional sites in South Africa expected to come on board soon, says Jeanne Marrazzo, MD, MPH, VOICE Study co-chair and associate professor of medicine in the Division of Allergy and Infectious Diseases at the University of Washington in Seattle. The study is expected to run about three and one-half years.

The trial will test the safety and efficacy of two HIV prevention strategies: an investigational microbicide gel containing the antiretroviral drug tenofovir, and oral tablets containing tenofovir or a combination of tenofovir and emtricitabine. The tablets are taken prior to exposure in an approach known as pre-exposure prophylaxis, or PrEP. Testing a microbicide and PrEP in the same trial will enable scientists to directly compare the two strategies' safety and acceptability.

To perform the study, women are randomly assigned to one of five regimens, each performed once daily: applying tenofovir gel vaginally, applying a placebo gel vaginally, taking a tenofovir pill and a placebo pill, taking a tenofovir/emtricitabine pill and a placebo pill, or taking two placebo pills.

Why are researchers hopeful that this particular approach will be effective in women? Marrazzo points to two possible reasons. "First, the strategies we are using — vaginal and oral products — use antiretroviral drugs [ARVs] that we know work very well to treat HIV," she notes. "Second, use of ARVs has been successful in preventing mother-to-child transmission of HIV, so that provides a great real-world model of its potential."

However, until the trial is complete, scientists won't know for sure whether the ARV-based gel or the pill will be safe and effective, and whether one will be more acceptable than the other for women to use on a daily basis, states Marrazzo.

References

  1. Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report, 2007. Atlanta: Centers for Disease Control and Prevention; 2009.
  2. El-Sadr WM, Mayer KH, Hodder SL. AIDS in America — forgotten but not gone. N Engl J Med2010; 362:967-970.
  3. National Alliance of State and Territorial AIDS Directors. Black Women and HIV/AIDS: Findings from Southeast Regional Consumer and Provider Focus Group Interviews. Washington, DC; 2010.