One-fourth of Americans living with HIV are women. In the United States, the disease disproportionately impacts women of color: The HIV infection rate among Black women is 15 times that of white women and the rate among Hispanic women is more than four times that of white women, according to the most recent data from the Centers for Disease Control and Prevention (CDC). Further, women and men have different biological, psychological, and cultural factors that increase their vulnerability to infection and disease progression. Achieving the goals of the National HIV/AIDS Strategy (NHAS) will require addressing the unique HIV prevention, care and treatment needs of women in the United States. With that in mind, I wanted to share a number of recent events that will help move all of us closer to achieving the goals of the NHAS for women in America.
HIV Testing and Counseling Included in Women’s Preventive Health Services Guidelines
Last week, the U.S. Department of Health and Human Services (HHS) announced historic new guidelines that will ensure women receive preventive health services, including HIV testing and counseling, at no additional cost. Developed by the independent Institute of Medicine, the new guidelines require new health insurance plans to cover women’s preventive services such as well-woman visits, breastfeeding support, domestic violence screening, and contraception– without charging a co-payment, co-insurance or a deductible. Under these guidelines, sexually active women will have access to annual screening and counseling on HIV (and sexually transmitted infections (STIs)). This is an important step toward making HIV screening a routine part of health care, as recommended by the CDC, and will bring us closer to identifying the 21 percent of people who are HIV-infected, but do not know it. New health plans will need to include these services without cost sharing for insurance policies with plan years beginning on or after August 1, 2012.
White House and HHS Consultations on Women and HIV/AIDS
Late last month, both the White House Office of National AIDS Policy and the Department of Health and Human Services convened consultations on efforts to address HIV/AIDS among American women. At the White House meeting, Jeffrey Crowley, Director of the Office of National AIDS Policy (ONAP), and Tina Tchen, Chief of Staff to the First Lady and Executive Director of the White House Council on Women and Girls, and senior HHS officials met with a group of women concerned about HIV/AIDS from across the nation. During this meeting, the group heard from representatives of the National Institutes of Health (NIH), CDC, and the Health Services and Resources Administration’s (HRSA) Ryan White AIDS program about activities underway in each agency that specifically focus on the prevention, care, and treatment needs of women living with or at risk for HIV.
The following day, a larger group of women, gathered for a meeting convened by the HHS Office on Women’s Health, one of the 14 core public health offices under the direction of the Assistant Secretary for Health. During the day-long meeting, participants dialogued about the impact of the National HIV/AIDS Strategy on women and girls and had the opportunity to share their thoughts with the Deputy Assistant Secretaries of Health for both Women’s Health and Infectious Diseases. In addition, representatives of CDC, the Centers for Medicaid and Medicare Services (CMS), NIH, HRSA, and the Substance Abuse and Mental Health Services Administration (SAMHSA) discussed how their HIV/AIDS portfolios are responding to the epidemic in women and what future directions they are considering. Themes that emerged from both meetings were: the importance of integrating sexual and reproductive health with HIV/AIDS efforts; the need for age-appropriate comprehensive sexuality education across the lifespan; and the need to identify and share emerging trends in new HIV infections among women so that partners across sectors can tailor responsive interventions quickly.
NHAS Implementation Update Features Several Achievements Benefiting Women
The brief National HIV/AIDS Strategy Implementation Update—released last month by the White House on the one-year anniversary of the President’s release of the Strategy—highlighted several key first-year achievements specifically relevant to addressing HIV among women. These included:
- The Food and Drug Administration’s (FDA) approval of a fourth generation HIV diagnostic test that allows for earlier detection of HIV. The new test is approved for use with pregnant women and, if properly administered, can help identify HIV infection and reduce its transmission during pregnancy.
- Announcements from NIH of several successful groundbreaking studies that have significant implications for women. Of particular note are the CAPRISA 004 findings, which demonstrated successful proof-of-concept for a female controlled prevention method in the form of a microbicide gel that reduces the risk of HIV infection in HIV-negative women.
Promising Recent HIV Prevention Clinical Trial Results
In addition, to the CAPRISA study, two more clinical trials recently announced promising findings with specific relevance for HIV prevention among women. The results from the NIH-supported HPTN 052 study were the first from a major randomized clinical trial to indicate that treating an HIV-infected individual can reduce the risk of sexual transmission of HIV to an uninfected partner. Then, the recently announced findings of the TDF2 study, conducted by CDC in partnership with the Botswana Ministry of Health, found that a once-daily pill containing two anti-HIV drugs reduced the risk of acquiring HIV infection among uninfected individuals exposed to the virus through heterosexual sex. The strategy of providing daily oral antiretroviral drugs to uninfected individuals prior to HIV exposure is called pre-exposure prophylaxis, or PrEP.
HHS Launches Updated Women and HIV Web Content
Finally, the NHAS calls on all of us to “educate all Americans about the threat of HIV and how to prevent it.” In support of that goal, the HHS Office on Women’s Health has recently updated and re-launched the Women and HIV/AIDS pages on womenshealth.gov, the Department’s online information source on a broad range of women’s health issues. The site covers topics including women’s risk for HIV, preventing HIV infection, getting tested for HIV, living with HIV, and HIV/AIDS research and clinical trials for women. I encourage you to visit the site to learn more and to join our efforts to educate more Americans about HIV/AIDS by sharing the site with friends and family members.
Ultimately, for the Strategy to be truly successful for women—and for all Americans—we need your support! The Strategy isn’t about what government can do alone. We need individuals—like you—as well as organizations and communities to complement federal activities with their own strategic steps aligned with the Strategy’s priorities. What actions are you or your organization taking to address HIV education, testing, prevention and/or care for women? Please share your thoughts and join the discussion in the Comments section below.