July 26, 2016
Written by Amy Rupert, Technical Officer, OPTIONS Consortium, FHI 360
The 21st International AIDS Conference in Durban was a celebration of the progress we have made in the last 16 years since the conference was last held in South Africa. In 2000, there were 3.5 million new HIV infections per year globally and fewer than 10,000 people in Africa were on life-extending antiretroviral therapy (ART). Today, there are 2 million new infections per year, and of the 17 million people worldwide on ART, 12 million are Africans. We even have two new HIV prevention products with proven efficacy when taken correctly – oral pre-exposure prophylaxis (PrEP) and the dapivirine vaginal ring.
Despite this progress, we know that young women around the world, particularly in sub-Saharan Africa, are two to three times more likely to acquire HIV than young men in their same age group.
In an effort to make unheard voices heard, the OPTIONS Consortium and WHO co-sponsored two workshops at AIDS 2016 that offered a forum for PrEP and ring users to share their thoughts, challenges, and needs regarding their sexual and reproductive health (SRH).
In both workshops, panelists acknowledged that young women need HIV prevention products that are effective and accessible without stigma and discrimination. South African SRH Advocate and ZAZI Champion Nomtika Mjwana mentioned how a young woman in her school uniform often receives judgment from clinic providers, which ultimately causes her to leave the clinic without anything.
“Social and economic factors need to be considered with PrEP and rings. There is no choice without justice,” said Nomtika.
Similarly, panelists discussed the communication gap that exists from researchers to providers to users.
One PrEP user, Bhule Mabaso, who never participated in a trial or demonstration project, chose to take PrEP on her own. When she went to a private hospital in South Africa and asked for PrEP, the provider misunderstood and thought she was asking for PEP, post-exposure prophylaxis, which is an ART taken after potential exposure to HIV to prevent infection. Bhule had to show the provider CDC’s PrEP information before she could access the daily pills.
“We need greater dialogue between research and civil society, so we’re not only hearing about new research at conferences like this” said Maureen Luba, a women’s health prevention advocate from Malawi.
One SAPPH-IRE PrEP demonstration project participant acknowledged that while she was appreciative to be receiving PrEP, adherence was difficult at first. She noted that her life was hectic, and she credits her ability to take the pill correctly to the support she received from her clinic provider.
“Young women need a tremendous amount of support to adhere to PrEP,” said Bathabile Nyathi.
These PrEP and ring users made it clear that young women want SRH choices to protect themselves but factors, such as stigma and lack of communication and support contribute to their ability to access and adhere to HIV prevention products.
As researchers, implementers and providers, we need to create a greater dialogue among all players at all levels to ultimately create youth friendly services and increased awareness and access to HIV prevention products as they become available.
Learn more about the OPTIONS Consortium.