tag:theconversation.com,2011:/africa/topics/aids2016-29227/articlesAIDS2016 – The Conversation2016-07-21T00:34:59Ztag:theconversation.com,2011:article/615252016-07-21T00:34:59Z2016-07-21T00:34:59ZWeekly Dose: Truvada, the drug that can prevent HIV infection<figure><img src="https://images.theconversation.com/files/130842/original/image-20160718-2147-1vmmq3h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">PrEP works by preventing susceptible cells becoming infected with HIV. Truvada blocks the HIV virus from making copies of itself.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-372956731/stock-photo-pills-for-pre-exposure-prophylaxis-prep-to-prevent-hiv-with-prep-text-engraved.html?src=C8q7NiKj2PVzbSqo4ZAzYQ-1-0">Marc Bruxelle/Shutterstock</a></span></figcaption></figure><p>Pre-exposure prophylaxis, or PrEP, is the administration of antiviral drugs to a person not infected with HIV to prevent infection. </p>
<p>The only licensed <a href="http://www.avac.org/trial-summary-table/PrEP">version of PrEP</a> is a daily oral tablet called Truvada®, which contains a combination of two antiretroviral drugs: tenofovir disoproxil fumarate (300mg) and emtricitabine (200mg).</p>
<p>Other strategies for delivery are being developed, including injections and topical applications with vaginal rings or gels. Other antivirals are also being tested for PrEP, but here we’ll focus on Truvada.</p>
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<h2>History of PrEP</h2>
<p>Antiretroviral therapy was first introduced as a life-saving treatment for people with HIV in 1996. Researchers then tested antiretrovirals similar to Truvada on monkey models to see if they could <em>prevent</em> infection with simian immunodeficiency virus, the monkey equivalent of HIV. They were successful. </p>
<p>The first large clinical trial to show PrEP was effective in humans, <a href="http://www.aidsmap.com/The-iPrEx-study/page/1746640/">iPrEX</a>, compared daily Truvada to a placebo, or a sugar tablet, in men who have sex with men. The trial, which ran from 2007 to 2009, showed overall efficacy of 44%. This means the HIV infection rate in gay men who were given the pill was reduced by 44% compared to men who were given the placebo.</p>
<p>Efficacy rates increased to more than 92% in participants who had detectable levels of Truvada in their blood, indicating they adhered to the strict daily treatment regimen. </p>
<p>Subsequent trials have shown similar efficacy of more than 86% using event-driven PrEP in men who have sex with men. This means taking the drug prior to and following sex. Among people who inject drugs, daily PrEP had an efficacy rate of 50%.</p>
<p>Clinical trials in heterosexual women of both oral and topical PrEP have had mixed findings, with some studies being stopped early due to no evidence of benefit. But women in these studies were often not taking the medication. In other studies of heterosexual women, PrEP reduced HIV transmission by up to 76%. </p>
<p>All studies have clearly demonstrated that efficacy was directly related to adherence. Users benefited only if they consistently took the medications or consistently used topical PrEP. </p>
<p>Efficacy is <a href="http://www.iprexole.com/1pages/prep/prep-whatistheiprexstudy.php">estimated to be as high</a> as 99% in men who have sex with men who take Truvada daily.</p>
<h2>Availability</h2>
<p>PrEP was licensed in the US in 2012 and was registered by the Therapeutic Goods Administration in Australia in May 2016. The Pharmaceutical Benefits Advisory Committee is evaluating whether PrEP will be listed and subsidised on the Pharmaceutical Benefits Scheme. </p>
<p>Newer forms of PrEP being evaluated include injections of antivirals such as cabotegravir, as well as topical administration of antivirals, including the vaginal ring containing the antiviral dapivirine and monoclonal antibodies. </p>
<p>Monoclonal antibodies are not drugs but they can bind to a virus and eliminate the capacity for the virus to infect a cell. </p>
<p>None of these strategies are currently licensed.</p>
<h2>How it works</h2>
<p>PrEP works by preventing susceptible cells becoming infected with HIV. Truvada blocks the HIV virus from making copies of itself. </p>
<p>When starting PrEP, it takes at least seven days to reach high levels of protection against HIV for men who have sex with men and also for women. </p>
<p>When stopping PrEP, people should continue using PrEP for four weeks after the last significant exposure. </p>
<p>It’s important to note that PrEP doesn’t protect against other sexually transmitted infections (STI) or pregnancy. </p>
<p>Truvada is, however, also active against hepatitis B virus and may have some activity against the herpes simplex virus too.</p>
<h2>Problems and controversies</h2>
<p>Although scientists demonstrated the efficacy of PrEP in 2010, it has taken several years for this preventative measure to be used in clinical practice. The main controversy has been related to cost and who pays. </p>
<p>Concerns have also been raised about a reduction in safer sex, but the majority of studies have not shown a decrease in condom use, or an increase in STIs. But even in the context of increased STIs, the benefit in PrEP reducing new HIV infections is clear. </p>
<h2>Side effects</h2>
<p>The main side-effects of Truvada are gastrointestinal. These tend to diminish after the first few months of PrEP. It <a href="http://www.ncbi.nlm.nih.gov/pubmed/26797207">occasionally causes</a> headaches and fatigue.</p>
<p>Regular screening of kidney function is performed for people receiving PrEP as the drug can impair kidney function. But this is reversible. Very rarely, PrEP can lead to more severe kidney dysfunction. </p>
<p>Some bone thinning has been reported, but this is also reversible.</p>
<h2>Cost</h2>
<p>The cost of PrEP depends on the source of supply. In Australia, Truvada can be purchased from the manufacturer, Gilead, and costs A$750 per month.</p>
<p>Generic forms are <a href="http://www.prepaccessnow.com.au/">available from overseas manufacturers</a>, which may cost A$158 for three months, or more. Having a valid Australian prescription, completed by a registered medical practitioner and completing all the paperwork will facilitate the process for delivery. </p>
<p>Some state governments are running large studies to demonstrate the effectiveness of PrEP. In these studies, medication is free except in Victoria.</p>
<hr>
<p><em>The authors acknowledge helpful discussions and contributions from Mr Bill Whittaker, National Association of People Living with HIV in Australia.</em></p>
