Expanding Prevention Options for Women and Girls Deirdre

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

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

Why We Need Female-Initiated and Controlled Methods n Biology ¨ n Economics ¨ ¨ n Women are 2 -4 times more likely than men to get HIV from unprotected sex 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

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

HIV/AIDS Toolkit Prior to exposure Point of transmission After infection • Education & Behavior change • Male and female condoms • Anti-retroviral therapy • Male circumcision • Care • Preventive Vaccines • Anti-retroviral therapy (mother-tochild) • Pre-exposure prophylaxis (Pr. EP) • Post exposure prophylaxis (PEP) • HSV 2 suppression • Microbicides • Diaphragm, cervical barriers & new FCs • Education & Behavioral change • Therapeutic Vaccines

Research that Could Redefine Prevention, 9/06 Female Barrier Diaphragm HSV-2 Treatment Infectiousness Microbicides Carraguard Oral Pr. EP West Africa 2006 Oral Pr. EP - IDU Male Circumcision Susceptibility Community VCT and HIV Support Male Circumcision - Infectiousness 2007 Vaccines Prime/Boost HSV-2 Treatment – Susceptibility Microbicides • BG/Pro 2000 • CS – 1 • CS – 2 • Pro 2000 • TDF Oral Pr. EP • MSM • Heterosexual 2008 2009 2010 Vaccines Adenovirus 1 Adenovirus 2 Index Partner Treatment 2012 See also http: //www. avac. org/timeline-website/index. htm

Research That Is Redefining Prevention, 8/08 Vaccine – Merck Adeno x 2 STEP/Phambili Female Barrier Diaphragm Vaccines – Thai Prime/Boost Microbicides – Carraguard Male Circumcision – Susceptibility Oral Pr. EP – West Africa 2006 Microbicides – CS-1 CS-2 Oral Pr. EP • Heterosexual (Fem. Pr. EP & Partners) HSV-2 Treatment – Infectiousness Community VCT and HIV Support Male Circumcision – Infectiousness HSV-2 Treatment – Susceptibility 2007 2008 Oral Pr. EP – IDU/Thai ` Vaginal & Oral Pr. EP (VOICE) Microbicides • TDF/PMPA (CAPRISA) Microbicides • BG/Pro 2000 • Pro 2000 Oral Pr. EP • MSM (i. Pr. Ex) • Heterosexual (Botswana) 2009 2010 Vaccine – VRC PAVE 100 Index Partner Treatment 2011++ See also http: //www. avac. org/timeline-website/index. htm

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

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

Female Condoms: An Overview Kimberly Whipkey Advocacy and Outreach Associate Center for Health and Gender Equity kwhipkey@genderhealth. org

What are Female Condoms? Female Health Company FC 1 and FC 2 VA-Feminine Condom aka Reddy Female Condom PATH Woman’s 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. 1994.

Why Female Condoms? n n n n n 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 n Challenges ¨ ¨ ¨ n 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! n Visit www. preventionnow. net n ¨ 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 n Connect with others n

Introduction to Microbicides Arwa Meijer European Programme Associate Global Campaign for Microbicides ameijer@path. org 16

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 © Salam Dahbor, Courtesy Doubleshots Studio § 17

Our Ideal Microbicide n n n n 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 n May help protect both partners n Could reduce risk of other STIs, yeast and bladder infections n May allow conception while protecting partner n 19

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

Introduction to Vaccines and Pr. EP Deirdre Grant Project Coordinator AVAC deirdre@avac. org 21

What is a vaccine? n A substance that creates an immune response in order to build immunity or resistance to a later, real infection n 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 n n n 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 Duration between discovery of microbiologic cause of selected infectious diseases and development of a vaccine Disease Years to develop vaccine Typhoid 105 Haemophilus Influenzae 92 Pertussis 89 Polio 47 Measles 42 Hepatitis B 16 HIV ? Source: AIDS Vaccine Handbook, AVAC, 2005

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

What is Pr. EP? n n n Pr. EP—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 Pr. EP trials; TDF and TDF/FTC In order to get a clear picture of whether Pr. EP is a viable prevention strategy, data on safety and efficacy are needed in different populations 27

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

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

Take Action n Learn more: ¨ Visit www. prepwatch. org for more information! Talk to your friends, family and colleagues about this important research n Sign up for the Advocates’ Network at www. avac. org for continued Pr. EP updates n

Promote Your Product! Develop: Youth-friendly messages & approaches 1. Identify barriers & challenges when advocating among peers n 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…. n 2. Compile youth friendly messages & approaches to overcome barriers & challenges n n 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?

At the conference… n n n 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 - 17: 45 / Skills Building Room 8] Satellite : Expecting (and managing) the unexpected: Reality check for Pr. EP 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 - 20: 30 / Session Room 6] Global Village Session: In Our Own Hands: Advocating for Women-Initiated Prevention Methods [Thursday, 11: 45 - 12: 45/GV session Room 2] See the HIV prevention roadmap for more!