Preventing the onslaught of the disease is as important as controlling
it
There is growing emphasis on
preventing the transmission of HIV as being easily as important as seeking a
cure once the disease is contracted.
The recently concluded XIX
International AIDS Conference in Washington, DC concentrated on a range of
AIDS-related interventions, with prevention one of the most important.
"We have to address the
needs, challenges and opportunities for development of multiple prevention
technologies that would provide simultaneous protection against HIV, other sexually
transmitted infections and unintended pregnancies" said Dr Helen Rees,
Executive Director, Wits Reproductive Health and HIV Institute, University of
the Witwatersrand, South Africa, co-chaired a satellite session at on
combination prfevention methods for women.
Dr Rees echoed what Badri Saxena,
president of Microbicides Society of India, said to before the Wasington
conference opened.
"There is not one preventive
product for HIV,” Saxena said. “There have to be several tools available -
microbicides, vaccines and, in some cases, male circumcision, among others. And
there has to be better use of existing methods like the male and female
condoms. When there was a big epidemic of HIV/AIDS in the 1980s America turned
the tide by effective use of barrier preventive products like condoms and safer
sex practices.”
For countries like India, Africa
and China the healthcare delivery systems must improve the implementation and
effectiveness of existing technologies, and then work for newer technologies,
Saxena continued.
“This requires training of
manpower, more public participation and safe sexual practices and behavior. In
India non-HIV sexually transmitted infections like Human Papilloma Virus and
cervical cancer are a big problem with an estimated 3 million people suffering
from them every year. These people are at risk for HIV, so better control of
such infections is more essential to prevent HIV in the country. New
technologies are welcome because no one method suits all, and it is for men and
women who are most at risk to choose."
Multiple prevention technologies
for sexual and reproductive health, also called combination or dual
technologies, include vaccines, microbicides and devices like intravaginal
rings and diaphragms and are designed to address multiple sexual and
reproductive health needs, including prevention of unintended pregnancies,
sexually transmitted diseases including HIV, and other reproductive tract
infections.
Multiple prevention technologies
are some of the most innovative health products under development to
simultaneously prevent unintended pregnancies and sexually transmitted
infections including HIV. Technologies that are safe, acceptable, affordable
and easily available can improve health across the world.
Promising innovations include
multipurpose vaccines and gels, easier-to-use vaginal rings and single-sized
diaphragms that may provide simultaneous protection against unintended
pregnancy and infection and have a major impact on the health of women and their
families. New microbicide gels can lead to declines in HIV and STIs while
contraceptive technologies appropriate for dual use can increase the positive
global health impacts of family planning.
The pipeline of multiple
technology products currently relies on combining anti-retroviral drugs and
hormonal contraceptives. At present one antiu-retroviral, tenovofir, has proof
of concept as a topical agent and another, dapivirine, will enter clinical
efficacy testing in rings in 2012.
Women worldwide bear the social,
health and economic burden of unintended pregnancies and STIs which are great
public health challenges. Unprotected sex puts women at simultaneous risk of
HIV, other sexually transmitted infections and unintended pregnancy—all of
which can impose heavy burdens on mortality and morbidity. Multipurpose
technologies integrating contraception and prevention of HIV and other sexually
transmitted infections would address these combined risks and, with improved
uptake, enhance public health impact. Effective, safe and affordable such
technologies would save lives and money and improve the health of women and
their families worldwide.
According to the World Health
Organization, every day more than 1,000 women die from preventable causes
related to pregnancy and childbirth (358,000 annually) with 99 percent of these
deaths occurring in developing countries. Also, 215 million women experience
the unmet need of family planning as they lack access to information and
services and/or support of their partners and communities.
This not only leads to population
growth, but also compromises women's health and economic prospects. There are
86 million unintended pregnancies and 4 million newborn deaths worldwide
annually, and 16.8 million women are living with HIV. For women in their
reproductive years (15-49) HIV/AIDS was the leading cause of death and disease
worldwide in 2009.
Women are five times more likely
to get sexually transmitted infections than men. Each day about 500,000 young
people, mostly women, contract a sexually transmitted infection. Africa and
South Asia are the two regions hit hardest by high rates of fertility, HIV and
HPV, all of which contribute to an unacceptable high percentage of women’s
deaths in this region.
Different global regions have
different reproductive health needs and public health priorities, so priorities
for multiple prevention therapy research and development will also differ. So
we need to identify products with highest potential for public health impact.
Emerging therapies include drug combinations, drug and device combinations,
bacterial therapeutics, multivalent vaccines and nano-particles. Key attributes
of these devices should be: storage at high temperatures; long shelf life;
concealable presentation; no life style effects; easy access in low resource
settings. There is variability in needs/priorities across different regions. In
sub Saharan Africa it is HIV and pregnancy with STI emphasis on HSV2, BV, TV
and HPV. In India it is pregnancy and HIV. IN China it is HIV/STI.
Thus the path to an ideal MPT is
not linear as there are many challenges to overcome - regional differences,
unique product specific regulatory considerations, hormonal contraception and
HIV relationship, trial designs to test efficacy without placebo control, and
above all resources (money, trial capacity, participants, development
partnerships).
Today’s technologies are not
meeting the health needs of women. Current prevention methods for any major
risk are limited, nonexistent or partner dependent and also there are many
constraints on access to and use of available methods. Most available methods
address single indications. there is an urgent need to bring together
researchers, healthcare providers, policy makers, health care providers, policy
makers, advocates, product developers and donors to develop MPTs to protect
women against unintended pregnancies, STIs and RTIs.
Technologies that can
simultaneously address multiple sexual and reproductive health and rights needs
will go a long way in helping women. Such products can help policymakers meet
multiple health and development goals.
The consequences of unsafe sex
are among the greatest public health challenges of our times. Women and their
families risk unintended pregnancies, as well as HIV and other infections,
leading to maternal mortality, low rates of child survival and a poor quality
of life. While their needs may vary according to where they live and their
stage of life, all women could benefit by improved prevention methods for reproductive
health. MPTs, though still in the development stages, can empower women and
decrease maternal mortality, improve child survival and health, enable women to
get better education and improve the economic opportunities for women.
Shobha Shukla
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