<p><em>* This article originally said generic forms of the drug were available from overseas for $158 per month rather than $158 for a three-month supply. This has now been corrected.</em></p><img src="https://counter.theconversation.com/content/61525/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sharon Lewin receives funding from the NHMRC, the National Institutes for Health, Wellcome Trust, American Foundation of AIDS research, the University of Malaya, the Danish Medical Council, the Australian Centre for HIV and Hepatitis and investigator-initiated company funded studies from Merck, Gilead and ViiV. She is a member of the International AIDS Society.</span></em></p><p class="fine-print"><em><span>Edwina Wright receives funding from a research grant from NIH, a Career Development Fellowship from the National Health and Medical Research Council of Australia, research funding from the Victorian Department of Health and unrestricted research funds from Gilead, Abbott, Janssen Cilag and Boehringer Ingelheim. She has also received funding that has been used for research purposes only from ViiV, Merck, Gilead, and Abbott for consultancy work, payment for lectures from ViiV and payment for developing educational resources for ViiV and Gilead. The study drug for the VicPrEP study has been donated by Gilead Sciences.</span></em></p>Efficacy is estimated to be as high as 99% in men who have sex with men who take Truvada daily.Sharon Lewin, Consultant Physician, Department of Infectious Diseases, Alfred Hospital & Director, The Peter Doherty Institute for Infection and ImmunityEdwina Wright, Associate Professor, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/624832016-07-19T05:30:15Z2016-07-19T05:30:15ZRemind me again, how close are we to a cure for HIV?<figure><img src="https://images.theconversation.com/files/131021/original/image-20160719-13845-d9nm1r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Simplicity of delivery will be critical if a 'cure' is going to be deliverable in the parts of the world where HIV is endemic.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-309709997/stock-photo-image-concept-with-the-result-of-the-hiv-test.html?src=quj8Rc5ag8OVtYzylTuqFQ-2-25">ktsdesign/Shutterstock</a></span></figcaption></figure><p>Finding a cure for HIV is a powerful concept, often spoken of as the Holy Grail of HIV research. Although effective anti-HIV drugs have transformed HIV into a chronic manageable condition – a condition you live with, rather than die from – taking life-long therapy is a very different proposition to being definitively cured. </p>
<p>An affordable, scalable HIV cure that worked as well in rural Malawi as in urban Sydney would put the global eradication of new HIV infections within reach, while also transforming the lives of those now living with the virus. This must the goal of cure research: to prioritise interventions that have potential application worldwide, not limited to settings with highly developed health systems. </p>
<p>Research into a cure for HIV has been gathering momentum. Global investment in cure research has <a href="http://www.aids2016.org/Media-Centre/The-Latest/Press-Releases/ArticleID/52/Prospects-for-developing-a-cure-or-sustained-remission-for-HIV-take-centre-stage-at-AIDS-2016">more than doubled</a> in the last four years, in contrast with <a href="http://kff.org/global-health-policy/report/financing-the-response-to-hiv-in-low-and-middle-income-countries-international-assistance-from-donor-governments-in-2015/">investment in other HIV</a> programs. </p>
<p>Given the effectiveness of antiretroviral drugs in both treating and preventing HIV infection, however, cure research raises a range of important questions about priority setting in global health. </p>
<p>Curing HIV – or at least achieving long-term remission – is possible, under the right circumstances. </p>
<h2>Bone marrow transplants</h2>
<p>In 2007, Timothy Rae Brown, formerly known as “the Berlin patient”, required a bone marrow transplant to treat his leukaemia. Brown also had HIV, and his doctor suggested that if they could find a bone marrow match from a donor who had rare genetic mutation on the CCR5 receptors – receptors that HIV uses to get inside cells – this could potentially cure Brown of HIV. </p>
<p>The immune cells that HIV infects are made in the bone marrow. So transplanting bone marrow using a donor who lacks HIV receptors means that the new bone marrow would produce immune cells that were resistant to HIV infection. </p>
<p>A matching donor with the CCR5 mutations was found, the harrowing transplant was performed, and it was successful. Brown was able to cease antiretroviral therapy, and has not had a viral rebound since (though his leukaemia did relapse and he required a second transplant). </p>
<p>While it is unknown whether HIV has been completely eradicated from his body, in 2016 Brown still has no detectable HIV in his blood, and does not require antiretroviral drugs.</p>
<p>While Brown’s case demonstrates HIV can be forced into remission, it has not resulted in a reproducible form of cure. Bone marrow transplants are themselves life-threatening and extremely resource-intensive. It would be highly unethical to transplant bone marrow in a person who did not require this for another serious illness such as leukaemia. </p>
<p>The particular CCR5 mutations required is and generally only found in Northern Europe, where an <a href="http://www.hivplusmag.com/research-breakthroughs/2016/3/23/anyone-immune-hiv">estimated 1%</a> has one copy of this genetic variation. Even fewer have the two copies that are required for high-level resistance to HIV infection. </p>
<h2>Shock and kill</h2>
<p>Current approaches to cure research are focused on achieving a “functional cure” or remission of HIV rather than a sterilising cure, which would aim at removing all traces of HIV from the body. </p>
<p>HIV integrates with the body’s DNA early in infection. It then “hides” in hard-to-reach immune compartments where cells turn over very slowly. So finding ways of flushing HIV out of the places where it lies dormant is an important aspect of cure research. </p>
<p>This is approach is often called the “shock and kill”. It uses latency-reversing agents (chemotherapy-like drugs) to activate cells that have been latently infected with HIV and then kill the HIV. </p>
<p>If a safe, limited dose combination of drugs could be developed, this approach could prove potentially deliverable in disparate settings globally. </p>
<h2>Immune-based therapies</h2>
<p>Another approach is bolstering the human immune system to control HIV replication without antiretroviral drugs using therapeutic vaccines and antibody-based therapeutics. </p>
<p>If a therapeutic vaccine was developed that controlled HIV replication without antiretroviral drugs and required limited dosing (ideally one-off dosing), this would be an improvement on the current need to take medication daily to control HIV.</p>
<h2>Treating newborns</h2>
<p>A third area of investigation is early intensive antiretroviral therapy for newborns. This strategy relies on intensive use of antiretroviral drug in infants who acquired HIV from their mothers. </p>
<p>Particular properties of the developing infant immune system make such an approach more likely to work in newborns than in adults. There is a documented case of a child who controlled HIV successfully for 27 months following cessation of treatment (<a href="http://www.nature.com/news/hiv-rebound-dashes-hope-of-mississippi-baby-cure-1.15535">known as the Mississippi baby</a>). </p>
<h2>Gene editing</h2>
<p>Finally there are cell-based therapies: genetic modification or “gene editing” in people with HIV, including stem-cell transplantation. </p>
<p>While these have the advantage of being one-off intervention, they carry the serious disadvantage of being extremely intensive in the use of medical technology and potentially risky to patients.</p>
