After over twenty years of searching in the scientific wilderness, researchers have developed an effective vaginal microbicide gel that can block HIV transmission. The gel, laced with the antiretroviral drug tenofovir, can cut overall HIV infection rates by 39 percent and empower women whose intimate partners refuse to use condoms. Despite the hope inherent in this breakthrough, and the international elation that greeted it, funding goals for the follow-up trials needed to confirm these results and begin the process of getting the gel into women's hands have not been met.
If funding does not materialize, an unprecedented opportunity to reduce HIV infection rates among women will be lost. African women comprise the majority of new HIV transmission cases in sub-Saharan Africa and are the group most likely to benefit from the development of this female-controlled HIV prevention tool.
Although condoms remain a highly effective method of HIV prevention, they are male-controlled. If a vaginal microbicide gel that can block HIV arrives on the market it will be a significant leap forward in the struggle for female empowerment and women's health. Women would not have to receive their intimate partners' permission to use the gel, which they could apply before or after sexual intercourse.
Several years ago I, along with colleagues at the Leitner Center for International Law and Justice, co-produced a documentary on women and AIDS in Malawi. After conducting hundreds of interviews with Malawian women throughout the country, we found that women's inability to negotiate condom use in their intimate relationships greatly increased their vulnerability to HIV. This truth is echoed throughout Africa, indeed throughout the world, and it was clear from our interviews that women need a method of protection that they can control.
During our community meetings with rural villagers they reported that it was impossible for women to insist on condom use because their husbands often interpreted such demands as veiled accusations of infidelity. This predicament should not be foreign to many women here in the United States where it can be challenging to negotiate condom use in intimate relationships that are supposed to be monogamous.
The countless Malawian women we interviewed cited poverty and violence as contributing factors to their inability to insist on safe-sex practices with their partners. Malawian men have primary access to land and household assets, which entrenches women's financial dependence. Women whose relationships with male partners are their only viable routes to economic survival have less power to negotiate condom use. "If you don't have unprotected sex, the man won't provide food for the family. You will get nothing," noted Daphne Gondwe, president of the Coalition of Women Living with HIV/AIDS in Malawi. "How are you going to live?"
In addition to economic dependence, domestic violence also contributes to women's inability to insist on condom use. A widowed HIV-positive mother of five feared demanding condom use in her abusive marriage: "I was afraid I might be exposed to HIV, but I couldn't even think about using a condom [with my husband]," she confided. Another HIV-positive woman whose husband assaulted her when she refused sex without a condom simply stated: "I had no power to say no condom, no sex."
Scientific researchers who desperately sought to develop a highly effective anti-retroviral vaginal gel understood that the complex dynamics of intimate partner relationships, especially those marked by economic dependency and violence, highlight the need for female-controlled HIV prevention methods.
In July, researchers in South Africa announced the breakthrough microbicide trial's results at the International AIDS Conference. They conducted the study in both a rural and urban area in South Africa and revealed that HIV-negative women who used the tenofovir-laced microbicide gel in 80 percent of their sex acts decreased their chances of contracting HIV by 54 percent. With average adherence, the HIV infection rate was reduced by 39 percent.
Despite the South African trial's great promise, less than 60 percent of the $100 million needed to fund subsequent research has been pledged, as donors shift from HIV efforts to other global health issues. Although global health priorities like maternal and child health should be major concerns for governments and private donors, we must not forfeit the opportunity to give women the tools they need to protect themselves from HIV.
African women make up 60 percent of new HIV transmissions in Africa. That number jumps to 75 percent for young African women between the ages of 15 and 24. If governments and private donors pledge the funds for two more trials to confirm the groundbreaking South African research, then the full-scale production, marketing, and public education needed to get the gel into women's hands and confront these staggering statistics can begin. Millions of women's lives hang in the balance.
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