This World AIDS Day, Putting the Power of Prevention in Women’s Hands

Lori Adelman

Woman-initiated prevention methods are key to the fight against HIV because they offer agency and protection to a disproportionally vulnerable demographic—women.

2010 has been a special year for women.

Brazil saw the election of its first-ever female president. Estimates of maternal deaths declined across the globe. Former Chilean President Michelle Bachelet was chosen to head a new United Nations agency on women, which will begin its operations in January 2011. And, excitingly, emerging technologies showed great potential to put the power of HIV prevention in women’s hands.

Woman-initiated prevention methods are key to the fight against HIV because they offer agency and protection to a disproportionally vulnerable demographic—women.

Globally, half of the people living with HIV and AIDS are female, and new infections in women and young people are growing rapidly, primarily through heterosexual sex. Biologically, women are more likely than men to acquire HIV. And gender inequalities and human rights violations heighten girls’ and women’s vulnerability; the use of physical force or emotional coercion during a sexual act greatly increases the risk of HIV transmission to the female, and violence and rape can further increase HIV risk by causing abrasions, bleeding, and tearing, especially among young girls whose genital tracts are not yet fully mature. Compounding this vulnerability, many girls and young women, especially the very young, cannot refuse unwanted sex or negotiate protection from pregnancy and STIs, including HIV, particularly when they fear retaliation.

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Despite these grim realities, over three billion women and girls worldwide are HIV-negative. And they have the right to stay negative. Woman-focused HIV prevention efforts and technologies will ensure that women are able to do just that. When a woman cannot convince her partner to wear a male condom either because he is violent, intoxicated, ignorant, or because he just doesn’t want to, a woman-initiated method such as a female condom or microbicide gel provides her with essential protection she can initiate herself.

In July, news that results from a clinical trial in South Africa found a microbicide gel to be nearly 40 percent effective in protecting women against HIV during intercourse was received with great excitement by the global and women’s health communities, and with good reason; the advent and approval of a microbicide gel such as this would mean that women could protect themselves from HIV without a barrier method, which often requires the cooperation of a male partner. For many women, who are unable to negotiate condom use or refuse sex, even with their husbands, this means a gel that they can use without men knowing, and could mean the difference between remaining HIV negative or contracting the virus.

Scientists are continuing to develop this new technology to increase its effectiveness and usability. For now, there is one female-initiated HIV prevention method that is already available in many places and ready for women’s use: the female condom.  

The female condom is, to date, the only woman-initiated protection method proven to be effective, both against HIV (94%- 97%) and unwanted pregnancies (87-95%). And women all over the world are taking note.  

In Cameroun, the Society for Women and AIDS in Africa-Cameroun (SWAAC) has helped create widespread demand for female condoms. SWAAC now distributes over 150,000 female condoms each year—and intends to generate even greater demand in the future. Click here to watch a video on demand and distribution of female condoms.

This World AIDS Day, we have an opportunity—and a duty—to call for increased investment in these crucial technologies. More work must be done to ensure that female condoms are available and accessible to women: only one female condom is distributed for every 700 male condoms. And making microbicides widely available to women will require political will and additional funding. But with continued attention to and investment in these interventions, 2011 will see an even greater array of achievement by healthy, empowered women, to the betterment of their families, their communities, and the world at large.

Roundups Sexual Health

This Week in Sex: The Sexually Transmitted Infections Edition

Martha Kempner

A new Zika case suggests the virus can be transmitted from an infected woman to a male partner. And, in other news, HPV-related cancers are on the rise, and an experimental chlamydia vaccine shows signs of promise.

This Week in Sex is a weekly summary of news and research related to sexual behavior, sexuality education, contraception, STIs, and more.

Zika May Have Been Sexually Transmitted From a Woman to Her Male Partner

A new case suggests that males may be infected with the Zika virus through unprotected sex with female partners. Researchers have known for a while that men can infect their partners through penetrative sexual intercourse, but this is the first suspected case of sexual transmission from a woman.

The case involves a New York City woman who is in her early 20s and traveled to a country with high rates of the mosquito-borne virus (her name and the specific country where she traveled have not been released). The woman, who experienced stomach cramps and a headache while waiting for her flight back to New York, reported one act of sexual intercourse without a condom the day she returned from her trip. The following day, her symptoms became worse and included fever, fatigue, a rash, and tingling in her hands and feet. Two days later, she visited her primary-care provider and tests confirmed she had the Zika virus.

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A few days after that (seven days after intercourse), her male partner, also in his 20s, began feeling similar symptoms. He had a rash, a fever, and also conjunctivitis (pink eye). He, too, was diagnosed with Zika. After meeting with him, public health officials in the New York City confirmed that he had not traveled out of the country nor had he been recently bit by a mosquito. This leaves sexual transmission from his partner as the most likely cause of his infection, though further tests are being done.

