What Works for Women and Girls

Critical Prevention Approaches Under DevelopmentA number of biomedical prevention technologies are currently in clinical trials to assess theirsafety and effectiveness. These include vaccines, microbicides and the use of ART as prophylaxis.Once these are shown in clinical trials to be safe and effective, they can be optimized toimpact the epidemic. Vaccines, microbicides and other female-controlled technologies representa large gap in primary prevention for women. Further progress in these areas is urgentlyneeded. For updates on biomedical HIV prevention research, please refer to: www.avac.org.VaccinesWhile recent trials have been promising, an HIV vaccine is yet to be developed. A vaccinecan have special benefits for women. An effective vaccine would provide women autonomyto protect themselves against HIV acquisition. A recent trial of an HIV vaccine with 16,402healthy men and women ages 18 to 30 in Thailand found a vaccine efficacy of 31.2 percent,a modest efficacy, with less HIV acquisition among women than men among those on thevaccine as compared to placebo. The vaccine efficacy may have been greater in persons atlower risk of HIV acquisition.” …After the exclusion of the subjects who were infected withHIV-1 before vaccination, the modified intention-to-treat analysis showed a significant, thoughmodest, reduction in the rate of HIV-1 infection, as compared with placebo” (Rerks-Ngram etal., 2009: 8–9). As some vaccine experts note, however: “It is misleading to say that a vaccine isthe solution” as even once a vaccine is invented in five to ten years hence, “the AIDS epidemicwill be with us for many years.” It is unlikely that the first generation of vaccines will be 100percent effective. “We remain cautiously optimistic that a substantial increase in our understandingof HIV infection and disease will lead to creative ideas about how to design an effectivevaccine” (Johnston and Fauci, 2008: 890). However, “scientists agree that with no prospectof an effective vaccine to curb the HIV/AIDS pandemic in the foreseeable future, expandingthe repertoire of prevention tools is all the more important” (Stephenson, 2008: 1529).MicrobicidesMicrobicides, a female-controlled technology, refer to a variety of topically applied productsthat holds great promise for women to be able to protect themselves from HIV, other STIs(Global Campaign for Microbicides, 2007), and unwanted pregnancy. Where the status ofwomen makes it difficult for women to refuse sex or negotiate condom use, microbicideswould greatly improve women’s ability to protect themselves. Microbicides are being designedto be applied by the woman in her vagina so that women could use this future HIV preventiontool more autonomously. “Because the majority of new infections, certainly in Africa, occurin married women who contract the infection from their husbands’ presumed extramaritalrelationships, methods that allow for discreet use may be especially attractive in marital orlong-term partnerships” (Mantell et al., 2008a: 97). However, in most clinical trials of microbicides,male involvement was the desired norm among female participants. Building on the48 CHAPTER 3 PREVENTION FOR WOMEN