This report was provided to The Root by the Black AIDS Institute's media delegation to the AIDS 2010 conference in Vienna, Austria. The writer, Linda Villarosa, is a member of that delegation and a regular contributor to The Root.
In a groundbreaking study, a gel made using an antiretroviral drug was found to be effective in reducing a woman's risk of becoming infected with HIV. This is the first time in history that this kind of topical medication, known as a microbicide, has worked, despite many earlier trials. The research broke yesterday at the International AIDS Conference in Vienna and is widely believed to be the biggest news that will come out of the six-day event.
Though the results will need to be confirmed and a product won't hit the market for at least a few years, this news marks a major stride for women around the world, particularly in Africa and in African-American communities. It will finally offer a female-controlled way for women to protect themselves in the sexual arena, where men, too often, call all the shots.
Gel containing the drug tenofovir and applicators. (blackaids.org)
"This becomes a self-empowerment resource for black women, who are disproportionately impacted among all women with HIV," said C. Virginia Fields, president and CEO of the National Black Leadership Commission on AIDS. "This would provide a much-needed tool in our arsenal against HIV, given that there are so few effective interventions targeting women of color. Ideally, it will stem the tide of increased infections."
The study of 889 uninfected black women, ages 18 to 40, in rural and urban KwaZulu-Natal, South Africa, found that the gel containing the HIV drug tenofovir (currently prescribed in pill form under the trade name Viread) cut the risk of infections by 39 percent. Among the women who used it consistently and correctly, the results were even better: 54 percent effectiveness. Either way you look at it, in the science world these numbers signal a major coup.
"When we sat down at the table to finally see the results, it hit us — this works — and we were stunned. In fact, we didn't say anything for a full minute," said Dr. Salim S. Abdool Karim, director of the Centre for the AIDS Programme of Research in South Africa (CAPRISA), located in Durban. Late last night, he and his wife spoke to a small delegation of black journalists who had traveled to Vienna. The two researchers of color provided this exclusive access to assure that African Americans got the full story the night before the couple presented their results to the full conference. When the scientists unveiled their findings at 1 p.m. Vienna time, thousands listened. Even the overflow room was full, as participants crowded around screens in the hall, applauding as Drs. Abdool Karim spoke.
This kind of breakthrough is urgently needed. In sub-Saharan Africa, where the epidemic is most dramatic and deadly, 22.4 million are living with HIV, and every year millions more become newly infected. Women account for almost two-thirds of those living with HIV in the region, and young women, often poor and powerless, bear the brunt of the epidemic. South Africa, where the study took place, has more people living with HIV than any other country in the world.
Dr. Quarraisha Abdool Karim explained that the research grew out of frustration at not being able to offer protection to women who would come into clinics where she worked in South Africa. "When they asked us what can we do to protect ourselves, we had nothing to offer them," she said. "Abstinence? They were married or in a stable relationship — no. Behavior change? They were faithful but not sure about their partners' faithfulness. Condoms? Men don’t want to wear condoms, and at the time there was no female condom.
"So today, although we don’t have the microbicide," she continued, "the results signal hope for women that they will have something that is 39 percent more effective than nothing."
In the United States, the disease continues to ravage African Americans. A number of communities have rates of infection as high as or higher than in some African countries. Black men and women represent only 13 percent of the American population but account for almost 50 percent of people living with HIV and just about half of new infections. Sixty-four percent of all women living with HIV/AIDS are black, and the diagnosis rate is 19 times higher than it is for white women. A government study released in March found that 50 percent of black women have genital herpes.
The vast majority of African-American women contract both herpes and HIV during heterosexual sex, most often from men they are married to or at least seriously involved with. This point strikes at the heart of why a woman-controlled form of protection is so important.
"This lets women take control of their own sexual health, instead of depending on husbands and boyfriends to protect them," said Vanessa Johnson, deputy executive director of the National Association of People With AIDS.
"It also potentially gives women living with HIV/AIDS a valuable means of not transmitting their HIV to others," continued Johnson, who contracted HIV from a former boyfriend and has been living with HIV for 20 years. "We have high hopes." Experts aren't sure whether this product protects against either female-to-male or anal transmission of HIV. The study didn’t look at either.
Participants in the study were sexually active and applied the gel both 12 hours before and 12 hours after sex. It is inserted into the vagina with a plastic applicator. Half of the women used a product that contained the drug, while the other half received a placebo: gel with no medication added. Sixty of the 444 women who used the placebo contracted HIV, compared with 38 of the 445 women who used the gel containing tenofovir. The region where the study participants come from is considered the "epicenter of South Africa's explosive HIV epidemic," where women engage in infrequent but every high-risk sex with migrant men.
Despite the promising results, experts advise women to celebrate, but cautiously. "This is great news, but it is not 100 percent effective," said Dr. Hilda Hutcherson, a clinical professor of obstetrics and gynecology at Columbia University and author of a number of books, including Pleasure: A Woman's Guide to Getting the Sex You Want, Need and Deserve. "We must continue to recommend condoms for protection against HIV.
"I think this will be most useful for married women who feel that they can't use a condom, but might be suspicious and want that bit of protection without demanding condom use," Dr. Hutcherson added. "However, I would personally demand the condom if I thought my husband was cheating."
It's important to remember that most black women in the United States with HIV contracted it from men who didn't know they were infected with the virus. One in five Americans aren't aware of their HIV status, and blacks are believed to be less likely to know. A woman who has no idea her partner is positive wouldn't see a reason to use the gel.
Though the study pointed to the gel's safety, best to keep expectations in check until more is known, urges Gail E. Wyatt, Ph.D., a UCLA professor of psychiatry and biobehavioral sciences, and associate director of the UCLA AIDS Institute. "If confirmed, the microbicide has potential to save women's lives, but the research needs to be carefully read and understood," said Dr. Wyatt, also the author, with her husband, of the book No More Clueless Sex. "The efficacy of the trial is promising, but the study also needs to be replicated in America before passing judgment."
Dr. Abdool Karim said he'll also feel more confident once the results are repeated. Another project called the VOICE study is currently looking at 5,000 African women, comparing a gel compound with HIV medication in pill form. Findings are expected in 2013.
"In the scientific community, we need to think about what it is going to take for all of us to work together to make this a reality," he said. "I would be disappointed if we were not able to make a microbicide tenofovir gel available in three years."
In the meantime, in Vienna, conference attendees are buzzing with the news.
"The microbicide trial results are fantastic. Women deserve a win," says Ebony, a young HIV-positive African-American woman living in Amsterdam and attending the conference as an activist. "A microbicide gives women choice and control; however, the work can't end there. We still need the female condom and male condoms to prevent unwanted pregnancies and other STIs, and a non-antiviral microbicide that can meet the needs of women living with HIV."
Linda Villarosa directs the journalism program at City College in New York. She has covered the International AIDS Conference five times.