Expanding Prevention Options for Women and Girls Deirdre Grant, AIDS Vaccine Advocacy Coalition Arwa Meijer, Global Campaign for Microbicides Kimberly Whipkey, Center for Health and Gender Equity Youth Pre-Conference, XVII International AIDS Conference July 31, 2008

Female and male condoms, clean needles, male circumcision, VCT Vaginal and rectal microbicides, PrEP, vaccines… Towards universal access Prevention & Testing TreatmentTrials Develop for tomorrow Deliver today A comprehensive, integrated & sustained response

Why We Need Female-Initiated and Controlled Methods Biology  Women are 2-4 times more likely than men to get HIV from unprotected sex Economics  Economic need or dependency  Less able to assert their rights Social and Cultural  Gender norms about sexuality  Gender based violence Current methods (abstinence, fidelity, and condom use) often require male consent, participation & cooperation

4 HSV-2 Suppressive therapy Cervical Barriers: vaginal diaphragms Male circumcision Exposure prophylaxis MTCT PEP PrEP Immunisation: Vaccines Behavioural Intervention (ABC) HIV PREVENTION Microbicides Male and Female Condoms Voluntary Counseling & Testing STI Treatment Strategies

Prior to exposure Point of transmission After infection Male and female condoms Anti-retroviral therapy (mother-to- child) Post exposure prophylaxis (PEP) Anti-retroviral therapy Care Education & Behavioral change Education & Behavior change Male circumcision Preventive Vaccines Pre-ex p osure prophylaxis (PrEP) HSV2 suppression Microbicides Diaphragm, cervical barriers & new FCs Therapeutic Vaccines HIV/AIDS Toolkit

Female Barrier - Diaphragm Male Circumcision - Susceptibility Microbicides - Carraguard Male Circumcision - Infectiousness Microbicides BG/Pro2000 CS – 1 CS – 2 Pro2000 TDF Oral PrEP - IDU HSV-2 Treatment - Infectiousness HSV-2 Treatment – Susceptibility Oral PrEP MSM Heterosexual 2012 Index Partner Treatment Vaccines - Adenovirus1 Adenovirus 2 Vaccines - Prime/Boost Community VCT and HIV Support Oral PrEP - West Africa Research that Could Redefine Prevention, 9/06 See also

` Research That Is Redefining Prevention, 8/ Female Barrier Diaphragm Male Circumcision – Susceptibility Microbicides – Carraguard Male Circumcision – Infectiousness Microbicides BG/Pro2000 Pro2000 Oral PrEP – IDU/Thai HSV-2 Treatment – Infectiousness HSV-2 Treatment – Susceptibility Oral PrEP MSM (iPrEx) Heterosexual (Botswana) Index Partner Treatment Vaccine – VRC PAVE 100 Vaccines – Thai Prime/Boost Community VCT and HIV Support Oral PrEP – West Africa Microbicides – CS-1 CS-2 Vaccine – Merck Adeno x2 STEP/Phambili Vaginal & Oral PrEP (VOICE) Oral PrEP Heterosexual (FemPrEP & Partners) Microbicides TDF/PMPA (CAPRISA)

Basic research Pre-clinical studies Clinical Phase I Phase II/IIB/III Efficacy Basic science Translational research Clinical trials From the lab to you

Vaccine, microbicide, PrEP, etc. Placebo How do you know if it works?

Female Condoms: An Overview Kimberly Whipkey Advocacy and Outreach Associate Center for Health and Gender Equity

What are Female Condoms? Female Health Company FC1 and FC2 PATH Woman’s Condom VA-Feminine Condom aka Reddy Female Condom Female condoms are currently the only available and effective method to prevent HIV, as well as STIs, that are designed for women to initiate. Correct use of FCs reduces the per-act probability of HIV transmission by 97%* * Trussell et al

Why Female Condoms? Woman-initiated and available for use now Dual protection against HIV and unwanted pregnancy Many potential benefits for HIV+ women Increases total number of protected sex acts Widespread acceptability Tool for negotiation Source of pleasure Alternative to male condom for MSM and anal sex Prepares consumers, policy makers and distributors for future interventions such as microbicides Despite the benefits that female condoms offer, they are still not readily accessible in most countries

Female Condom Challenges and Opportunities Challenges  Cost  Product characteristics  Cultural and societal attitudes and behavior  Lack of comprehensive and effective programming  Political will Opportunities  Growing demand where accessible (e.g. Zimbabwe)  Must advocate and convince local policymakers/international donors that there is need for female condoms!

