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Why the war against HIV will not end without focusing on women and girls

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Added 7th March 2016 10:56 AM

Efforts must also be made to speed up licensure and regulatory approval of the vaginal ring so that women and girls can use it as soon as it is available

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By Rachel Nandelenga

As we mark International Women’s Day, 2016, it is high time we reflected on HIV prevention for women and girls.


Last month, we received encouraging results from two large clinical studies (ASPIRE and The Ring Study) about a vaginal ring that was found to reduce HIV in women by about 30%.

But because there is still a long way for licensure and regulatory processes to be completed and pave way for its inclusion in the HIV prevention toolbox, countries with a high HIV burden such as Uganda should urgently take on oral pre-exposure prophylaxes (PrEP), an already existing option.

Several studies of PrEP have shown that the risk of getting HIV infection was about 92% lower for those who took the medicines consistently. 

Efforts must also be made to speed up licensure and regulatory approval of the vaginal ring so that women and girls can use it as soon as it is available.

Women, who are still participating in the trials, must already be put on active rings to reduce their vulnerability to HIV infection, like it has happened in Kenya and South Africa.

The research teams in Uganda have already submitted this request to regulatory authorities - Ministry of Health, National Drug Authority and Uganda National Council for Science and Technology. 

This good news about the success of the vaginal ring couldn’t have come at a better time, when we are registering increasing HIV infections among women and adolescent girls, especially in Sub Saharan Africa.

In Uganda for example,the HIV prevalence rate is higher, at 8.3% as opposed to 7.3%, the national rate. Recent UNAIDS data shows that one in every four new infections among women aged 15-49 years in Uganda occur in adolescents and young women aged 15-24 years. 

The increasing HIV infections among women clearly demonstrate that although the existing HIV prevention tools and approaches have contributed to reducing new HIV infections by 40%, the same cannot be said for women and girls. 

The female folk do have much control over the use of most HIV prevention tools. Socio-cultural, economic and biological factors also increase women and girls’ vulnerability to HIV infection.

Women are physiologically more vulnerable to infection because they have a larger surface area of mucosa exposed to their partner’s semen, which remains in the vagina several hours after sex, increasing the length of exposure to HIV. Biologically women are at greater risk for HIV infection if they have unprotected sex during menstruation, or if they experience bleeding during intercourse.

Women are also more vulnerable to HIV infection because of other infections, such as: vaginosis, genital ulcers, genital warts (HPV), and pelvic inflammatory disease (PID), the most common effect of sexually transmitted diseases (STDs).

If STDs are left untreated for a long time like is the case in many countries in Sub Saharan Africa, they increase vulnerability to HIV. 

Eradicating HIV in this era, therefore, requires that women be put at the centre of the HIV and AIDS response. Health care systems must be responsive to the unique needs of women and girls, including access to sexual and reproductive health information and services.

Women and girls must access HIV prevention services, including female-initiated tools that have been proven to work.

Drivers of HIV infections among women and young girls, such as early marriages, gender based violence, widow inheritance, poverty must be addressed. Girls must be kept longer at school because it has been found to reduce their risk to HIV infection. 

The vaginal ring trial results also found that the product was less effective among younger women aged 18-21, who may have not used the ring as expected.

This underscores the need for further study of the product and other ways to prevent HIV in young girls as they transition into adulthood.

Existing prevention options and approaches must be tailored and made more relevant to young and adolescents girls. HIV prevention education must focus on their needs and life-circumstances. 

In 2015, the World Health Organisation (WHO) released guidelines, which recommend the use of PrEP to prevent HIV infection in populations at risk.  This means vulnerable groups such as women and girls can benefit from PrEP to reduce HIV infections. 

If resources and investments in research and development of HIV prevention for women are not increased, and if policies and programmes do not put women and young girls at the centre, we risk reversing the gains made in fighting the epidemic. 

Commitment to zero HIV infections should be matched by increased commitment to reverse infections among women and girls. 

Writer is a Human Rights Advocate (HIV/AIDS)

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