Woman-Centric Research and Why it’s Time to Listen to the Ladies

Earlier this month, AVAC hosted a webinar to explain and explore the complex issues of hormonal contraceptives and HIV risk in light of a new analysis that is generating plenty of debate. New findings raise increased concern that one type of hormonal contraceptive, known as Depo-Provera, may raise a woman’s risk of acquiring HIV. At the same time, Depo-Provera has been an effective way for a generation of African women to control their reproductive health. The debate surrounding Depo-Provera has been passionate and comes at a time when a number of influential voices are calling for a paradigm shift that would align scientific research with the health needs of women.

In mid-September, Anthony Fauci, the director of the US National Institute of Allergy and Infectious Disease (NIAID), hitched onto the star power of Barbara Streisand to jointly pen a call to action for greater scientific attention on women’s health, particularly when it comes to research on HIV and heart disease. Just a few days before, Melinda Gates, who along with her husband Bill, helps to set the global health agenda through the philanthropy of the Bill and Melinda Gates Foundation, announced a new priority for the foundation—eliminating inequalities among the sexes.

While Gates put out a message to the scientific field that women and girls need to be at the center of research on malaria, tuberculosis and HIV, the Foundation is also pledging $80 million to collect quality data on the conditions faced by women and girls all over the world. In an interview published September 10th in Canada’s L’actualité magazine, Melinda Gates said women…

“…are the center of the family. It’s the woman who decides what’s eaten in the house, when to have the kids vaccinated; everything that has to do with the children’s health revolves around her. If you don’t invest in her, empower her, give her the things she needs to lift her family up, you’re just not going to make the progress that you want to make. But if you put her at the center, you can change a lot for that family, and it has ripple effects through the economy.”

And over at NIAID, Fauci and Streisand are trumpeting the work of the REPRIEVE Trial, which has gone the extra distance to give equal attention to both men and women as it looks at the impact of statins to control heart disease in people living with HIV.

It’s starting to sound like leaders in global health recognize a chronic challenge that is undermining their good work: great advances in research, comprehensive efforts to develop solutions, and a commitment to share resources and insights continue to leave far greater numbers of women than men outside the circle of prevention and recovery.

It’s undeniable that global health indicators have shown some remarkable achievements to date: as many as 14 million men have volunteered to be medically circumcised as a preventive measure, mother to child transmission is heading towards eradication, access to treatment for HIV has reached 17 million people, many of whom live in the hardest-hit regions of the world. Yet in sub-Saharan Africa, the region most affected by HIV, young women and adolescent girls acquire HIV five to seven years earlier than young men, and in some countries HIV prevalence among young women and adolescent girls is as much as seven times that of their male counterparts, according to UNAIDS 2015 report on the issue.

The debate around Depo-Provera spotlights these contradictions. In a statement released September 26, 2016, The International Community of Women Living with HIV & AIDS Eastern Africa (ICWEA) called on authorities to meet the challenges raised by the complex reality of women’s lives. ICWEA pointed out that maternal mortality continues to be high in sub-Saharan Africa, and that doubts persist about the link between HIV and the popular contraceptive. ICWEA urgently called for an expanded mix of contraceptive methods, and the information to go with it so that women are able to act on real choices.

The World Health Organization (WHO) must invite more than a few token sub-Saharan women advocates to the up-coming Expert Review Group, which is meeting to evaluate the current evidence of a link between hormonal contraceptives and HIV. Governments and policy makers must prioritize the empowerment of girls and women as a center piece in their response to these pressing public health concerns. Any response to HIV, heart disease, and maternal mortality will fail whenever we fail to confront the inequalities that govern the lives of so many women around the world.

For more on issues focused on women and research, stay tuned for AVAC and Athena’s webinar on the vaginal biome coming soon. For a little background on this check out AVAC’s recent Px Wire.