The Centers for Disease Control and Prevention (CDC)’s recommendations for preventing Zika have been based on the assumption that virus was spread from a male to a receptive partner. Therefore the recommendations had been that pregnant women whose male partners had traveled or lived in a place where Zika virus is spreading use condoms or abstain from sex during the pregnancy. For those couples for whom pregnancy is not an issue, the CDC recommended that men who had traveled to countries with Zika outbreaks and had symptoms of the virus, use condoms or abstain from sex for six months after their trip. It also suggested that men who traveled but don’t have symptoms use condoms for at least eight weeks.

Based on this case—the first to suggest female-to-male transmission—the CDC may extend these recommendations to couples in which a female traveled to a country with an outbreak.

More Signs of Gonorrhea’s Growing Antibiotic Resistance

Last week, the CDC released new data on gonorrhea and warned once again that the bacteria that causes this common sexually transmitted infection (STI) is becoming resistant to the antibiotics used to treat it.

There are about 350,000 cases of gonorrhea reported each year, but it is estimated that 800,000 cases really occur with many going undiagnosed and untreated. Once easily treatable with antibiotics, the bacteria Neisseria gonorrhoeae has steadily gained resistance to whole classes of antibiotics over the decades. By the 1980s, penicillin no longer worked to treat it, and in 2007 the CDC stopped recommending the use of fluoroquinolones. Now, cephalosporins are the only class of drugs that work. The recommended treatment involves a combination of ceftriaxone (an injectable cephalosporin) and azithromycin (an oral antibiotic).

Unfortunately, the data released last week—which comes from analysis of more than 5,000 samples of gonorrhea (called isolates) collected from STI clinics across the country—shows that the bacteria is developing resistance to these drugs as well. In fact, the percentage of gonorrhea isolates with decreased susceptibility to azithromycin increased more than 300 percent between 2013 and 2014 (from 0.6 percent to 2.5 percent).

Though no cases of treatment failure has been reported in the United States, this is a troubling sign of what may be coming. Dr. Gail Bolan, director of CDC’s Division of STD Prevention, said in a press release: “It is unclear how long the combination therapy of azithromycin and ceftriaxone will be effective if the increases in resistance persists. We need to push forward on multiple fronts to ensure we can continue offering successful treatment to those who need it.”

HPV-Related Cancers Up Despite Vaccine 

The CDC also released new data this month showing an increase in HPV-associated cancers between 2008 and 2012 compared with the previous five-year period. HPV or human papillomavirus is an extremely common sexually transmitted infection. In fact, HPV is so common that the CDC believes most sexually active adults will get it at some point in their lives. Many cases of HPV clear spontaneously with no medical intervention, but certain types of the virus cause cancer of the cervix, vulva, penis, anus, mouth, and neck.

The CDC’s new data suggests that an average of 38,793 HPV-associated cancers were diagnosed each year between 2008 and 2012. This is a 17 percent increase from about 33,000 each year between 2004 and 2008. This is a particularly unfortunate trend given that the newest available vaccine—Gardasil 9—can prevent the types of HPV most often linked to cancer. In fact, researchers estimated that the majority of cancers found in the recent data (about 28,000 each year) were caused by types of the virus that could be prevented by the vaccine.

Unfortunately, as Rewire has reported, the vaccine is often mired in controversy and far fewer young people have received it than get most other recommended vaccines. In 2014, only 40 percent of girls and 22 percent of boys ages 13 to 17 had received all three recommended doses of the vaccine. In comparison, nearly 80 percent of young people in this age group had received the vaccine that protects against meningitis.

In response to the newest data, Dr. Electra Paskett, co-director of the Cancer Control Research Program at the Ohio State University Comprehensive Cancer Center, told HealthDay:

In order to increase HPV vaccination rates, we must change the perception of the HPV vaccine from something that prevents a sexually transmitted disease to a vaccine that prevents cancer. Every parent should ask the question: If there was a vaccine I could give my child that would prevent them from developing six different cancers, would I give it to them? The answer would be a resounding yes—and we would have a dramatic decrease in HPV-related cancers across the globe.

Making Inroads Toward a Chlamydia Vaccine

An article published in the journal Vaccine shows that researchers have made progress with a new vaccine to prevent chlamydia. According to lead researcher David Bulir of the M. G. DeGroote Institute for Infectious Disease Research at Canada’s McMaster University, efforts to create a vaccine have been underway for decades, but this is the first formulation to show success.

In 2014, there were 1.4 million reported cases of chlamydia in the United States. While this bacterial infection can be easily treated with antibiotics, it often goes undiagnosed because many people show no symptoms. Untreated chlamydia can lead to pelvic inflammatory disease, which can leave scar tissue in the fallopian tubes or uterus and ultimately result in infertility.

The experimental vaccine was created by Canadian researchers who used pieces of the bacteria that causes chlamydia to form an antigen they called BD584. The hope was that the antigen could prompt the body’s immune system to fight the chlamydia bacteria if exposed to it.

Researchers gave BD584 to mice using a nasal spray, and then exposed them to chlamydia. The results were very promising. The mice who received the spray cleared the infection faster than the mice who did not. Moreover, the mice given the nasal spray were less likely to show symptoms of infection, such as bacterial shedding from the vagina or fluid blockages of the fallopian tubes.

