It’s been an interesting year in HIV science.  The folks over at The Body and Poz have chronicled the year nicely, so I’ll draw on their work to look specifically at women.

In the big picture, microbicides are still an elusive target: a trial using tenofovir vaginal gel was discontinued when it didn’t show effectiveness. Oral pre-exposure prophylaxis therapy proved a disappointment too, although research continues on both. That’s good, because women represent 50% of infections worldwide (60% in Sub-Saharan Africa). Women also experience disease progression at lower viral loads than men do – another thing to consider when looking at treatment recommendations. There’s still a lot to be done in terms of stigma, treatment access and social issues. Women struggle with convincing partners of the necessity for condoms, and violence runs through many relationships, increasing HIV and other health risks.

In Canada, the contentious issue of supervised injection sites came to a head with the Supreme Court Appeal regarding InSite. The Court ruled in September that InSite could remain open, as the health benefits outweighed the potential harms. Criminalization of HIV continues to be a difficult issue, and media portrayals don’t help. See Erin’s “The HIV Party Woman” for a great analysis. Just recently, we heard that a Canadian vaccine candidate will go to human safety trials in 2012- could this be a turning point?

At home in BC, the team at Oak Tree Clinic is exploring whether the HPV vaccine will help women with HIV-  a partnership with researchers in Uganda reaching beyond our borders. The STOP project forges on, seeking those who are undiagnosed. A trial of serodiscordant couples found that those who delayed treatment were more likely to transmit HIV to their partners, underlining the benefits of early treatment and reducing transmission that STOP embraces.

Here at PWN, we hit the milestone of 20 years of supporting women with HIV and educating the communities that work with them just how different HIV is for women. It’s been an honour and a privilege. 

I am deeply appreciative of the folks I work with in this field and passion, and know my coworkers at PWN feel the same. To everyone in our communities, all the best for the coming year. May we work together to address the many pieces of the HIV puzzle and improve the lives of all communities.

Janet 

Photo: nokhoog_buchachon / FreeDigitalPhotos.net
 

Serious title of a serious post, yes. But today’s a big day: it’s the 30th anniversary of the first identified cases of what would eventually be called AIDS. The cases puzzled the doctors- seemingly healthy young men suddenly developing pneumonia and dying. What was going on? More cases appeared, and in 1984, the human immunodeficiency virus (HIV) was identified.

HIV attacks the very core of our body’s defence framework: the immune system. It takes over healthy immune cells and uses them to create more copies of HIV. This weakens the immune system over time, and when HIV positive people are exposed to infections or viruses, their body doesn’t have the oomph to fight. In those early days, people fell ill and died quickly with no effective treatment to battle HIV’s progression.

The Challenge for Hope

In 1996 the introduction of Highly Active Antiretroviral Therapy (thankfully shortened to HAART) or Antiretroviral Therapy (ART) began to turn the death toll around. Combination therapies meant multiple pills every day and difficult side effects, but it was worth it for life. For those starting medications now, side effects aren’t as severe or dramatic, but they are still present and nasty for many.

But medications are only available to a select few: those who are insured or live in places where governmental programs cover costs. Universal access is not a reality. And even if it were, would it affect the millions who don’t even know they have HIV? Lack of sexual health education and lack of HIV awareness means many wouldn’t even think to test.

Heads Up- It Could be Anyone

HIV was first diagnosed in communities of men having sex with men, but viruses don’t have brains to judge the morality of people’s sex lives, despite what many faith leaders pronounced. “God’s revenge on homosexuality” is an equal opportunity virus when given the chance.

HIV is transmitted via blood to blood contact, most commonly through unprotected vaginal and anal sex which exposes tender receptor cells in the anus and on the cervix to any number of sexually transmitted infections. It may also be passed from mother to child during pregnancy, but treatment reduces the risk to about 1 in 100 – if it’s accessible. It can also be passed through sharing drug equipment.

HIV is the leading cause of death in African American women aged 25-34. In Canada, Aboriginal women accounted for 49% of new infections among Aboriginal populations between 1998 and 2008. Maybe you don’t belong to either of these identities, but that doesn’t protect you. Learning about HIV can help protect you.

Healing

It’s true that treatment for HIV has improved significantly since 1996. Some people may have to take medication only once a day, a big improvement from the fistfuls multiple times a day. But this shouldn’t rank HIV as a minor detail in one’s health. There are still side effects to living with HIV and HIV treatments. There is still the big stigma. There are still challenges for women in insisting on condom use and safe sex with partners who have no interest in complying. We need prevention options like microbicides, but they’re not available yet.

