Prevention technologies for HIV and STIs at AIDS 2014

Women of reproductive age have a need for prevention of sexually transmitted infections (STIs) including HIV, and family planning methods. More importantly, women need prevention tools/methods that are under their control and do not leave them at the mercy of their partner, in as far as their sexual and reproductive health (SRH) is concerned. Dr Elizabeth Bukusi, Deputy Director (Research and Training), Kenya Medical Research Institute (KEMRI) spoke to Citizen News Service (CNS) at 20th International AIDS Conference (AIDS 2014).

She quoted Sharon Camp who had said: "Women want contraceptive methods that can protect against both pregnancy and disease without unpleasant side effects that do not interfere with sex, require little or no medical supervision and are effective when used post-coitally."

Hence developing products that can be used for dual purposes (multipurpose prevention technologies or MPTs) with a single mode of delivery is a critical need. MPTs are a range of prevention options, still in development, that will enable women to address their sexual and reproductive health concerns as they change over time-- ranging from delay in first birth, to planning and spacing pregnancy, to long term or permanent method of contraception. But the need for prevention of STI/RTIs & HIV remains a lifelong overriding need throughout.

An MPT is a single product, configured for at least two prevention indications: contraception, protection against HIV and other STIs, and other health benefits. It thus promises greater efficiency in terms of cost, access and delivery of prevention products.

There are a host of MPT options in the development pipeline. MPTs can be in the form of gels, intra-vaginal rings (IVRs), vaginal tablet, injectables or implantable barrier devices used with a gel or film that have a combination of contraceptive, microbicidal and/or anti- STI properties with different mechanisms of action that act to prevent pregnancy, HIV and/or STIs. They could be on demand--used around time of intercourse-- or could be sustained release devices like IVRs, which do not require daily action, or they could be long acting injectables.

According to Dr Nomita Chandhiok, Senior Scientist at the Division of and Child Health, Indian Council of Medical Research: "The main challenge of researchers, providers and policy makers is to address the primary sexual and reproductive health concerns of all women in terms of (i) Healthy timing & spacing of intended pregnancies, (ii) Safe birth for mother and child and (iii) Protection against STIs, including HIV. "

Dr Chandhiok added: "For a country like India, where unmet contraception needs of women are high, along with high fertility and maternal mortality rates, MPTs offer great potential for public health impact through prevention of unintended pregnancies and HIV/STIs. Of course, the products will need to be tailored to address women’s changing needs throughout their life cycle and also keep in mind socio-cultural beliefs and practices, and the gender dynamics. Moreover users and providers perspective and positioning of product would impact product acceptability."

Understandably, the status and empowerment of women in society and within their households is critical for promoting change in reproductive attitudes and behaviour. If found safe and promoted strategically, MPTs will indeed transform the health of women.

Dr Bukusi concluded with a statement from Hillary Clinton: "Women's health is essential to the prosperity and opportunity of all, to the stability of families and communities, and the sustainability and development of nations. There is a direct line between women’s reproductive health and their ability to lead a productive, fulfilling life. Investing in the potential of women and girls is the smartest investment we can make."

Shobha Shukla is the Managing Editor of Citizen News Service - CNS. She is reporting from the XX International AIDS Conference (AIDS 2014) with support from the World Health Organization (WHO) Global Tuberculosis Programme. She is a J2J Fellow of National Press Foundation (NPF) USA and received her editing training in Singapore. She has earlier worked with State Planning Institute, UP and taught physics at India's prestigious Loreto Convent. She also co-authored and edited publications on gender justice, childhood TB, childhood pneumonia, Hepatitis C Virus and HIV, and MDR-TB. www.citizen-news.org

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