Getting to Women-Controlled HIV Prevention
How do sexually active girls and women prevent HIV infection? The standard answer is “Use condoms”. Condoms have been a central part of safe sex messaging since we found out about HIV and AIDS thirty years ago and discovered that they could help stop transmission. Yet “Use condoms” is not so straightforward for women, something I can find hard to reconcile with telling girls they get to take charge of how their sex lives take shape.
I love that so much work is being done to make consent and relationship dynamics part of sexual health and sexuality education. It’s good to talk power, and trust, and choices as well as the plumbing facts of sexuality. I also recognize that even with these excellent additions, we have to deal with realities. The reality that tons of kids don’t get sex education of any kind. The reality that even if sex education is available in schools, some parents may think it’s too much for their kids, and excuse them. The reality that even with stellar sex ed, girls and women can find themselves in situations where they don’t have the choices they deserve. The reality that there are people who have the belief that women shouldn’t have choices about their sexual or reproductive health. Cast your eyes south of our border for its ugly playing out these days regarding American women’s access to abortion.
Making sure girls and women have the right to make choices about sexual and reproductive health is an ongoing movement with lots of needs, one of them a woman-controlled HIV prevention method. Epidemiologist Quarraisha Abdool Karim is passionate about this goal. She has done research in South Africa, where the rates of HIV are desperate- the country has 1% of the world’s population but 17% of the world’s HIV infections. Abdool Karim found that women were becoming infected because they had no choice. Prevention methods are not women-centred at all:
“Abstinence, behavior change, male/female condoms, medical male circumcision, even treatment as prevention—a lot of these actually have very little space for women and young women who are unable to get their partners to do all of these things.”
Abdool Karim and her partner Salim Abdool Karim are working on microbicides- a chemical gels, films, suppositories and other forms that will be inserted vaginally (and some rectally) to halt the transmission of HIV. There have been research challenges with inconsistencies in how and when people have used microbicides being tested. We are not there yet, but getting closer.
Microbicides are part of a larger area of research for the development of multipurpose prevention technologies. These are envisioned tools women can use discretely to prevent pregnancy and STIs with one product, or to prevent HIV and other STIs but still get pregnant. Again, we’re not there yet, but work is in progress.
Until these options are available, we have to rely on what we have. Talking frankly about what we can do (and what to do when we can’t) and making sexuality a topic that is shame free is a good step towards the best possible outcomes.