<p>As antiretroviral treatment for HIV is now highly effective and relatively simple (often just a pill a day), approaches to a potential HIV cure need to be evaluated according to whether they might offer a real advantage over lifelong therapy at both individual and population levels. </p>
<p>Evaluating the social value of particular cure strategies is a critical aspect of ensuring that the <a href="http://jme.bmj.com/content/early/2016/07/08/medethics-2015-103125.full">right kinds of research are prioritised</a> – those that have the potential to transform the epidemic in resource poor contexts. Simplicity of delivery will be critical if an intervention is going to be deliverable in the parts of the world where HIV is endemic.</p><img src="https://counter.theconversation.com/content/62483/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bridget Haire receives funding from the National Health and Medical Research Council (NHMRC). She is the President of the Australian Federation of AIDS Organisations. </span></em></p>Curing HIV – or at least achieving long-term remission – is possible, under the right circumstances.Bridget Haire, Lecturer in ethics, HIV prevention, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/623782016-07-18T18:19:05Z2016-07-18T18:19:05ZScientists are combining forces to tackle the deadly duo of TB and HIV<figure><img src="https://images.theconversation.com/files/130713/original/image-20160715-2122-r5mgza.png?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Africa Centre for Population Health</span></span></figcaption></figure><p><em>TB and HIV are, separately, two of the deadliest infections in the world. They kill around 3 million people every year. Combined, they are even more dangerous. Tackling the problem of HIV and TB co-infection presents both diagnostic and therapeutic challenges.</em> </p>
<p><em>That’s why a new US$79-million centre, the Africa Health Research Institute, has been established in KwaZulu-Natal, South Africa. It will combine the efforts of two leading research organisations – the Africa Centre for Population Health and the KwaZulu-Natal Research Institute for TB-HIV (K-RITH). Incoming Africa Health Research Institute Director Professor Deenan Pillay explains the importance of this new research venture to KwaZulu-Natal, South Africa and the world.</em></p>
<p><strong>Why is HIV and TB co-infection a challenge?</strong></p>
<p>HIV and TB form a lethal combination, each speeding the other’s progress. TB is the leading cause of death among people living with HIV. It accounts for one in four HIV-related deaths. There are huge challenges in accurately diagnosing TB in people living with HIV, and then properly treating the co-infections. </p>
<p>The drugs that are used to treat TB must be taken for at least six months. Patients with drug resistant strains are sometimes treated for longer than two years, and have to use drugs which are more toxic. Anti-TB drugs may interact badly with antiretroviral drugs and both TB drugs and antiretrovirals have side effects, which means people often don’t adhere to their treatment regimes. </p>
<p><strong>What are the co-infection rates in South Africa and how do they compare to the rest of the world?</strong></p>
<p>Despite advances in antiretroviral therapy and talk of the ‘end of Aids’, HIV and HIV-related TB remain devastating diseases. </p>
<p>According to the World Health Organisation at least one-third of the 37 million people living with HIV worldwide are infected with latent, or inactive, TB. Globally, people living with HIV are 26 times more likely to develop active TB than those without HIV. </p>
<p>South Africa is the epicentre of HIV and TB co-infection. Of the 22 high burden TB countries the World Health Organisation lists, South Africa is ranked third. And more than 70% of patients with TB in South Africa are also HIV infected. TB is among the leading causes of death in the country. </p>
<p>KwaZulu-Natal (KZN), a province on the east coast of South Africa, has the highest rates of HIV and TB in the country. It also has one of the highest prevalence rates of TB globally. The largest outbreak of extensively drug resistant TB (XDR-TB) in history occurred in the province in 2006, while uMkhanyakude district, the area of northern KZN where the Africa Centre is based, has the highest prevalence of drug resistant TB in the country.</p>
<p><strong>What prompted the centre and how will it actively help target co-infection?</strong></p>
<p>The Africa Health Research Institute will use an interdisciplinary approach to fight HIV and TB, bringing together leading researchers from different fields.
The Africa Centre, a population studies research centre, has existed since 1999. It has 16 years of detailed population data from more than 100 000 participants, and has been at the forefront of describing the development of the HIV epidemic and the positive impact that HIV treatment has had, both in terms of reducing the number of new infections and reducing mortality. </p>
<p>K-RITH was formed in 2009 in response to the devastating outbreak of XDR-TB in KZN. It is focused on the basic science of TB and HIV biology and pathology and has world-class laboratory facilities, including Biosafety Level 3 labs, which allows scientists to safely work with TB. </p>
<p>Bringing the two together links population and lab research to create an interdisciplinary “population to laboratory – and back to population” approach to addressing the TB and HIV co-epidemic. This is the first institute of its kind in the world where the highest class of lab research can be applied to such large population longitudinal surveillance.</p>
<p>In the past the Africa Centre has been able to describe the changes in the rates of new HIV infections and how that has affected the population. The Africa Health Research Institute can now look at why there are changes and can develop tools to do trials on that population. We are moving from observing, to doing something about it. </p>
<p><strong>What are your targets?</strong></p>
<p>The Africa Health Research Institute’s goals include providing the research to significantly reduce new HIV infections and new TB infections – based on developing optimal drugs, vaccines and trials of interventions and research of on-the-ground impact. </p>
<p>It is an important component of the South African effort to fight HIV and TB. The prevalence of infection is so high that we are in a good position to do the research and apply the findings not just to sub-Saharan Africa, but to areas across the world where HIV and TB is less prevalent but still a challenge. </p>
<p>The institute will also help develop the next generation of African scientists.</p><img src="https://counter.theconversation.com/content/62378/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Deenan Pillay is the incoming Director of the Africa Health Research Institute. He has received funding from Wellcome Trust, the Bill and Melinda Gates Foundation, the UK MRC, and NIH.
The new venture is made possible through R1.2-billion in grants from Wellcome Trust and the Howard Hughes Medical Institute, with UCL (University College London) and the University of KwaZulu-Natal as significant academic partners.