AIDS Research and Treatment Special Issue

This journal is accepting submissions for an upcoming Special Issue titled “New Approaches to HIV Prevention and Therapy,” to be published in June 2017, and is open to original research and review articles. Submission deadline February 3, 2017. Call for papers here.

Start Talking. Stop HIV.

Nicely Done. The US Centers for Disease Control (CDC) gets five stars for this music video showcasing a number of key strategies for preventing HIV. It’s sex-positive, it’s fun and it gets the word out: There are more tools than ever before to protect you from HIV—try them, you’ll like them.

The glitzy two-and-a-half minute production is part of the CDC’s Start Talking. Stop HIV. campaign reaching out to men who have sex with men, particularly black and latino gay men. The music video was just released and we’re dancing along in full support of this well-crafted, entertaining piece of work.

Moving Forward with PrEP and MSM in Kenya and Uganda—And It’s Just the Beginning

It’s been five months since the first ever consultation about PrEP for gay African men was held in South Africa. (Yes, there was consensus at the meeting at the outset to use the term “gay men”, rather than MSM, and also to be clear that we were not addressing the specific needs of transwomen, an urgent and separate agenda.) It’s terrific to be able to share the meeting report from the April consultation, and to provide the first of a series of ongoing updates, in this case from Kenya and Uganda, about work to expand access to oral PrEP to all the Africans who need it!

Kenyan PrEP Ambassador accepts PrEP User of the Year Award

From Kenya, the key population focused organization HOYMAS held their HIV/AIDS Champions’ Day in Nairobi on Monday this week. This year HOYMAS focused their HIV/AIDS Champions’ Day on highlighting the advocacy needs for new prevention options including oral PrEP. The event provided a platform for participants to exchange best practices, strategies for advocacy and ideas that advance the overall goal of prevention of HIV. One highlight from the meeting was when Brandon, who was named Kenyan PrEP ambassador by a Kenyan health organization known as LVCT, won the PrEP User of the Year.

Earlier in September, the Uganda LGBTQ community, led by Sexual Minorities Uganda (SMUG), held a meeting to discuss expanding PrEP access that put gay men at the center.

I am personally intrigued by the resilience of SMUG and of the entire Uganda LGBTQ community, even in the midst of the unrest. In the past six weeks alone, they have endured terrible police brutality at a Pride-related event, cancellation of the main Pride parade and ongoing harassment and stigmatization. In the midst of these rights violations, and their crucial work as human rights’ defenders, SMUG is also helping to ensure that the right to health is upheld. I salute them.

The September 9 meeting, held at a secure location, brought together about 25 participants from civil society organizations, members of Uganda’s LGBTQ community and members of SMUG. Some of the participants were attending a PrEP advocacy strategy meeting for gay men for the first time.

Richard Lusimbo from SMUG, the lead organizer of the meeting, reports that there was a deep sense of urgency within the members of the community who were at the meeting and others who were following on social media. You can get a sense of the lively discussion by searching #PrEP4MSM on Twitter he questions debated by meeting participants included: “Where has PrEP been?”, “Why don’t we have it yet?”, “How do we make this important prevention method available for our community now!?” Lusimbo noted, “The key word is ‘NOW.’” They want it now and they deserve to have access to it now!

The meeting participants stressed that community members need to be empowered with more education and information about PrEP. Many people are still confused about the difference between PrEP and PEP. PrEP stands for pre-exposure prophylaxis. It is an HIV prevention strategy in which HIV-negative people take an oral pill once a day before coming into contact with HIV to reduce their risk of infection. PEP stands for post-exposure prophylaxis. PEP is an HIV prevention strategy in which HIV-negative people take a short course of ARVs after possible exposure to reduce their risk of HIV infection. Basic questions that members of the community might be having about PrEP need to be asked and answered.

Some of the participants expressed the fear of continued stigmatization and homophobia in the country that might be heightened if PrEP is considered only for MSM. They stressed the need for PrEP to be rolled out for all populations at risk, as WHO has recommended, so that the Uganda government can support it without singling out specific populations.