There are many steps to go before this vaccine could become available. The researchers need to test it on other strains of the bacteria and in other animals before testing it in humans. And, of course, experience with the HPV vaccine shows that there’s work to be done to make sure people get vaccines that prevent STIs even after they’re invented. Nonetheless, a vaccine to prevent chlamydia would be a great victory in our ongoing fight against STIs and their health consequences, and we here at This Week in Sex are happy to end on a bit of a positive note.

Roundups Sexual Health

This Week in Sex: A Reason to Celebrate on Tax Day?

Martha Kempner

Same-sex married couples get a long-awaited policy change (but maybe not a tax break), there’s encouraging news about the development of a male contraceptive method, and the month of April brings some much-needed attention to sexually transmitted diseases.

This Week in Sex is a summary of news and research related to sexual behavior, sexuality education, contraception, STIs, and more.

Tax Day 2016: A Reason to Celebrate for Same-Sex Couples

Many in the United States dread this time of year because it means dealing with the Internal Revenue Service (IRS). But there is something to celebrate this time around: 2016 is the first year that every married same-sex couple can file both federal and state taxes together.

After the U.S. Supreme Court ruling striking down part of the Defense of Marriage Act in 2013, the IRS changed its rules to allow legally married same-sex couples to be treated as married for federal tax purposes. While this was a step forward for equality, it actually made tax filing far more complicated for some couples, as NPR explains. Those who lived in a state where same-sex marriage was not recognized would have to file federal taxes as a married couple, but state taxes as individuals. To make matters trickier, state taxes are often based on your federal tax return; some couples had to create mock individual federal returns just to figure out what they owed their state.

This all changed in June 2015, when the Supreme Court ruled in Obergefell v. Hodges that no state can prevent same-sex couples from marrying and all must recognize their unions, effectively legalizing marriage equality nationwide. So this makes Tax Day 2016 the first day that all married couples—regardless of gender—will be treated equally.

While many are celebrating the symbolic victory, some couples may be shocked to find out that they actually owe more taxes as a married couple.

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Another Step Toward Male Contraception

Over the last few decades, researchers have developed numerous ways to prevent pregnancy, from hormonal pills that block ovulation to IUDs that slow the movement of sperm through the reproductive tract. Up until now, male contraception has been limited to one barrier method, condoms, and one permanent one, vasectomies. Now, a new study lends some proof of concept for possible reversible male contraception methods.

As Rewire has reported, one method in development, known as Vasalgel, is intended to be injected into the vas deferens and create a physical barrier preventing sperm from leaving the testicles. Scientists behind Vasalgel say they intend for it to be reversible with another injection. This could be on the market as soon as 2018. But scientists are still looking for other ways to temporarily render males infertile—possibly ones that do not involve an injection into the testicles.

A new study suggests new chances for one such method. University of Virginia researchers are focused on an enzyme known as TSSK2, which helps make sperm motile. They think this enzyme could be the key to a contraceptive method because it is only found in the testicles and only involved in the very last state of sperm production. In theory, this means that blocking this enzyme could produce nonswimming sperm without causing side effects in the rest of the body. They have found a way to mass produce this enzyme in a laboratory, and their next step is to test existing drugs to see if any can bond only to TSSK2 in the testicles without affecting the rest of the body.

Clearly, they are years away from an actual male birth control pill based on this concept. But this is not the only idea for a male birth control pill under development. As Rewire reported last year, other scientists are working with existing drugs to block a protein called calcineurin and have successfully rendered mice infertile by doing so.

While men wait—though it’s still unclear if many are really interested in their own pill—we should all remember that between condoms, pills, patches, rings, and IUDs, there are many methods couple can rely on for preventing pregnancy.

April is STD Awareness Month

With so many months and even weeks dedicated to disease, causes, or remembrances, it can be easy to let them pass unrecognized. But we here at Rewire thought it was important to remind our readers that April is STD Awareness Month, because the epidemic in this country is growing out of control. For the first time in a decade, cases of chlamydia, gonorrhea, and syphilis are all on the rise.

Syphilis—a disease that not long ago, we thought could be eradicated—has increased by 40 percent between 2010 and 2014. While much of this increase is seen in men who have sex with men, rates among women are increasing as well. There has also been an increase in cases of ocular syphilis, which infects the eyes and can cause permanent blindness.

Along with this, we have seen a rise in the rate of congenital syphilis, which occurs when an infected woman passes the bacteria to her infant. As Rewire reported, the rate of congenital syphilis increased 38 percent between 2012 and 2014. Congenital syphilis can cause miscarriage, stillbirth, severe illness in the infant, and even early infant death. There were 438 nationwide cases of congenital syphilis in 2014, which led to 25 stillbirths and eight deaths within 30 days of birth.

Rewire has also been reporting on the possibility of antibiotic-resistant strains of gonorrhea that could turn a once easy-to-treat bacterial infection into a very dangerous disease.

We really do need to be aware of STDs and take steps to prevent them in ourselves and our communities. The CDC has given us all three easy tasks for this month—Talk, Test, Treat. So, for April, let’s talk openly about STDs with our friends, relatives, and partners; get tested if we’ve been exposed to any risk; and of course, seek treatment if necessary.