Investments in empowering women, as recently pointed out by Nancy Gibbs in Time magazine, can yield vast returns in terms of health and development impact. But it's a hard battle -- women in many developing societies are deprived of resources and disadvantaged when it comes to protecting themselves from exposure to sexually transmitted disease and having control over their own fertility. As noted by Gibbs, today 1 in 7 girls in the developing world are married by the age of 15.
Empowering women -- making even limited progress in the overall battle -- is a particular challenge when it comes to the dominant global health challenge of the last generation, HIV. Despite increasing investments, more than twice as many persons are newly infected each year as receive treatment. Women represent over half of the currently infected population globally, and as a proportion of new infections, rates among women are still growing in many parts of the world (UNAIDS 2010).
But there is new promise -- for women especially, and for men as well -- when it comes to HIV prevention, promise found in clinical research and mobile technology.
In the past year, two trials have demonstrated that the antiretroviral (ARV) drugs used to treat HIV could also be used to prevent people from contracting the virus in the first place, the Holy Grail of intervention. The first study, conducted among women in South Africa, showed that the use of a topical gel could reduce acquisition of HIV in women by 39% or more. The gel is applied vaginally before and after sex and thereby gives women a tool to protect themselves from infection without having to engage in an often unequal negotiation with partners, as is the case with condom usage.
The second study, this one among men who have sex with men but equally important to women as a proof of concept, showed that use of a pill can reduce HIV acquisition by 44%. The research community is now eagerly awaiting the results of several ongoing trials of this same ARV intervention among women, with the expectation that we will see additional woman-controlled prevention intervention added to our arsenal.
At the same time, the emergence of mobile technologies and social networks is placing power in the hands of women, as they leapfrog traditional communications infrastructures with a minimum of investment, making the networks easier, more widely accessible and less expensive to build out. These mobile technologies have penetrated most rapidly in Asia, the Middle East, and Africa where, by the end of 2011, nearly two-thirds of the population will have access.
Our opportunities as public health professionals, private industry, entrepreneurs, policy-makers, donors and community members to use these tools to improve health outcomes and development efforts are limited mainly by our own creativity. mHealth, the general term applied to all health-focused mobile applications, capitalizes on the acceleration of mobile infrastructure to provide vulnerable people with the information necessary to take a more active role in their own health. The availability of cell phones allows flow of data, access to support networks, appointment reminders. For women, they allow access traditionally denied.
In Kenya and Tanzania, text messaging has already been put to use to distribute schedules for community-based distribution of injectable contraception. Another text-based campaign in Kenya, Mobile for Reproductive Health, gives women access to information about different types of contraception.
Because of its relatively low cost and extraordinary potential for putting women in charge of their health, interest in mHealth has political support at the highest level. Last October, for example, the State Department, together with the Cherie Blair Foundation and GSMA, launched mWomen which aims to cut in half the gender gap in women's access to mobile phones over the next three years.
So where do we go from here in optimizing the benefit of these opportunities for health and development, and in particular, to help women? The first step is to prepare for the rollout of ARV regimens for prevention, ensuring successful delivery to the highest risk populations. Concurrently, we need to hype the proven advantages of mHealth strategies to attract further funding, build infrastructure, and put equipment into the hands of women. This will empower them to live healthy lives, and thereby lay the groundwork for financial stability.
Winning the fight to empower women will require all of us with an interest in global health and development to bring adequate resources, smart and coordinated strategies, and our total commitment to fully developing these HIV-prevention and communications tools. It would be more than a shame not to maximize this moment of opportunity to advance women's empowerment.
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