</span></em></p>A new centre in South Africa will work to significantly reduce emerging HIV and TB co-infections.Deenan Pillay, Director of the Africa Centre for Population Health and Professor of Virology, University of KwaZulu-NatalLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/623992016-07-14T18:25:02Z2016-07-14T18:25:02Z16 years on, the world’s biggest AIDS conference returns to Africa<figure><img src="https://images.theconversation.com/files/130423/original/image-20160713-12358-11t8wn7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">At the 13th International AIDS Conference, 11-year-old Nkosi Johnson, who had AIDS, begged the South African government to distribute antiretroviral drugs.</span> <span class="attribution"><span class="source">Reuters</span></span></figcaption></figure><p>I have profound memories of the 13th International AIDS Conference in Durban, South Africa. It was July 2000 and I was among 12,000 people from across the world who attended: scientists, clinicians, health-care workers, public-health agencies, and people living with HIV/AIDS. </p>
<p>For me, it was a turning point. I realised that HIV/AIDS would be the most significant disease in my professional life. I wanted to contribute to the fight against it.</p>
<p>At the opening event, a tiny figure in a shiny dark suit walked up to address those gathered. <a href="http://nigeriahealthwatch.us8.list-manage.com/track/click?u=1eb94606ed6eb9189fc0467f5&id=d4768b8270&e=30a6129dba">Nkosi Johnson</a>, who was just 11 at the time, brought most of the delegates to tears as he told his story. His <a href="http://nigeriahealthwatch.us8.list-manage2.com/track/click?u=1eb94606ed6eb9189fc0467f5&id=e0a13f9091&e=30a6129dba">words</a> that night have stayed with me:</p>
<blockquote>
<p>Hi, my name is Nkosi Johnson, I am 11 years old and I have full-blown AIDS. I was born HIV-positive … Care for us and accept us – we are all human beings … We are normal. We have hands. We have feet. We can walk, we can talk, we have needs just like everyone else. Don’t be afraid of us … we are all the same.</p>
</blockquote>
<p>He died one year later, at the age of 12. At the time of his death, he was the longest surviving child born with HIV in South Africa.</p>
<p>Another delegate was Judge Edwin Cameron, a senior jurist in South Africa who was living with HIV. He delivered the <a href="http://nigeriahealthwatch.us8.list-manage.com/track/click?u=1eb94606ed6eb9189fc0467f5&id=d7f3a143d1&e=30a6129dba">Jonathan Mann</a> lecture, one of the most <a href="http://www.tac.org.za/Documents/Speeches/ec10july.txt">passionate speeches</a> I have ever listened to. Cameron addressed the prevailing inequity of access to antiretrovirals in Africa at the time. I particularly remember this quote:</p>
<blockquote>
<p>I exist as a living embodiment of the inequity of drug availability and access in Africa. My presence here embodies the injustices of AIDS in Africa because, on a continent in which 290 million Africans survive on less than US$1 a day, I can afford monthly medication costs of approximately $400 per month. Amidst the poverty of Africa, I stand before you because I am able to purchase health and vigour. I am here because I can pay for life itself.</p>
</blockquote>
<p>Cameron, who reflected on those epic years in his book, “<a href="http://nigeriahealthwatch.us8.list-manage1.com/track/click?u=1eb94606ed6eb9189fc0467f5&id=98f97bbd5e&e=30a6129dba">Witness to AIDS</a>”, still serves on the bench of South Africa’s Constitutional Court. At this year’s conference, he will once again be speaking – and, 16 years later, much has changed. At the time, there were just a handful of people on antiretrovirals in Africa. Today there are more than <a href="http://nigeriahealthwatch.us8.list-manage.com/track/click?u=1eb94606ed6eb9189fc0467f5&id=6c620bfa79&e=30a6129dba">7.5 million Africans</a> on treatment.</p>
<p>On the periphery of the 2000 conference the <a href="http://nigeriahealthwatch.us8.list-manage1.com/track/click?u=1eb94606ed6eb9189fc0467f5&id=484e83274b&e=30a6129dba">Treatment Action Campaign</a>, a South African HIV/AIDS activist organisation, was finding its voice. It was highlighting the fact that focusing on the science at a conference like this was not enough; that we also had a responsibility of “<a href="http://www.sahistory.org.za/article/2000-south-african-international-aids-conference">breaking the silence</a>”, as the conference was themed – to speak up about the injustices of those times. </p>
<h2>Nigeria’s challenges</h2>
<p>I had come to the conference on the back of a trip to Nigeria, where I had carried out a small <a href="http://nigeriahealthwatch.us8.list-manage.com/track/click?u=1eb94606ed6eb9189fc0467f5&id=04071ae816&e=30a6129dba">study</a> to expand access to AIDS through physicians in private practice. It was an exploratory survey of knowledge and practices in two Nigerian states. At the time, the talk of the town in Nigeria was of “<a href="http://www.premiumtimesng.com/news/more-news/175168-will-release-hiv-vaccine-nigerian-government-abalaka.html">Dr Abalaka</a>”, a surgeon turned immunologist who claimed to have developed an HIV vaccine. </p>
<p>In one of the worst periods in Nigerian journalism, newspapers went to town extolling his virtues.</p>
<p>But out of the darkness of the reportage on Abalaka rose journalist and activist Omololu Falobi, who was one of a kind. In 1998, he formed a coalition called <a href="http://nigeria.smetoolkit.org/nigeria/en/directory/show_listing/3863">Journalists Against AIDS in Nigeria</a>. His group became the most credible source for stories and policy advocacy on HIV/AIDS in the country. </p>
<p>Like most good things and people in Nigeria, we lost him too soon when unknown gunmen shot him on his way home from work in Lagos in 2006. </p>
<p>It was the norm in all the early years of the international conferences on AIDS that there were meetings called for all Nigerians attending or those working on HIV/AIDS in Nigeria. The meeting at the Durban conference in 2000 was chaired by Professor Ibironke Akinsete, the then chairperson of <a href="http://nigeriahealthwatch.us8.list-manage.com/track/click?u=1eb94606ed6eb9189fc0467f5&id=8ee401e75a&e=30a6129dba">National Agency for the Control of AIDS</a>, which was still a committee at the time. </p>
<p>Nigeria was one year into its new democracy, with an HIV prevalence that had just crossed the 5% mark, and Nigerians were enthusiastic about defining the way forward.</p>
<p>A wide variety of issues were discussed on the day – a plan to place the first 10,000 patients on antiretrovirals, a new strategic plan, negligence of non-governmental organisations, poor research capacity and the pervasive “Abalaka issue”.</p>
<p>In Nigeria there has been progress, but it’s been painfully slow despite the enormous resources thrown at the disease. There is a response programme that is still almost completely donor-funded. Less than 20% of those infected with HIV are on treatment and Nigeria has the biggest burden of mother-to-child transmission of HIV, leading to about <a href="http://nigeriahealthwatch.us8.list-manage1.com/track/click?u=1eb94606ed6eb9189fc0467f5&id=b4b2bac3be&e=30a6129dba">50,000 new infections in children</a> every day. Yet despite all of this, there is no sense of urgency and it seems to be business as usual.</p>