Participants also expressed the need to come up with a clear communications strategy to inform the community about PrEP and to address misconceptions.

Further allies in PrEP advocacy in Uganda such as Health GAP helped members challenge the myth that lack of government funding in the short term should hold back implementation advocacy.

We are very excited about the ongoing PrEP advocacy and the work to create demand for prevention options for all populations in Africa, especially those most at risk. Ongoing collaboration with our Africa partners supports a broad and crucial effort—engage with national governments and other stake holders, advocate for the development of national PrEP guidelines and make sure there is community awareness of PrEP.

Watch this space for how the group moves forward in the weeks to come.

Medical Officer job posting

USAID is pleased to invite applications for a Medical Officer position in the Microbicide Branch of the Research Division, Office of HIV/AIDS. The Medical Officer will support clinical testing, development, and implementation of HIV prevention technologies, especially microbicides and PrEP in the near term, as well as alternative ARV-based products, vaccines, and other novel approaches in the future. For additional information, please see here. Note that applicants must be US citizens and this posting closes October 18, 2016.

Who inspires you in HIV prevention? Nominations open for 2016 Falobi Award

AVAC is pleased to join a number of partners to announce the call for nominations for the 2016 Omololu Falobi Award for Excellence in HIV Prevention Research Community Advocacy. This update includes information on the award, a link to the nomination form due September 28, 2016 and information about the upcoming HIV Research for Prevention (R4P) Conference where the selected advocates will be honored.

On October 5, 2016, it will be ten years since Nigerian HIV prevention advocate Omololu Falobi was tragically killed. Those who knew Omololu will remember him—among many other things—as a talented journalist, an activist for social justice, an advocate for prevention research and a son of Africa who worked tirelessly to ensure Africans were taking ownership of their own HIV care and prevention. Omololu founded the Journalists Against AIDS in Nigeria (JAAIDS), co-created the Nigeria-AIDS eForum, co-founded the New HIV Vaccine and Microbicide Advocacy Society (NHVMAS), was an instrumental pioneer member of the Treatment Access Movement (TAM) Nigeria and a key leader of the African Civil Society Coalition on HIV and AIDS.

In 2008, in honor of Omololu’s memory and commitment to the field, the Omololu Falobi Award for Excellence in HIV Prevention Research Community Advocacy was established by the African Microbicides Advocacy Group (AMAG) and partners. The Award has since been given to a community advocate in recognition of his/her contribution to the HIV prevention research field through community advocacy. Individuals are nominated by their peers, and the winner is announced at a biennial international HIV prevention research conference. Lori Heise (USA) and Aylur Srikrishnan (India) were the 2008 recipients, Charles Shagi (Tanzania) the 2010 recipient, Anna Forbes (USA), the 2012 recipient and Taiwo Oladayo Oyelakin (Nigeria), the 2014 recipient.

When Omololu left us in 2006, we had few people who called themselves prevention research advocates and there was a real need to celebrate the unseen work of community advocates. We also had no proof of concept of vaccines, microbicides or PrEP working. Today it’s time to celebrate the success of the last decade and to acknowledge the different kinds of advocates – activists, researchers, community educators, trial participants, policy-makers – who have contributed to it in one way or another. This is fitting of Omololu’s legacy because he was devoted to building movements.

The 2016 partners coordinating the Award are pleased to call for nominations for the 2016 Omololu Falobi Award for Excellence in HIV Prevention Research Community Advocacy. Given the growing movement, we want to profile the community of advocates who help shape this field.

Click here for further details on the nomination process.

Self-Testing is on the Map

UNAIDS’ “Fast Track” plan to end the AIDS epidemic includes a trio of targets known as “90 90 90”. Achieving the first 90 (testing) can only happen with a dramatic growth in the number of people testing their HIV status. Only about 54 percent of the approximately 37 million people with HIV around the world know their status. One way to reach this goal might be “self-testing” kits. Studies reported at the AIDS 2016 conference brought insight into how self-testing kits could work.

