September 29, 2016
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. You can find their post on the issue here, at the Health Affairs Blog.
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.