<h2>Things have changed but remain the same</h2>
<p>This year we will return to Durban, 16 years after the first conference in Africa for only the second International Conference on AIDS held in Africa.</p>
<p>Globally, we still do not have a cure, but it is no longer the death sentence that it was in 2000. The discovery of highly active antiretroviral drugs has made HIV/AIDS more of a chronic disease, and is beginning to have an impact on prevention. </p>
<p>The cost of antiretrovirals has reduced significantly, to about $100 per patient per year. This has been driven by the aggressive advocacy of the 2000s and the roll-out of the biggest public-sector antiretroviral treatment programme in the world in South Africa in the years after <a href="https://theconversation.com/south-africas-remarkable-journey-out-of-the-dark-decade-of-aids-denialism-62379">Thabo Mbeki’s</a> presidency, during which the government refused to roll-out antiretrovirals. </p>
<p>By 2013, an estimated <a href="http://nigeriahealthwatch.us8.list-manage.com/track/click?u=1eb94606ed6eb9189fc0467f5&id=8e9e025837&e=30a6129dba">24.7 million people</a> were living with HIV in sub-Saharan Africa accounting for 71% of the global total. In the same year, there were an estimated 1.5 million new HIV infections and 1.1 million AIDS-related deaths.</p>
<p>A lot has changed in 16 years and much has stayed the same. But there’s still lots to talk about. Join the conversation.</p>
<p><em>This is an edited version of a blog that appeared on <a href="http://nigeriahealthwatch.com/">Nigeria Health Watch</a>. The blog will also be providing updates from the conference.</em></p><img src="https://counter.theconversation.com/content/62399/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Chikwe Ihekweazu does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Chikwe Ihekweazu relives his experience from 2000, when the International AIDS Conference was last hosted in South Africa.Chikwe Ihekweazu, Senior Honorary Lecturer on Infectious Diseases, UCLLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/623792016-07-13T20:56:56Z2016-07-13T20:56:56ZSouth Africa’s remarkable journey out of the dark decade of AIDS denialism<figure><img src="https://images.theconversation.com/files/130419/original/image-20160713-12389-13zu6k1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Finbarr O'Reilly/Reuters</span></span></figcaption></figure><p>HIV changed the nature of health in South Africa as the new democracy emerged. It slashed life expectancy and wiped out a generation of economically active adults in their prime across sub-Saharan Africa. It reversed gains in under-five mortality and created a cohort of AIDS orphans. The disease also revealed the inter-relatedness between social behaviour, stigmatisation, cultural mores, religious beliefs and human health. </p>
<p>HIV changed South African society at a time when it needed no distraction as it battled to rebuild a nation post-apartheid.</p>
<p>The history of AIDS in South Africa is a particularly fraught and traumatic story, more than in any other country in the world. The country got off to a disastrous start in managing the pandemic, which meant that its impact on health was all the more acute. It took ten years after the first democratic elections in 1994 for the tide to turn.</p>
<p>Today, just over a decade and a half after the International AIDS Conference in 2000, the country is on a completely different trajectory. Over the past ten years, life expectancy has improved by nine years. And infant and child mortality have improved dramatically.</p>
<p>These enormous strides are a tribute to South African activists, health-care workers and scientists. They were faced with a horrific epidemic and did the right thing. <em>En masse</em> they spoke truth to power. They were relentless in their pursuit of scientific evidence and ruthless in their implementation. </p>
<p>It is gratifying to have been part of the crusade, and to be able to look back at how much progress has been made.</p>
<h2>The difficult early years</h2>
<p>From 1998 to 2003, civil society together with AIDS activists, doctors and scientists began to systematically and methodically use scientific evidence – in the face of government AIDS denialism – to force the use of antiretrovirals for the prevention of mother-to-child transmission of <a href="http://www.avert.org/professionals/hiv-science/types-strains">HIV-1</a>, the most widespread type of the virus. Subsequently antiretrovirals would also be rolled out as life-saving treatment. </p>
<p>A number of research projects were initiated to underpin our work.</p>
<p>Our work at the Perinatal HIV Research Unit in Soweto was at the centre of these controversies. In 1996 we established the unit when we started research into the prevention of mother-to-child transmission of HIV-1.</p>
<p>Initially, we evaluated interventions to minimise breast milk transmission of HIV-1. This was before embarking on the <a href="http://apps.who.int/rhl/hiv_aids/jmicom/en/">PETRA study</a> – one of the first antiretroviral perinatal transmission studies. It was conducted after the famous <a href="https://aidsinfo.nih.gov/news/101/actg-076-questions-and-answers">ACTG 076</a> study in the US, which demonstrated that antiretroviral medication AZT could reduce perinatal transmission significantly. </p>
<p>Because of our involvement in the management and follow-up of HIV-1 infected pregnant women and their infants, we became one of the first public-sector sites to conduct antiretroviral treatment trials in adults and children. This gave us the necessary comfort to propagate the use of antiretrovirals in Soweto in the late 1990s.</p>
<p>Soweto became one of the first demonstration projects for both prevention of mother-to-child transmission and ARV treatment roll-out. It was funded by the French government’s Fonds de Solidarité Thérapeutique International in a direct grant to the unit.</p>
<p>This <a href="http://www.ctu.mrc.ac.uk/dart/">Demonstration of Antiretroviral Treatment</a> was approved in about 2002 under strict conditions by the then Minister of Health, Dr Manto Tshabalala-Msimang. </p>
<p>But as governmental denialism intensified, our efforts to secure additional funding from the <a href="http://pangaeaglobal.org/about-us/overview">Pangaea Global AIDS Foundation</a> and <a href="https://www.clintonfoundation.org/">Clinton Foundation</a> were closed down.</p>
<p>We received a phone call from the then AIDS director at the National Department of Health instructing us to stop developing the proposal. Communication with the donors then stopped without explanation. A decade later Pangaea acknowledged that the South African government had applied pressure for them to stop working with us.</p>
<p>Political interference was rife at this time. The use of antiretrovirals for prevention of mother-to-child transmission was seen as a subversive activity. </p>
<p>Then in 2002 a document was distributed to African National Congress branches throughout South Africa. It attacked South Africa’s earliest and most prominent AIDS scientists, including Salim Abdool Karim and ourselves. Abdool Karim’s research was characterised as “anti-human” and promoted by “corporate forces”, and we were singled out, because of our work using antiretrovirals for preventing mother-to-child transmission of HIV, as “killers of black women”.</p>