UNAIDS’ “Fast Track” plan to end the AIDS epidemic includes a trio of targets known as “90 90 90”—ninety percent of all people living with HIV will know their status, ninety percent of them will get effective treatment, and ninety percent of them will see the virus suppressed in their bodies… all by 2020. Achieving the first 90 (testing) can only happen with a dramatic growth in the number of people testing their HIV status. According to US Department of Health and Human services, only about 54 percent of the approximately 37 million people with HIV around the world know their status. One way to reach this goal might be “self-testing” kits, which can be used at home and yield results within twenty minutes using technology as simple as a swab and a test tube.

Studies reported at AIDS 2016 conference in Durban brought insight into how self-testing kits could work. We’ve summarized some of these abstracts and their key findings below.

Community-based distribution of HIV self-test kits: results from a pilot of door-to-door distribution of HIV self-test kits in one rural Zimbabwean community
Euphemia Lindelwe Sibanda reported on the findings of a study conducted by the Centre for Sexual Health and HIV/AIDS Research, Zimbabwe. Researchers distributed more than 8,000 HIV self-testing kits over a one-month period, door-to-door, in a rural district in Zimbabwe. People could choose to take their test with a trained community volunteer present or on their own. Participants were asked to return their used test kits to a locked drop box. Results were obtained from the used tests.

The 8,000 people who received kits represent well over half the adult population (both men and women) in the district. 85 percent declined assistance from a community volunteer and chose to take their test alone or with their partner. Sixty-eight percent of the kits were returned to the locked drop box. Researchers were able to establish HIV positive results for more than 1100 individuals (21 percent of the returned kits), and 824 of them sought follow-up services which represents 10 percent of the 8,000 who received a kit, and 15 percent of the returned kits. The study’s authors said demand for the kits exceeded supply. The authors also reported that especially high numbers of men and young people tested themselves at home.

Acceptability, feasibility and preference for HIV self-testing in Zimbabwe
Another study based in Zimbabwe also demonstrated the acceptability and desirability of self-testing. Sue Napierala Mavedzenge from RTI International presented a study of 1,000 participants, recruited from rural and urban outskirts. Of these, 70 percent opted to test themselves and 30 percent chose testing administered by a provider. At a two week follow up, 663 (95 percent) had used the home test kit, 32 individuals (5 percent) had not. Forty-seven (8 percent) had tested positive and 25 of them had sought follow up care.

Provision of oral HIV self-test Kits triples uptake of HIV testing among male partners of antenatal care clients: results of a randomized trial in Kenya
A study from Kenya suggests that self-testing could be an important tool for reaching men, who as a rule are less likely to seek testing. The Kenya study was presented by Anthony Gichangi of Jhpiego Kenya. This randomized trial followed 1,410 women who were counseled about HIV testing during ante-natal care visits. Some were provided standard care. Others were given literature about partner testing and the risk of HIV transmission from mother to child. A third group took home both literature and self-testing kits. Testing rates for the latter group (literature and a home testing kit) far surpassed the other two: 83 percent of the men in group three took the test. Only 28 percent of men from the first group, who received standard care, obtained a test. Thirty-eight percent of men responded to the literature alone. A majority of men and women who tested, including all three options, reported they took the HIV tests together.

Together these studies suggest that scaling up the availability of home test kits could spur accelerated HIV testing in countries hard hit by the epidemic. Visit here for a look at current initiatives, funded by UNITAID and implemented by Population Services International, advancing this work.

All this sounds like good news. And maybe it will be, especially if the field pays proper attention to the potential risks.

Understanding coercion in the context of semi-supervised HIV self-testing in urban Blantyre, Malawi
Wezzie Lora explored one such risk in a study conducted by the Malawi Liverpool Wellcome Trust.