For those who have not been touched with HIV and think it’s no big worry these days, I suggest think again. Working with HIV+ women tells me a different story every day. And for those who have been affected by HIV, either living with it or knowing someone in their lives who is, you know.

Look after yourself and your partners. Learn about preventing STI transmission and get regular sexual health checkups.

Please love well and live kindly. We’re not done yet.

- Janet

Cross posted at You Should Know

Money for follow up on Caprisa trial

Okay, I know this could be unrealistic to want something BIG in one year, but I’m hoping for a leap or a bound just the same (it’s the season of magical thinking). The news of success in the CAPRISA microbicide trial (a 39% reduction in HIV transmission and 50% reduction in herpes transmission while using a microbicide gel for vaginal intercourse) was really something, and I hope there is going to be some serious money dedicated to following up on this study. I hope it will fund more widespread testing and testing for anal intercourse. (That might be too big a dream at this point).

More women-focussed support  
Voices of Positive Women folded in 2010 after almost twenty years of connecting positive women in Ontario. It was a huge shock out here. It gave me a greater sense of responsibility to realize that Positive Women’s Network was “it” in terms of long-standing organizations with a women- specific historical perspective of HIV in Canada. It also made me think about the positive women all across Canada who would appreciate women-only spaces. We’re doing our best to hold up our end (with the help of community allies across the country, thank goodness). We can offer resources and support online. But I’m wishing that women in Ontario and women in communities all across Canada have opportunities to safely and confidentially connect face t face if they want to. Talking with others about disclosure, treatment, parenting, relationship and health issues makes such a difference to women here in BC. Connections matter.  

STOP success in more than HAART
Seek and Treat for Optimal Prevention (STOP) is rolling in this province. STOP is a pilot project in the Lower Mainland and Prince George region that is seeking folks for HIV testing, providing medical care and offering HAART if health status indicates it. The aim is to get more people into care and on treatment. This will support more individuals to get health care, but will also reduce new infection rates as people get onto treatment. If HAART is successful, viral load is reduced to undetectable, and the likelihood of HIV transmission goes down (HIV isn’t “cured” so transmission is still possible, but with less HIV in the system, it’s not as infectious).

But treatment is more than taking pills. It’s a mindset, a dedication, an everyday admission that you live with HIV. It’s something a person has to be ready for, and something that could benefit from support to establish the routine- someone to talk to, someone to help with making the routine part of a new outlook on life. A supportive community can understand the emotional and logistical side of going on treatment. For women who haven’t disclosed their HIV status to their kids, where will they keep the medicines so they aren’t seen? For women who don’t have stable housing, how will they ensure a stable enough routine to take the meds consistently to assure that HIV doesn’t become resistant? A network of support for people can make or break the success of HAART. I know that Vancouver Coastal Health is looking to community organizations and networks to ensure this support is available. Everyone who wants it should have access to it.

It’s been an amazing year. Here’s to 2011 surprising us all with its good news.

Happy New Year,

Janet and everyone at PWN

I just got back from a vacation of hanging out along the coast amongst beautiful arbutus trees.  Re-entry after vacation can be a little rocky, but I’m happily jazzed about the microbicide news that came out of AIDS 2010 in Vienna. Miriam blogged about  the conference and the CAPRISA 004 trial a couple of weeks ago, but what’s really caught my eye is that this microbicide does double duty: it also prevents herpes transmission.  

To recap briefly, the study from the Centre for AIDS Programme of Research(CAPRISA) in South Africa trial has been investigating a microbicide that contains tenofovir,one of the many drugs included in HIV treatment regimes.  Results from CAPRISA 004 show it may be a serious contender. According to the press release: 

“The microbicide … was found to be 39%  effective in reducing a woman’s risk of becoming infected with HIV during sex and 51% effective in preventing genital herpes infections in the women participating in the trial."

For women who were strictly adherent (using the microbicide over 80% of the time for sexual intercourse) HIV infection risk was reduced by over fifty percent (see slide 16 of the CAPRISA presentation. Sorry I can’t link to each individual slide!). This is a huge step in the HIV prevention field. But the 51% reduction in herpes transmission is huge too.

Having other STIs can make a person more vulnerable to HIV infection. For those with HIV and herpes, infection with both can make matters much worse. If a product offers multiple benefits, all the better for the women or men who use it. While more research is needed, there is reason to be optimistic, and I’m hoping that the results of this trial will encourage further research dollars. This could be a turning point.

It would be ideal if there was a microbicides that could be used vaginally and rectally. In my dreams, it  could be used by all receptive partners, male or female, whether they’re having anal or vaginal sex (“straights” have anal sex too). And my hopes may be closer to realization now. I don’t think it’s just post-vacation energy.

- Janet