As we approach the annual observance of National Women and Girls HIV/AIDS Awareness Day next week, we wanted to share another interview we captured at the 2015 Conference on Retroviruses and Opportunistic Infections (CROI). While at CROI in Seattle last week, Dr. Ronald Valdiserri, Deputy Assistant Secretary for Health, Infectious Diseases, spoke with Dr. Gina Brown who leads women and girls and microbicide research activities at NIH’s Office of AIDS Research. She observed that there were many interesting presentations at CROI this year designed to help us better understand and address the many differences and disparities that exist in HIV risk, prevention, care, and treatment among women and girls compared to men.
Observing that the National HIV/AIDS Strategy has sharpened our focus on efforts to improve outcomes along the HIV care continuum, Dr. Brown pointed to a CDC study presented at the conference that provided a better understanding of linkage to HIV care and viral suppression among women in 18 U.S. jurisdictions. The CDC analysis indicates that while high rates (83%) of women diagnosed with HIV were linked to HIV care within 3 months, rates of retention in care and viral suppression were lower and varied by age and race/ethnicity. With fewer than half of American women diagnosed with HIV in the study achieving viral suppression, the CDC analysis underscores the need to improve care and treatment for all women, with a particular focus on younger women, and African American women. (View the presentation and read the abstract ).
Dr. Brown also discussed the disappointing results presented at CROI from a clinical trial that evaluated the safety and effectiveness a vaginal gel used to prevent women from acquiring HIV infection. The lead researcher, Dr. Helen Rees, reported that while the USAID -funded FACTS 001 study involving more than 2,000 women in South Africa demonstrated that the tenofovir gel was safe, it was not effective in preventing HIV infection because the majority of the participants were not able to achieve the levels of adherence needed for protection. Observing that the circumstances of their lives posed a significant barrier for the young women participants’ effective use of this gel, Dr. Rees observed that these findings underscore “the urgent need for a range of HIV prevention options for young women which may be easier to integrate into their lives… What we really need are different technologies that are more forgiving of the challenging lifestyles they have.” The NIH-funded Microbicide Trials Network (MTN) is currently studying a new technology to address adherence issues that tests a potential microbicide (dapivarine) delivered via an intravaginal ring.
Dr. Brown observed though, that a separate study, the HPTN 067 trial, reported more promising findings regarding PrEP adherence among women. That study, also based in South Africa, investigated whether a non-daily versus daily regimen of oral PrEP (in the form of a pill, not a gel), resulted in preventing HIV infection. It concluded that daily dosing resulted in greater adherence and “may foster better habit formation and provide the most forgiveness for missed doses.” (Read the related abstract, 978B, here .)
Finally, Drs. Brown and Valdiserri highlighted a conference discussion about the association of hormonal contraceptives and HIV risk among women. The session, “Hormonal Contraceptives: Enduring Controversy,” explored some of the mechanisms by which contraceptives could increase HIV risk. Dr. Brown observed that among the important topics explored during the session was the fact that a woman’s risk for HIV as well as her risk for unplanned pregnancy, which may also increase morbidity and mortality, both must be considered when designing effective strategies for HIV prevention and treatment for women. (View the videos from this discussion beginning with opening remarks by Dr. Betsy Herold of Albert Einstein College of Medicine. Read the related abstracts beginning on this page .)
Read about Dr. Gina Brown’s observations and watch the video from the 2014 International AIDS Conference in Melbourne.