<p><a href="http://ccs.ukzn.ac.za/files/Mbeki's%20document.pdf">The document</a>, partly penned by then President Thabo Mbeki, was titled “Castro Hlongwane, Caravans, Cats, Geese, Foot & Mouth and Statistics: HIV/AIDS and the Struggle for the Humanisation of the African”. The document had a devastating impact on the work we were doing. It legitimised the position taken by denialists and made us targets. </p>
<h2>The turnaround</h2>
<p>In 2003/2004, government policy changed under mounting pressure from civil society as well as political pressure from within government. In an era where the cost of drugs was declining, we were fortunate beneficiaries of USAID and <a href="http://www.pedaids.org/">Elizabeth Glaser Pediatric AIDS Foundation</a> funding that enabled scaling up of treatment in Soweto. </p>
<p>Within six months of the policy change, the team – led by Dr Lerato Mohapi – put just under 1,000 people in treatment. Our prevention of mother-to-child transmission programme, directed by Dr Avy Violari, expanded in Soweto. It accelerated access by opening prevention of mother-to-child transmission programmes in every antenatal clinic.</p>
<p>Even though we were involved with rolling out care and scaling up interventions for maximum impact, we knew we also had to focus on the clinical science, and designed a number of programmes. These were funded under the <a href="http://www.phru.co.za/hiv-treatment/households">CIPRA-SA</a> banner. </p>
<p>Studies executed under this programme had a major impact on international guidelines that revolutionised treatment management for infants and defined that antiretroviral treatment could be executed by nurses instead of doctors. The <a href="https://www.niaid.nih.gov/news/qa/pages/cher_qa.aspx">Children with HIV Early Antiretroviral</a> study, undertaken at the Chris Hani Baragwanath and Tygerberg hospitals, showed that early treatment in HIV-infected infants could significantly reduce deaths. </p>
<p>The CIPRA-SA study demonstrated that ARV care could be task-shifted to nurses, which allowed for the mass roll-out of treatment in South Africa and beyond. We continued with prevention of mother-to-child transmission research, which continued to help elucidate and refine regimens to make them more potent, the requirement to eliminate paediatric HIV.</p>
<p>Knowing that the only effective way to control the HIV epidemic was through prevention, the perinatal unit expanded its focus beyond prevention of mother-to-child transmission and antiretroviral treatment for adults and children. </p>
<p>At this time the South African AIDS Vaccine Initiative was also established. The South African-developed HIV vaccine candidate drugs were trialled on people in South Africa and the US. </p>
<h2>South Africa has come a long way</h2>
<p>All these interventions had a dramatic effect. In the past ten years estimates of South Africa’s burden of disease show a nine-year increase in the average life expectancy, which reached an all-time post-apartheid low of 55 in 2005. </p>
<p>The under-five mortality has been slashed by half from 80 deaths for every 1,000 births to 40 deaths for every 1,000 births. </p>
<p>Similarly spectacular gains have been made in the infant mortality rate. This went from from 54 deaths for every 1,000 births to just under 30 deaths for every 1,000 births. </p>
<p>Maternal deaths have also declined from 190 mothers dying for every 100,000 births to only 155 mothers dying. Most of this is attributed to the scaling up of antiretovirals in the public sector.</p>
<p>Now the next challenge is to ensure that the lessons garnered in our experience with the HIV epidemic are recapitulated. There is the quadruple burden of disease and the interconnecting epidemics of communicable and non-communicable diseases, maternal and child mortality, and injury and violence.</p>
<p><em>This is an edited version of the article that appeared in <a href="http://www.spotlightnsp.co.za/">Spotlight</a>, a quarterly South African health publication.</em></p><img src="https://counter.theconversation.com/content/62379/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>James McIntyre is Executive Director of the Anova Health Institute but does not work for, consult to, own shares in or receive funding from any company or organisation that would benefit from this article, and has no other relevant affiliations.</span></em></p><p class="fine-print"><em><span>Glenda Gray does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Activists, health-care workers and scientists in South Africa were faced with a horrific epidemic but went on a ruthless crusade to turn it around.Glenda Gray, President of the SAMRC and Research Professor, Perinatal HIV Research Unit, University of the WitwatersrandJames McIntyre, Honorary Professor, University of Cape TownLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/621362016-07-12T16:16:26Z2016-07-12T16:16:26ZHIV, AIDS and 90-90-90: what is it and why does it matter?<figure><img src="https://images.theconversation.com/files/130271/original/image-20160712-9264-y3w75c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Ajay Verma/Reuters </span></span></figcaption></figure><p><em>Twenty years ago when someone acquired HIV, they would, on average, not live more than 12 years. Today, a young person who becomes infected in the developed world can expect to have a near-normal lifespan with access to lifelong, uninterrupted HIV treatment. Globally, the HIV/AIDS community has worked hard to realise the Sustainable Development Goal of ending the AIDS epidemic by 2030. One crucial part of this plan is bringing HIV treatment to all who need it. Professor
Glenda Gray, President of the South African Medical Research Council, explains the importance of 90-90-90 and why there is so much talk around it.</em></p>
<p><strong>What is 90-90-90?</strong></p>
<p>A concept introduced by the United Nation’s programme on HIV/AIDS in 2013, <a href="http://www.unaids.org/sites/default/files/media_asset/201506_JC2743_Understanding_FastTrack_en.pdf">90-90-90</a> is a set of goals. The idea is that by 2020, 90% of people who are HIV infected will be diagnosed, 90% of people who are diagnosed will be on antiretroviral treatment and 90% of those who receive antiretrovirals will be virally suppressed. <a href="https://www.verywell.com/viral-suppression-3132658">Viral suppression</a> is when a person’s viral load – or the amount of virus in an HIV-positive person’s blood – is reduced to an undetectable level.</p>
<p>The strategy is an attempt to get the HIV epidemic under control and is based on the principal of universal testing and treating. What is central to “test and treat” approaches is that if one can identify people early on in their infection, and start treatment so they become virally suppressed, the onward transmission of HIV will be prevented and this will impact on HIV incidence at a population level.</p>
<p>There are an estimated <a href="http://www.unaids.org/en/resources/fact-sheet">36.7 million HIV-positive</a> people across the globe. In line with this, the goals would mean that 33.2 million of these people would be diagnosed, 29.5 million would be on antiretrovirals and 26.9 million would have viral suppression.</p>
