Hadiyah Charles, Community HIV/AIDS Mobilization Project Naina Khanna, WORLD/U.S. Positive Women’s Network HIV Research Catalyst Forum April 21, 2010

 Increase understanding of current landscape of Prevention Research for women  Discuss emerging trends and key issues in prevention research  Identify opportunities for advocacy and further collaboration to improve prevention research for women

 Over 80% of women in U.S. are infected through heterosexual contact  Globally, women are more than 50% of all infections  For women, acquiring HIV is not primarily correlated with having a lot of sex partners or using injection drugs  Factors that correlate with a woman’s risk for acquiring HIV include: poverty; violence; housing instability; food insecurity; and power dynamics in relationships

For women, “risky behavior”  risk for HIV infection

 Why do some women seem to have innate immunity to HIV and others don’t (including genetic markers - HLA)?  How does homophobia impact the epidemic among women?  What kinds of sex are serodiscordant heterosexual couples having; and has it changed since the release of the Swiss study data?  What are the prevention needs of heterosexual men?

 What motivates women or men to use a condom?  Why is seroprevalence higher among WSW than among women who have sex with only men?  What, if any, role does anal sex play in women’s risk for acquiring HIV?  What percentage of women testing positive suspected they were at risk for acquiring HIV?

Behavioral Biomedical Structural

1. (D)EBIs - (Diffused) Effective Behavioral Interventions  compendium of prevention interventions that showed “positive behavioral and/or health outcomes”  Funded by CDC (Centers for Disease Control & Prevention)  17 DEBIs specifically target women 2. Homegrown Interventions: e.g. Healthy Love Workshop by SisterLove, Inc.

 Focus is individual or group level  Promote increased use of condom, fewer partners Limitations:  Numbers reached are relatively small  May not be reaching women at highest risk  Asks women to change behaviors that may not be up to them: male condom; reduced number of partners  Limited cultural relevance

 PreP // pre-exposure prophylaxis (take it before you think you may be exposed) This strategy uses antiretrovirals to reduce the risk of HIV infection in HIV-negative people Currently in trials – nearly 20,000 people are enrolled  How does this apply to women, especially in a U.S. context, who usually don’t perceive themselves as being at risk?  What role does violence PreP play in women’s motivation to use a mechanism like PreP?  Will women utilize PreP?  What impact might MSMW taking PreP have on their female partners?  What happens when PreP becomes PEP?

PEP // post-exposure prophylaxis (take it after you think you may have been exposed: rape; unplanned unprotected sex)  Access, affordability, coverage, implications for health insurance, etc  Limited options during pregnancy

Treatment as Prevention/TLC+ - Studies show if viral load is suppressed to undetectable the likelihood of transmission is low. - ARV treatment of people living with HIV may reduce their infectiousness and improve their outcomes Questions: - What are long term effects of starting treatment earlier? - Does this overemphasize burden of prevention on HIV-positive partner and minimize responsibility of negative partner? - Human rights implications

Currently in development Special considerations for women:  Sex differences in effectiveness  Pregnant women  Women of reproductive potential  Breastfeeding women  Girls and adolescents  Women are under-enrolled

Vaginal and Anal Microbicides (currently in development)  Microbocide is a substance that would reduce risk of contracting HIV when applied vaginally or rectally  Over a dozen trails are ongoing in ten countries  Results are expected in mid 2010

 FC1- female condom 1 was approved by the FDA for use in the US since 1993  FC2 - Female Condom 2 was approved by the FDA for use in the US in March 2009 FC2 offers women a choice, that they can initiate, to provide dual protection against unintended pregnancy and sexually transmitted infection including HIV. The Female Health Company

 Intervene further “upstream” - on factors other than behavior and biology which influence risk  Change balance of power  Economic, policy, social, physical Examples:  IMAGE project - South Africa  2 currently funded pilot CDC projects in Florida  Housing (CHHC)

What about… Health care access (over 50% of HIV+ women not in care in U.S.) Violence prevention Economic opportunity for women Comprehensive Sex Education throughout lifetime?

 How can we most effectively target testing resources for women?  What structural interventions could work in the U.S. and how?  How can structural interventions be integrated with biomedical and behavioral interventions?  How do women want to use PreP?  Are there ways (nutritional, other) to enhance innate immunity for women vulnerable to HIV infection in areas with generalized epidemics?

 AIDS Vaccine Advocacy Coalition  Global Campaign for Microbicides  Prevention Justice Alliance  National Women and AIDS Collective  Chicago Female Condom Campaign – Put a ring on it  Prevention Now!  Happiness and Satisfaction - facebook (FC2)