MPTs Protect Women from HIV, STIs and Unplanned Pregnancies

Finding that magic bullet that can keep women from getting HIV, STIs or becoming pregnant is a promising new field of research for doctors across the globe. Disappointing news from the recent Conference on Retroviruses and Opportunistic Infections in Seattle about the failed trials of Tenofovir vaginal gel for HIV prevention has taken some wind from their sails.

But researchers at CAMI Health, led by coordinator Dr. Bethany Young Holt, are doggedly advancing Multipurpose Prevention Technologies (MPTs), among them a one-size-fits-all diaphragm, easy-to-use vaginal rings, gels and injectables for contraception.

"We are talking about intervaginal rings, films and more novel technologies as well," Holt told EDGE. "Condoms have definitely been included in this, both women's and men's, but since we know they've been around with low acceptability, we are really looking to expand our options."

Some of these options that are now in early phases of clinical trials are intravaginal rings that would release an anti-AIDS drug like Tenofovir or a hormone to prevent pregnancy. Holt said that there were some promising technologies in development, and was pleased that the behavioral research component of the research was being taken seriously, rather than relegated to an afterthought.

"One of the things we're really excited about is working with our partners at the National Institutes of Health and social behavioral researchers to try and create a new paradigm for the way women's health prevention technologies are created for HIV and pregnancy prevention, so produce developers are going to take into serious account what women or girls are really going to need," she said.

Holt said researchers need to think of the woman's living situation and the social factors that will impact its use. What's frustrating to those researchers who have been in the field for 20 years is the failed results of the latest clinical trials targeting women in the most high-risk population: women 15-25 years old living in South Africa.

"They are at such a high risk for HIV, and they are given drugs and prevention methods that can save lives, but the methods provided are not those that make sense for women in the contexts of their daily lives," said Holt. "We are trying to understand why. There is so much commitment from funders and developers who are really trying to understand this."

Of the unsuccessful FACTS 001 Tenofovir HIV prevention study, Professor Helen Rees, FACTS Protocol Chair and Executive Director of the Wits Reproductive Health and HIV Institute (Wits RHI) in Johannesburg commented, "Interviews with participants throughout the study taught us that HIV prevention tools for women must be convenient and take account the complex social and economic realities of their lives."

She continued, "A product that is applied around the time of sex may be suitable for some women, but it did not meet the needs of the majority in our study, most of whom were young, single and lived with their parents. Methods that are easier for women to incorporate into their lives are likely to be more effective."

Barrier protection like condoms are largely successful at preventing pregnancy, HIV and STIs, but with 86 million unintended pregnancies around the world every year and 2.7 million new HIV cases, women need a user-friendly product that provides more comprehensive protection. Even for women using family planning, most birth control methods offer no protection against HIV and STIs, and condoms are under used.

"MPT spells the future of women's sexual and reproductive health prevention," said Holt. "It is abundantly clear that women around the world want methods that offer broad spectrum prevention. Condoms work great, but data shows that people stop using them in relationships within the first couple times or months. It's clear that there needs to be other options. We've done a lot of research among college women in the U.S., and across the spectrum, condom negotiation is tough, even for women who think they are really empowered."

Barrier methods such as the condom are a form of MPTs: they protect against pregnancy and many STIs, including HIV. But the reality is that condom use is inconsistent and a great number of women cannot insist on their use. Meanwhile, contraception methods like the Pill and injectables offer no protection against HIV and STIs. MPTs address these shortcomings and build on years of contraceptive and HIV research to develop more comprehensive and effective prevention methods. But they are slow in the making.

"For women who need something on demand, this is proving to be a challenge," said Holt. "Taking a hormone on demand doesn't even exist right now, besides Plan B. We are really striving for a range of products to meet different women's needs at different points in their lifetimes."

CAMI Health is working with partners in India, Africa, China, the U.S. and Europe. Now, they are starting to engage partners in Latin America. Women's needs in all these places vary, both regarding STIs and pregnancy prevention. Globally, herpes is a huge problem. So is countering the stigma around HIV. Researchers have to be mindful to provide prevention for women in a way that's not stigmatizing or in some cases will make them fear for their safety, if they are perceived to be using such products.

"MPTs can significantly reduce unplanned pregnancy rates, along with rates of HIV and other STIs," said Dr. Elizabeth Anne Bukusi of KEMRI and University of Washington. "MPTs will make it possible for women to delay childbearing and advance their education while avoiding HIV and other STIs that can cause, if untreated, infertility and cancers. And women who are healthy are more likely to have healthy children. The impact of MPTs on global health will be tremendous."

Ordinary women can have a voice, too. CAMI Health is mounting a movement to advance MPTs and tell the world what they will enable women to do -- take charge of their life, safeguard their health, and be in control of their future. You can download a sign here, write about what an MPT will enable you to do, take a photo of yourself holding the sign, and email it to [email protected]. They'll add it to the mosaic of women's voices supporting MPTs. A video below gives voice to these concerns.

"Listen to the last person in the video, and you'll hear here say that basically, if you have a healthy women who can have her babies when she's ready to, babies who are wanted and healthy, and the mother can have the education, employment and income she needs, that's good for everyone in the family, including the father. It's good for the entire planet."

For more information, visit www.cami-health.org/ or https://www.facebook.com/camihealth