Take Action Get informed! Visit  Join the campaign and sign the petition  Download Saving Lives Now: Female Condoms and the Role of U.S. Foreign Aid Talk to friends, family, providers Connect with others

Introduction to Microbicides 16 Arwa Meijer European Programme Associate Global Campaign for Microbicides

What is a Microbicide?  A product that could reduce the transmission of HIV and other STIs when applied vaginally, and possibly, rectally. They are not yet available. Early products  Gels and creams In the future  Sponges, vaginal rings  Gels with barrier devices 17 © Salam Dahbor, Courtesy Doubleshots Studio

Our Ideal Microbicide Safe and non-irritating Easy to use Contraceptive and non-contraceptive Reduce risk of other STIs Inexpensive and available over the counter Could be used without other partner’s cooperation or awareness Have a microbicide in women’s hands in the near future 18

What abut people living with HIV/AIDS? Could reduce risk of co-infection with other HIV strains May help protect both partners Could reduce risk of other STIs, yeast and bladder infections May allow conception while protecting partner 19

Take Action Visit Free downloadable resources for advocates like you!  Presentations  Factsheets/briefing papers: Youth Advocates and Microbicides  GC News – Online newsletter  Sign the Petition Learn the easy way: visit to view the new Microbicides Essentials course Get in touch with local advocates Spread the word to your fellow community members, friends, family

Introduction to Vaccines and PrEP 21 Deirdre Grant Project Coordinator AVAC

What is a vaccine? A substance that creates an immune response in order to build immunity or resistance to a later, real infection Vaccines protect individuals from becoming infected with harmful viruses or bacteria—they also protect society as a whole by preventing the spread of viruses or bacteria from person to person 22

Why do we need an AIDS vaccine? “The impact of vaccination on the health of the world's peoples is hard to exaggerate. With the exception of safe water, no other intervention, not even antibiotics, has had such a major effect on mortality reduction and population growth.” — Stanley Plotkin, M.D. 23

Current AIDS vaccine research Following a disappointing result from the “STEP” vaccine study, the field is focused on answering scientific questions that can help guide vaccine design – some of these questions will be answered in human trials, others in laboratory studies. There are 30 AIDS vaccine trials ongoing. Most of these are small-scale studies. One large ‘test of concept’ study in Thailand is expected to end next year. Many scientists think finding an AIDS vaccine is one of the greatest challenges of our time – while the search must continue, it will be many years before a vaccine becomes available.

Time between Discovery & Development DiseaseYears to develop vaccine Typhoid105 Haemophilus Influenzae92 Pertussis89 Polio47 Measles42 Hepatitis B16 HIV? Duration between discovery of microbiologic cause of selected infectious diseases and development of a vaccine Source: AIDS Vaccine Handbook, AVAC, 2005

Take Action Learn more:  Visit for fact sheets and additional resources, including a dynamic flash presentation—Introduction to AIDS Vaccineswww.avac.org Volunteer to be in a trial Sign up for the Advocates’ Network at for continued vaccine updateswww.avac.org Talk to your friends, family and colleagues about this important research.

What is PrEP? PrEP—pre-exposure prophylaxis—refers to an experimental HIV prevention strategy that would use ARVs to protect HIV-negative people from HIV infection. There are two ARVs being tested in PrEP trials; TDF and TDF/FTC In order to get a clear picture of whether PrEP is a viable prevention strategy, data on safety and efficacy are needed in different populations 27

Current PrEP research As of June 2008, there are five human clinical trials of PrEP ongoing and two scheduled to begin in late ‘08/early ‘09 Current studies will not provide definitive answers about PrEP safety and efficacy in all populations. The NIH-funded Adolescent Trials Network in the US is in the planning stages for a PrEP preparedness study that will inform design of a possible future effectiveness and acceptability trial of PrEP in young gay men and other MSM 28

Why do we need PrEP? PrEP, if proven effective, would be an important addition to the current menu HIV prevention options— more are sorely needed! PrEP could be used without a partner’s knowledge— i ndividuals who are unable to insist on condom use would still be able to increase their protection v. HIV Some mathematical models show that if PrEP proves to be highly efficacious it can avert millions of infections.

Take Action Learn more:  Visit for more information! Talk to your friends, family and colleagues about this important research Sign up for the Advocates’ Network at for continued PrEP updates

Promote Your Product! 1.Identify barriers & challenges when advocating among peers How would your peers, community members react towards the product when you advocate for it back home? Specify what they would agree or disagree with, what do they like or dislike, if they would advocate for it towards their governments…. 2.Compile youth friendly messages & approaches to overcome barriers & challenges What youth-friendly messages would YOU use to overcome any of the barriers/challenges? What approaches in terms of materials and/or tools do you think would be useful to convince your peers? Develop: Youth-friendly messages & approaches

At the conference… Visit us in the Global Village / The Women’s Networking Zone!  Partners in Prevention Research – booth 263  Prevention Now! Campaign and Female Condoms Fitting Booth - Global Village space 213 Satellite: New Minds, New Ideas: Attracting the next generation of investigators and technologies to HIV vaccine research [Sunday, 15: :45 / Skills Building Room 8] Satellite : Expecting (and managing) the unexpected: Reality check for PrEP and other new prevention options [Sunday, 15:45 – 17:45/Session Room 5] Satellite session: "No Simple Solution: Investing in HIV Prevention Research for Women and Girls” [Monday, 18: :30 / Session Room 6] Global Village Session: In Our Own Hands: Advocating for Women-Initiated Prevention Methods [Thursday, 11: :45/GV session Room 2] See the HIV prevention roadmap for more!