In this study, fifteen heterosexual couples were interviewed on two occasions after having been provided with self-testing kits. A total of thirty men and women participated. Researchers asked if the participants experienced coercion by their partners to take the test. Some women reported feeling empowered by the option to bring a self-test home. More men than women said they felt coerced to take the test. Some of the participants rationalized coercion as sometimes acceptable or ethical, where there was history of infidelity, for example. Others characterized coercion as an “infringement of human rights,” according to the study’s authors. The study framed coercion as a culturally-informed concept and concluded that in certain contexts, under particular conditions, men and women expressed tolerance for coercion.

This raises a range of important questions about minimizing the risk of coercion in culturally appropriate ways. Details about what led women to feel empowered and how that affected their choices is important to understand. Certainly, the issue is complex—the privacy associated with testing at home may be appealing and empowering, and it may also invite coercion. What’s more, the privacy surrounding this technology might make it difficult for the field to ascertain if the net effect increases or reduces safety.

Self-testing offers the potential to quickly expand the global population who knows their status. Such a tool belongs alongside an equal imperative in the fight against HIV: an absolute commitment to protect human rights. More exploration is necessary and these studies, while leaving questions, also support that ongoing work.


Uptake, Accuracy, Safety and Linkage into Care over Two Years of Promoting Annual Self-Testing for HIV in Blantyre, Malawi: A Community-Based Prospective Study in PLoS Medicine

Home Tests – Centers for Disease Control and Prevention

Two Women, Both with Stories Showing How Hard It Is for Women to Get PrEP

This article, originally posted on the US-based Betablog.org, is a strong reminder that PrEP access for women is facing significant hurdles in the US and around the world. AVAC is working with partners including the US Women & PrEP working group and current Fellows Nigeria’s Amaka Enemo, Zambia’s Chilufya Kasanda and South Africa’s Ntombozuko Kraai, to address this critical gap.

One year: That’s the amount of time it took for Elena and Freya1—two women with HIV-positive male partners—to figure out how to access pre-exposure prophylaxis (PrEP) and get their first prescription filled after finding out about this option for HIV prevention. Both women live in the Southern US—in states with some of the highest rates of HIV infection. Both women identify with a race/ethnicity disproportionately affected by HIV (Elena is African American, Freya is Hispanic). And both are HIV-negative—and wish to stay that way.

Their respective experiences—having to advocate for their own health and demand access to an effective HIV prevention drug—highlight the many challenges women still face in accessing, paying for, and even getting information about this effective way to prevent HIV.

“When I read about PrEP for the first time, I thought, ‘Is this real?’ And then I got a little upset. I even asked my OB/GYN after the fact, ‘Why didn’t you ever tell me about this?,’” said Elena.

After three years, PrEP use by women still lags behind use by men

Truvada-based PrEP was approved by the FDA for the prevention of HIV in 2012. Just last month, the drug’s manufacturer, Gilead Sciences, released data on the number of people starting Truvada-based PrEP in the US. In three years—from the third quarter of 2013 to the third quarter of 2015—the number of people taking PrEP in the US has increased by 523 percent. But when you look at the breakdown by sex, it’s clear that men (especially men who have sex with men) are responsible for the increase.

The Centers for Disease Control estimate that about 468,000 women in the US have substantial risk for HIV and may benefit from PrEP, but only a relatively small number of women have accessed PrEP in the US to date.

In fact, from 2012 to 2015, the number of new women starting PrEP per year has declined over time, with about 2,600 women starting PrEP in 2012 to about 2,500 each starting in 2013 and 2014, and a little less than 2,500 starting PrEP in 2015. PrEP uptake among African American and Hispanic women is significantly less than that of white women.

Compared to men, PrEP uptake by women has steadily lagged behind—with less than 2,500 women initiating PrEP in 2015 (compared to over 19,000 men in that same year).