<p>According to some of the <a href="http://www.unaids.org/en/resources/fact-sheet">latest figures</a>, there are only 19.8 million people – or 53% – who have been tested. About 13.4 million people remain undiagnosed. There are 17 million people on antiretrovirals while a substantial 12.9 million have not been initiated on antiretrovirals and remain untreated. Of those on antiretroviral treatment, only 11.6 million have viral suppression, which means that almost a third of HIV-infected individuals on treatment are not virally suppressed. This not only impacts on the development of antiretroviral drug resistance and future treatment options; it also has implications for the onward transmission of HIV.</p>
<p><strong>How realistic is this plan?</strong></p>
<p>This is a strategy to try and control the HIV epidemic and get towards an HIV-free world. The concept of universal test and treat is an aspirational concept, but it is an incredibly difficult plan to implement at scale, particularly in resource-poor settings that are heavily burdened with HIV.</p>
<p>This plan entails that the health service identify HIV in people who are not symptomatic, and who are not seeking care. It entails taking HIV testing out of the clinics and into the community, and requires new and innovative ways to get people tested for HIV infection. In order to make this plan realisable the health system has to endeavour to make HIV testing easily available even in the most remote areas of the world.</p>
<p>The second component of this plan entails ensuring that HIV-infected individuals are triaged into care, and they need to start antiretroviral treatment as close to diagnosis as possible. People who are asymptomatic and well may not feel ready to start taking treatment for life, which means that there needs to be adequate counselling and support, and the health benefits of early initiation of care need to be adequately explained.</p>
<p>Antiretroviral drugs need to be available in all places at all times. Once treatment is initiated, the aim is to keep people on treatment and adherent so that they can be virally suppressed and incapable of transmitting the virus to sexual partners, and to have maximal health benefits from early initiation of treatment. It also requires countries to have at least three lines of drug therapy. Currently only five countries in sub-Saharan Africa have three lines of treatment for people to transition onto once they have drug resistance or experience toxicities.</p>
<p>Most countries are unable to realise these ambitious programmes. There are several reasons for this:</p>
<p>First, they require resources for extraordinary access to HIV testing. Second, they need resources to procure drugs and prevent stock-outs. And, lastly, they need resources to keep people on treatment for life. No country either rich or poor can boast this kind of access or resources.</p>
<p>Although resource-rich countries that have less of a burden of disease are more likely to get and retain people on treatment, in heavily burdened countries there are difficult choices to make as a government, as programmes such as this require extraordinary resources.</p>
<p>It entails a robust health system, innovation to improve HIV testing access, and antiretroviral supplies that will be uninterrupted and support all three lines in case of drug resistance. It will entail not only a robust health system but a cadre of health-care workers who are trained and able to deliver a good service.</p>
<p>It also requires financial investment and a country that sees the investment case and is willing to put its own money and not that of donors into the programme.</p>
<p><strong>Which countries have made remarkable progress towards 90:90:90?</strong></p>
<p>In Africa, Botswana is close to reaching the 90-90-90 target for testing, treatment and viral suppression. Botswana was the first country on the African continent to provide free antiretroviral treatment to people with HIV, starting in 2002. Furthermore it has achieved its level of coverage when providing treatment to people with CD4 cell counts below 350 cells/mm³, even before moving to providing treatment for everyone diagnosed with HIV infection.</p>
<p>Previous international reviews of treatment cascade performance have shown that northern European countries and Australia have made the greatest progress towards reaching the 90-90-90 target.</p>
<p>Switzerland, Australia, the UK, Denmark and the Netherlands were well on their way to achieving this target. In each case, easily attainable improvements in the rate of diagnosis or treatment initiation should allow these countries to reach the goal.</p>
<p><strong>Which countries are struggling to reach the 90:90:90 goals?</strong></p>
<p>Many countries are struggling to reach these targets because of hard-to-reach populations. Testing and treatment has enormous challenges irrespective of the country you live in.</p>
<p>Many of those who receive HIV treatment are those who are the easiest to reach. This means that the road to universal access for all populations still poses major challenges.</p>
<p>There are substantial coverage gaps in many regions. To use Africa as an example: in 2013, treatment coverage on the continent ranged from <a href="http://www.unaidsrstesa.org/wp-content/uploads/2015/06/unaids_profile_Regional.pdf">41% in eastern and southern Africa</a> to 11% in the <a href="http://onusidalac.org/1/images/botones/UNAIDS_Treatment_target_V5.pdf">Middle East and North Africa</a>.</p>
<p>At least 30 countries in the world account for <a href="http://www.unaids.org/sites/default/files/media_asset/201506_JC2743_Understanding_FastTrack_en.pdf">89% of all new HIV infections</a>. At least 18 of these countries are in Africa, including Côte d’Ivoire, the Democratic Republic of the Congo, Mozambique, Nigeria and South Africa. But the list also includes other low- and middle-income countries like Brazil, China and India, and high-income countries like the US.</p><img src="https://counter.theconversation.com/content/62136/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Glenda Gray does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The 90-90-90 strategy is an attempt to get the HIV epidemic under control by adopting a ‘test and treat’ approach. This is part of the plan to eliminate AIDS by 2030.Glenda Gray, Research Professor, Perinatal HIV Research Unit and President, South African Medical Research CouncilLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/513582015-12-03T04:32:06Z2015-12-03T04:32:06ZThe all-in-one solution to sexual health is on its way<figure><img src="https://images.theconversation.com/files/104145/original/image-20151202-22448-f7rnzq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Women would prefer a product that addresses multiple sexual and reproductive health risks at the same time.</span> <span class="attribution"><span class="source">shutterstock</span></span></figcaption></figure><p>The current sexual and reproductive prevention methods have significantly improved the health and well-being of women and their families. But this is not enough. Worldwide each year there are still 85 million unplanned pregnancies, 21.6 million unsafe abortions, and nearly 300 000 <a href="http://www.guttmacher.org/graphics/ContraceptionWorks(Table).png">maternal deaths</a> from complications related to pregnancy and birth.</p>
