Women at Durban
Globally, women and girls comprise the growing majority of people living with HIV. Reflecting this shift in the epidemic was an increased focus on women's issues at the 13th International Conference on AIDS. In all of its sessions, the conference grappled with many of the issues facing women and girls living with, and at risk for, HIV. Appropriately, many of the discussions focused on the plight of women in sub-Saharan Africa and other resource-poor areas. Nearly all sessions highlighted the inequities in human rights, HIV care and resources between sexes, classes and nations.
While there were no groundbreaking developments in basic science or the treatment and care of HIV+ women, the conference did break ground by providing attendees with a clear understanding of just how much this disease impacts women in the developing world. Moreover, it left attendees with a better sense of the difficult work that lies ahead and a renewed desire to undertake that work.
A Focus on Prevention
Preventing mother-to-child HIV transmission was one of the major themes of the conference. Results from several studies suggest that very short courses of therapy with either nevirapine (Viramune), or AZT (Retrovir, zidovudine), or AZT and 3TC (Epivir, lamivudine, the combination of AZT and 3TC is Combivir), are able to lower transmission rates by about 50%. With better access to therapy, a significant reduction in vertical transmission rates in resource poor countries is possible.
The Achilles Heel of preventing mother-to-child HIV transmission remains breast-feedinga necessity for many women around the world. Two major studies report a decrease in the protective effect of short-course anti-HIV therapy to reduce transmission as a result of breast-feeding. By 12 to 18 months after birth, transmission rates rose to 24% and then 30%, respectively, as babies became infected via breast-feeding. Thus, strategies to reduce mother-to-child transmission must address related social and economic issues, such as feeding children.
Several studies are now looking at different strategies for safer breast-feeding. Early results from one study suggest that mixed breast-feedingbreast milk supplemented with cereal, juice, water and so forthhas higher risk of transmission compared to exclusive breast-feeding. The HIV transmission rates at 15 months were 19.4% in formula-fed infants, 24.7% in infants exclusively breast-fed and 35% in mixed-fed infants. More study is needed to determine the reason for these surprising results.
Challenges to stem the unabated spread of HIV among women garnered considerably less attention than decreasing mother-to-child transmission. Many sessions described the social, cultural and economic factors that must be addressed to decrease transmission rates among women. However, few sessions were able to offer concrete and presently attainable responses to address the problems.
In the future, one potentially effective tool may be microbicides, which include gels and lubricants that hopefully destroy HIV on contact. The goal with microbicides is to provide people with something they can apply, like a vaginal or rectal suppository, that would help them prevent infection. This approach might be particularly useful for people who have a difficult time negotiating safer sex and/or people in resource poor countries where obstacles exist to condom availability or use. If safe and effective microbicides are developed, they may one day be a standard part of HIV prevention.
There were several sessions on microbicides, much of which highlighted some negative data linked to the use of nonoxynol-9, a spermicide found in many lubricants as well as lubricated condoms. Fortunately, a number of other microbicides are being studied now, including topical solutions of anti-HIV therapies. Several other products are also in late-stage development. Hopefully, products will soon be on the market to help reduce sexual transmission of HIV and other diseases.
Treatment and Care
While new data were presented on new therapies and strategies for anti-HIV treatment, there was little specific to women.
Study results presented at the conference largely confirmed much of what we already know. These included studies reporting that women have different side effect patterns with certain drugs, that body composition changes may appear differently in women, that human papilloma virus (HPV, the virus associated with cervical and anal cancer), including anal HPV, is a persistent problem for positive women and that viral load and viral dynamics may differ between the sexes.
Comprehensive coverage of these and other topics specific to positive women, presented at the recent Durban conference, will be in the forthcoming issue of WISE Words, Project Inform's treatment newsletter for women. To receive WISE Words, call Project Inform's Hotline at 1-800-822-7422.
This article was provided by Project Inform. It is a part of the publication Project Inform Perspective. Visit Project Inform's website to find out more about their activities, publications and services.