Women won’t use PrEP if they don’t know it exists—or that it could work for them

“It was surprising to find out about something that I might be able to use that I had never heard about before,” said Elena. “And then when I started doing research online about PrEP, all I found were articles about PrEP for gay men. I thought—there’s no way I’m going to be able to get this. Very few things online said anything about PrEP for women.”

Susan Alvarado, who coordinates a PrEP study for cisgender women at AIDS Project Los Angeles, said that she’s seen similar responses from women she’s spoken to about the study. At a presentation at a community event, she found women in attendance didn’t know about PrEP, or through it was only for men who have sex with men. When doing outreach in the HIV community, she found that people knew about PrEP but were surprised to hear about a project specifically for cisgender women.

There isn’t consumer demand for PrEP from women because there haven’t been many marketing campaigns targeting women who may be vulnerable to HIV, said Shannon Weber, MSW, director of HIVE and founder of PleasePrEPMe.org. Targeting women who may be at risk for HIV, she said, is difficult.

“There isn’t a club, or a clinic, or a bar that higher-risk women go to chat and hang out with other women at substantial risk. Gay men have done a great job identifying gay-friendly doctors and places they can get reliable health information. And even from an online perspective, it’s more challenging to target campaigns and ads to women at substantial risk than it is to target gay men. It’s a little more like, ‘Who is this group?’”

Which means that there isn’t the same “buzz” in the community about PrEP for women as there is for men who have sex with men, said Dázon Dixon Diallo, DHL, MPH, CEO of the women’s reproductive justice nonprofit SisterLove. When PrEP was first brought to the public space, she said, it was marketed as an HIV-prevention option for adult men and women. That changed, though, and many agencies began delivering information about PrEP specific to men who have sex with men.

“Most women don’t know about PrEP, so they can’t ask about it,” said Jessica Terlikowski, the director of prevention technology education at AIDS Foundation of Chicago. “They can’t demand what they don’t know about.”

Women may not be worried about HIV, or think of themselves as ‘at-risk’

Another challenge, said Diallo, is that many women—including African American women at other women at risk for HIV—may not consider HIV infection as a possibility or believe they are at risk.

“Women don’t think about relationships in terms of ‘risk-taking.’ And they don’t think in terms of ‘sexual behavior.’ They’re thinking in terms of relationships, which many times women may perceive as ‘safe.’ If I’m in a committed relationship, or I don’t have multiple partners—or even if I do—I may feel like I ‘know’ that person or those people. So there are some real issues around risk assessment,” said Diallo.

Alvarado said that a similar view can be found among women in the Latina community. “I think this happens a lot with our women,” she said. “They don’t see the risk because of the relationships they find themselves in. They may think, ‘I’m married,’ or ‘I only have one partner. Why would I need to be concerned about HIV?’ And even if their partner is being unfaithful, they’d rather not know.”

This sentiment stands in stark contrast to the deep-seated fear of HIV that many men who have sex report experiencing—and then report seeking PrEP to alleviate.

There’s no consensus on who should be providing PrEP to women

Both Freya and Elena reached out to their OB/GYNs in the hope that their reproductive and sexual health care providers could offer and prescribe them PrEP. Both had their requests rebuffed or denied outright.

Freya’s provider said she needed to find an infectious disease specialist to provide PrEP, while Elena’s didn’t know enough about PrEP to prescribe it.

“Provider training is an issue,” confirmed Weber. “Most of the provider trainings have been geared toward HIV providers, gay men’s sexual health providers—and very few have been directed toward women’s health providers, although that is shifting. It would take a coordinated, national effort to broadly train women’s health providers around HIV prevention counseling—beyond condoms.”

Both Elena and Freya were eventually able to find providers willing and able to prescribe them PrEP, but it took a while. Over the course of months, Elena contacted her fiancé’s doctor and his Ryan White advocate, and her primary care doctor—none whom were able to prescribe PrEP. Through a support group that she and her fiancé attend for those affected by HIV at an LGBT center in her region, she was linked to a PrEP specialist, who was finally able to help Elena start PrEP.

