March 5, 2007
The commemoration of the second annual National Women and Girls HIV/AIDS Awareness Day reminds us that worldwide, our mothers, daughters, sisters, aunts, cousins and friends are struggling with HIV/AIDS in growing numbers, and becoming infected with HIV at alarming rates. The imperative to bolster our collective commitment to fighting HIV/AIDS among women and girls has never been stronger.
Since the mid-1980s, the number of women and girls affected by HIV/AIDS has steadily increased, despite intensive prevention efforts. In this country, the proportion of AIDS cases among female adults and adolescents (13 years of age and older) increased from 7 percent in 1985 to 27 percent in 2005. Racial and ethnic minorities represent the vast majority of new cases among women. Between 2001 and 2005, an estimated 83 percent of women newly diagnosed with HIV/AIDS in the United States were African American or Hispanic. Globally, of the estimated 39.5 million people living with HIV/AIDS, nearly half are women and girls. In some regions, women are especially hard-hit: for example, in Sub-Saharan Africa, for every ten adult men living with HIV, about 14 adult women are infected with the virus.
Globally, the vast majority of women with HIV/AIDS became infected through heterosexual intercourse, frequently in settings where saying no to sex or insisting on condom use is not an option because of cultural factors, lack of financial independence, and even the threat of violence. These issues compel us to develop HIV prevention tools that women can use in situations when negotiating with sexual partners is difficult or impossible.
One critical avenue of research is the development of safe, effective and acceptable topical microbicides -- gels, creams and foams that could be used prior to sexual intercourse to prevent infection with HIV and other sexually transmitted pathogens. The development of these woman-controlled agents is a top HIV/AIDS research priority of the National Institutes of Health (NIH).
The NIH supports a full spectrum of microbicide research, from basic studies to clinical trials, with coordination by the NIH Office of AIDS Research. Of particular note, the National Institute of Allergy and Infectious Diseases (NIAID), with support from the National Institute of Mental Health and the National Institute of Child Health and Human Development, recently funded the Microbicides Trials Network, a new international HIV/AIDS clinical trials research network devoted to reducing the sexual transmission of HIV through the development and evaluation of topical microbicides.
In ongoing studies, the NIAID-supported HIV Prevention Trials Network is examining the safety and preliminary effectiveness of two topical microbicides -- BufferGel and PRO2000/5 Gel (P) -- in large clinical trials in Africa and the United States. NIAID also has an agreement with the International Partnership for Microbicides to share information and expertise and thereby draw on the complementary strengths of the two organizations.
Other female-specific research has helped illuminate the fact that women are affected by the HIV/AIDS epidemic differently than men. Women suffer gender-specific manifestations as a result of HIV infection and respond differently to antiretroviral therapy, including a higher incidence of drug toxicities. NIAID supports the Womens Interagency HIV Study designed to help us better understand the course of HIV/AIDS disease in women. Frequently, HIV-infected women have more difficultly accessing health care and subsequently are diagnosed at later stages in the disease than men. Major obstacles such as caring for family and lack of social support may interfere with their adherence to treatment regimens. Therefore, we need to expand and support educational and employment opportunities for women and girls to address the harmful effects of inequality that exist for women in both social settings and sexual relationships.
The theme of this year's National Women and Girls HIV/AIDS Awareness Day, "Taking Action to Save Our Lives," is particularly apt. This day provides an opportunity for everyone, particularly women and girls, to take action and advance education, prevention and treatment efforts, to be tested for HIV and to consider participating in an HIV/AIDS clinical trial. Please join me in thanking all the volunteers, educators, researchers, individuals, organizations and institutions involved in the effort to save lives and prevent new infections in women and girls.
Dr. Fauci is director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health in Bethesda, Maryland.