Speaking Out

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Wed Aug 18, 2010

Finally a Woman-Controlled Way to Prevent HIV

By Sohaila Abdulali

Last month offered a rare and wonderful opportunity for anyone connected with HIV/AIDS to cheer, celebrate, and hope. The Centre for the AIDS Programme of Research in South Africa (CAPRISA 004) trial found that a vaginal gel containing a common AIDS drug can reduce a woman’s risk of becoming infected with HIV by 39%.

This is fantastic news, and while further research needs to be done, it is the most significant step yet in the search for an effective microbicide — something that blocks or kills microorganisms. 

When AZT, the first antiretroviral drug, was introduced in the 80’s, the world experienced a similar lift as people at the point of death were miraculously given hope. Tenofovir, the active ingredient in CAPRISA 004, has been used for treatment, along with AZT, and now it may become a vital part of prevention.

The study included almost 900 women from an at-risk population in Durban, South Africa. They used the gel up to 12 hours before and as soon as possible up to 12 hours after having intercourse. Not only did the gel block HIV, but it was also 51% effective in preventing HSV-2, a type of genital herpes. This is important because the presence of genital herpes increases one’s susceptibility to HIV. About 80% of HIV-positive people suffer from HSV-2, according to The Lancet. 

If further research continues to show promise, the gel could be available to women in about four years. CAPRISA researchers say that the gel, at this level of protection, could prevent 500,000 new HIV infections in the next ten years in South Africa alone. 

We know that condoms are highly effective in preventing transmission. Why, then, is there such excitement at the prospect of another preventive method that is only 39% effective? This moment of optimism and achievement shines an uncomfortable light on the grim reality of just how badly off women are when it comes to controlling their own lives. 

In almost every culture, men have more control over their sexual lives than women do. A highly effective condom offers a woman no protection at all if her husband, lover or client refuses to use it and she cannot insist. Leaving aside extremely coercive situations of rape and assault, millions of women do not have the power to choose when and if to have safe sex with their partners. For these women, 39% protection is a vast improvement over 0%.

So, yes, the CAPRISA results are cause for celebration. The wild applause that greeted the announcement at last month’s International AIDS Conference was more than justified. But the disturbing fact remains that part of our ecstatic response is the tacit acknowledgement that too often women cannot protect themselves in the most effective possible way, and they will not be able to do this as long as they are discriminated against economically, socially and politically.