Freya heard from her OB/GYN that she wasn’t considered “high risk” enough to start PrEP, even though she was dating an HIV-positive man. Her OB/GYN said she wouldn’t be able to prescribe it since she wasn’t familiar with the medication, but that she’d do a little more research on it. She asked her, in the meantime, to reach out to HIV specialists, which Freya did. They, in turn, said they only served HIV-positive patients.

So she looked online for help—eventually finding assistance from HIVE, an organization based in the San Francisco Bay Area, which linked her to a provider at the University of Miami who eventually helped Freya start PrEP.

“It was crazy, that someone in San Francisco—all the way across the country—was helping me get where I needed to be,” said Freya.

This issue—of providers’ willingness to provide PrEP services—goes part and parcel with existing problems that women have accessing HIV counseling and testing through reproductive health service providers in some areas already, said Diallo.

“We have women diagnosed with HIV who tell stories about how long they went never being tested until they demanded it for themselves. It makes sense for all GPs [general practitioners] and other providing services to women to be educated to provide sexual health assessments, HIV testing and PrEP guidance,” she said.

Terlikowski, through the Midwest HIV Prevention and Pregnancy Planning Initiative, is working on just this issue—to bring PrEP education to women’s health care providers operating in the Midwest.

“Family planning settings are such crucial points, because the majority of women get their care from a family planning provider. A recent survey of family planning providers indicate they need more training to have the knowledge and skills to offer and manager PrEP. We’re really excited to have this program where we can help meet some of those needs—and to help make sure that conversations providers have with women are about their overall sexual health needs, go beyond ‘What are your contraception needs?’,” said Terlikowski.

And so far, the response by providers has been very positive, said Terlikowski, especially among nurses, who have shown great interest.

Affordability affects access and uptake

Elena said that she doesn’t have a better option than PrEP when it comes to HIV-prevention, so she’s willing and able to incorporate it into her regular routine. “Gilead covers the cost of the pill for me. I got a pharmacy card with help from the person at the LGBT center. But I will say this—I still have to pay for my labs—which I will need to get every three months. I get a bill for my labs and I’m on the hook for $300-something dollars.”

Freya had some difficulty, once she finally got a prescription, getting it filled. The pharmacy in a local grocery store chain wouldn’t fill the drug they considered a “specialty” medication, and referred Freya to a national pharmacy chain. Freya dropped her prescription off and received an assurance that her insurance company would cover it. Two weeks later, they asked her if she wanted to apply for copay assistance, which she had to enroll for separately.

“Access is the final piece,” said Weber. “If you look at where most women are acquiring HIV and at the most vulnerable women—Black women in the South—those are the states where the Affordable Care Act has not been rolled out. This is going to push forward the racial inequality in HIV acquisition among women. Even if you train providers, if they don’t have a way to bill for these different services, women will see that they’re not being allowed to access basic health care prevention.”

“People are expected to be responsible for their sexual health, but we don’t have easy access to these resources. My advice is to ask the questions, and be persistent,” said Freya.

1 Not her real name.

Webinar: An Update on Hormonal Contraception and HIV

UPDATE: Webinar recording is now available. Click here.

AVAC, in collaboration with ICW East Africa, is pleased to invite you to listen to this webinar on the most recent data regarding hormonal contraception and HIV.

This discussion provides an excellent review of the data and explores the implications for the ECHO trial, the current research initiative attempting to answer how hormonal contraceptives affect the risk of acquiring HIV.

The webinar agenda included:

  • A summary of the recently released systematic review on hormonal contraception and HIV
  • Updates from the World Health Organization on its actions, planned and underway, related to this important question
  • Reflections from investigators involved in the ongoing ECHO trial that is studying three different contraceptive methods and their impact on the risk of acquiring HIV
  • The civil society view from the HC-HIV Advocacy Working Group—an issue-focused platform of African women advocates and their allies, convened by AVAC and ICW-EA

For background on this topic, please see the following resources: