Preventing HIV Infection in young women the disconnect

Preventing HIV Infection in young women – the disconnect between evidence and action Quarraisha Abdool Karim 1

The urgent need for new prevention: Age & gender profile of HIV infection: South Africa 10 Male Female Prevalence (%) 8 6 4 2 0 <9 10 -14 15 -19 20 -24 25 -29 30 -39 Source: Abdool Karim Q, Abdool Karim SS, Singh B, Short R, Ngxongo S. AIDS 1992; 6: 1535 -9 40 -49 >49

High HIV prevalence in Africa: the disproportionate burden in young women Kenya Cameroon Malawi Lesotho

What works for HIV prevention: Results from RCTs with HIV incidence • Review: 37 HIV prevention RCTs on 39 interventions: § Pr. EP : 1 § Behavioural: 7 § Microbicides: 12 Microfinance: 1 Diaphragm: 1 Male circumcision: 4 Study STI treatment: 9 Vaccines: 4 Effect size (CI) HIV Vaccine 31% (1; 51) (Thai RV 144) STD treatment 42% (21; 58) (Mwanza) 57% (42; 68) : M-A Circumcision (Orange Farm, Rakai, Kisumu) 0% 10 20 30 40 50 60 70 80 90 100% Efficacy Padian NS, et al. Weighing the gold in the gold standard: challenges in HIV prevention research. AIDS 2010, 24: 621– 635

Preventing sexual spread of HIV: • Existing accepted proven HIV prevention strategies - ABCCC: § Abstinence § Behaviour § Condoms § Counselling and Testing § Circumcision Which of these prevention tools for young women in Africa?

HIV prevalence in pregnant women in rural Vulindlela (2005 -2008) Age Group (Years) HIV Prevalence (%) (N=1237) ≤ 16 10. 6 17 -18 21. 3 19 -20 33. 0 21 -22 44. 3 23 -24 51. 1

Need to include young women in prevention trials • Preventing HIV infection in young women key to altering epidemic in southern Africa • Urgent need for HIV prevention methods for young women • Need to be included in HIV prevention trials now not as bridging populations

Overcoming barriers to inclusion of young women in clinical trials • Legal • Ethical – autonomy to consent vs assent • Right to save their lives