Gender Equality in AIDS Prevention: Why We Need Prevention Options for Women

HIV/AIDS Is Rapidly Becoming a Women's Epidemic

• Approximately 6,800 people become infected with HIV every day. Half of them are women. In 2007, 61% of the people living with HIV/AIDS in sub-Saharan Africa were women and girls; the majority had only one mode of exposure to HIV -- sex with their intimate partners (UNAIDS).

• In India, there are approximately 1 million women living with HIV, representing 40% of the HIV positive population.

• Among African youth (15-24 years old), three quarters (76%) of those who are HIV positive are female. In some countries, girls are 5-6 times more likely to have HIV than their male peers.
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• In Eastern Europe, women (many of them younger than 25 years of age) bear a growing part of the HIV burden -- they accounted for 41% of new reported HIV infections.

Women Are Biologically More Vulnerable to Infection and Its Consequences

• Women are at least twice as likely as men to contract HIV from unprotected intercourse.

• Vaginal membranes are exposed to infectious fluids for hours after sex. Younger women are at greatest risk because the immature cervix is more vulnerable to damage and infection.

• Sexually transmitted infections (STIs) often go undetected, and therefore untreated, in women. STIs increase women's vulnerability to HIV. In addition, untreated STIs can lead to infertility, ectopic (tubal) pregnancy, infant mortality, and cervical cancer.

Gender Inequities Prevent Many Women From Being Able to Protect Themselves

• Millions of women lack the social and economic power to insist on HIV prevention measures such as condoms, abstinence or mutual monogamy. Male and female condom use requires the tacit cooperation, if not outright participation, of a woman's male partner.

• HIV risk escalates among adolescent girls because of their physical vulnerability and their susceptibility to rape, forced marriage, trafficking, economic dependence and coercion.

• Violence, coercion, and economic dependency render millions of women of all ages unable to "negotiate" condom use or to abandon partners who put them at risk. Millions live in societies that permit them no role in sexual decision-making, condone male infidelity and assign to women the burden of shame and stigma associated with infectious disease.

• Increasing economic inequality and eroding social support networks drive many women to sell or trade sex to support their families.

• Many women want to get pregnant -- for their own reasons and/or to achieve the status and security that, in many societies, they can only attain through motherhood. Since condoms are contraceptive, women now have to choose between childbearing and HIV prevention.

HIV Prevention Strategies Must Address Women's Needs and Vulnerabilities

Women need education, economic opportunity, and social support.

Women need gender equality in order to protect their health and rights.

Women need HIV and STI prevention tools they can control.

Women need microbicides.

What Are Microbicides (Mi-KRO'-bi-sidz)?

"Microbicides" are products designed to help prevent the sexual transmission of HIV and other STIs when applied topically. A microbicide could be produced in many forms, including gels, creams, pessaries (suppositories), films, or as a sponge or ring that releases the active ingredient over time.

Would a Microbicide Eliminate the Need for Condoms?

No. Microbicides alone will probably never be as effective as correctly used condoms. They will, however, offer back-up protection for condom users. They will also offer a real prevention alternative for people who can't or don't use condoms. Researchers have shown that, if even 20% of women in 73 lower income countries used a 60% effective microbicide in half the sex acts where condoms aren't used, 2.5 million HIV infections could be averted over 3 years.

What If a Woman Wants to Get Pregnant?

Some of the microbicides being investigated prevent pregnancy and some do not. We need contraceptive ("dual-action") microbicides to prevent both pregnancy and disease and non-contraceptive microbicides to enable women to protect their health and still have children. This is not possible with condoms.

Would Men Benefit From Microbicides as Well?

By using a bi-directional microbicides (one that disables HIV in both semen and vaginal secretions), HIV positive women may be able to help protect their partners from HIV infection. It may also be possible to develop microbicides that can be used rectally, but the safety and effectiveness of microbicides for rectal use must be established separately. Rectal safety studies of some potential microbicides are now beginning.

Who Is Working on Microbicide Research and Development?

Virtually all microbicide research to date has been conducted by non-profit and academic institutions or small biotech companies. Studies are funded by charitable foundations and government grants. These public funds also support basic science, social and behavioural research, and clinical trial infrastructure that contribute to microbicide research and development. Large pharmaceutical companies have not invested significantly in this field, primarily because microbicides are a classic "public health good" which would yield tremendous benefits to society but for which the profit incentive to private investment is low.

Why Do We Need Microbicides If We Will Eventually Have an HIV-Vaccine?

No one strategy or technology will end the AIDS pandemic. We need existing prevention strategies -- such as behaviour change, voluntary counselling and testing, access to clean needles and syringes, STI diagnosis and treatment, broad access to male and female condoms, and anti-retroviral drugs -- and new tools such as microbicides and vaccines. Once developed, these new technologies will meet specific areas of need, with microbicides putting prevention options directly in women's hands.

Why Aren't Microbicides Available Now?

Scientists have identified more than 50 product leads and are testing them to find out which ones could be safe and effective for regular use. Unfortunately, not enough public funding is available to move their research along efficiently. Getting a safe, effective microbicide on the shelves in the near future doesn't depend as much on the speed of scientific progress as it does on increasing the level of funding to support research, development and access. If we want microbicides, we have to demand sufficient public funding to develop them without delay.