<p>HIV remains the leading cause of death of women of reproductive age worldwide. <a href="https://www.guttmacher.org/graphics/MultipurposePreventionDevelopingWorld(IG)-800.png">Sub-Saharan Africa</a> has the highest burden. While anti-retroviral drugs are effective treatments, half of the women living with HIV in resource-limited settings can’t access them. And women’s HIV prevention technologies remain limited. Their use is often outside a woman’s sphere of control.</p>
<p>Enabling women to maintain good reproductive health requires innovative and improved prevention technologies. A revolutionary class of women’s sexual and reproductive health prevention products is being developed and may prove to be the linchpin to achieve the sustainable development goals that relate to women’s health.</p>
<p>Multipurpose Prevention <a href="http://cami-health.org/mpts">Technologies</a>, more commonly known as MPTs, are a new class of product in development. They deliver varying method combinations to simultaneously prevent HIV, sexually transmitted infections and unplanned pregnancies. </p>
<p>Although these technologies are complicated to develop, they are technically feasible. Since the field was launched six years ago, it has <a href="http://www.ncbi.nlm.nih.gov/pubmed/24188708">evolved</a> from an innovative concept. Currently there are over <a href="http://mpts101.org/mpt-database">20 products</a> being developed with nearly a dozen products in clinical trials.</p>
<h2>New methods of prevention</h2>
<p>There are many forms of innovative technologies being developed. Some combine contraception with prevention from sexually transmitted infections while others provide women who want to get pregnant with protection from HIV and other Sexually Transmitted Infections (STIs). Many do so in discrete forms that do not require partner negotiation. Some are designed to be used just before or at the time of a sexual encounter while others are long-acting products. </p>
<p><a href="http://mpts101.org/mpt-database">The innovations</a> currently being developed include:</p>
<ul>
<li><p>vaginal rings that release both hormonal contraception and an HIV prevention drug; </p></li>
<li><p>vaginal films and tablets that prevent HIV and herpes (HSV); </p></li>
<li><p>rectal suppository MPTs offering HIV and STI prevention for anyone engaging in anal sex; </p></li>
<li><p>new bio materials that will feel more like skin to make better feeling condoms; and other innovative technologies.</p></li>
</ul>
<p>The goal is to create an array of broad-spectrum prevention <a href="http://healthaffairs.org/blog/2015/11/02/mpts-combine-contraception-with-hiv-and-other-sti-prevention/#one">methods</a> which a woman can choose from to best suit her circumstances. But without increased investment in the research and development of these technologies, these powerful new prevention methods may never reach women’s hands.</p>
<h2>A benefit for all</h2>
<p>The intersecting nature of sexual and reproductive health risks is especially apparent in areas of the world where women have the least access to modern contraception and face the highest HIV and STI risks. </p>
<p>In 2012, young women in sub-Saharan Africa accounted for <a href="http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12842/full">70%</a> (25 million) of the 35.3 million people estimated to be infected with HIV globally.</p>
<p>By reducing non-HIV sexually transmitted infections at the same time as HIV and unplanned pregnancy and health costs will be cut. In addition lives can be saved. If sexually transmitted infections such as herpes, chlamydia and human papillomavirus are left untreated they can result in infertility and cancers. Herpes and human papillomavirus also put women at greater risk of acquiring HIV.</p>
<p>Sub-Saharan Africa has the highest burden of <a href="http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12842/full">herpes</a> where up to 80% of sexually active women are estimated to be infected.</p>
<p>It is no secret that improving women’s ability to plan and space children improves the economic well-being of families, saves millions of <a href="https://www.guttmacher.org/pubs/gpr/18/1/gpr180101.html">lives</a> and billions of dollars. Reducing the incidence of HIV and STIs also offers clear and well documented benefits to women, families, and economies. Doing it all at the same time will magnify these benefits. </p>
<p>And it is key to ending poverty and fulfilling the range of interlocking sustainable development <a href="http://www.un.org/sustainabledevelopment/sustainable-development-goals/">goals</a> that shape our interconnected futures. </p>
<h2>An all-in-one solution</h2>
<p>Women, providers and advocates of women’s health are enthusiastic about the multipurpose prevention technology. Combining prevention benefits into one product will be more efficient and will increase the number of women covered by this umbrella of prevention. </p>
<p>Early <a href="http://resource.cami-health.org/resources/ipsos.php">market research</a> shows an overwhelming preference for products that can address multiple sexual and reproductive health risks. And <a href="http://onlinelibrary.wiley.com/doi/10.1111/bjo.2014.121.issue-s5/issuetoc">research</a> shows that HIV stigma is a barrier that prevents many women from seeking HIV prevention. It suggests combining HIV prevention and protection from STIs with contraception delivered in family planning settings will increase HIV prevention uptake for many women.</p>
<p>Researchers, health care providers, and funders from around the globe, including China, India, Kenya, <a href="http://www.wrhi.ac.za/Pages/ClinicalTrials.aspx">South Africa</a> and the US have forged in-country collaborations to ensure multipurpose prevention technologies will be desirable and accessible to those who need it most. </p>
<p>The <a href="http://mpts101.org/infographic-mpts">social benefits</a> of these technologies are far reaching. It ranges from educational attainment to reducing child mortalities, improving incomes, reducing inequity and having a positive impact on the environment. </p>
<p>For the young women in sub-Saharan Africa who bear a disproportionate burden of HIV infection, unwanted pregnancies and sexually transmitted infections, these technologies could be life-changing. </p>
<p>_This article is a version of a <a href="http://healthaffairs.org/blog/2015/11/02/mpts-combine-contraception-with-hiv-and-other-sti-prevention/">blog</a> originally written by Professor Helen Rees and Dr Bethany Young Holt, who is the director of the IMPT (Initiative for MPTs), a project of <a href="http://cami-health.org/about">CAMI Health</a> where she serves as executive director. CAMI Health is dedicated to the health empowerment of women and girls and is sponsored by the Public Health <a href="http://www.phi.org/">Institute</a>.</p><img src="https://counter.theconversation.com/content/51358/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Helen Rees does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Scientists are developing various products that can provide contraception and protection from sexually transmitted infections and HIV at the same time.Helen Rees, Executive Director of the Wits Reproductive Health and HIV Institute, University of the WitwatersrandLicensed as Creative Commons – attribution, no derivatives.