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  XVII International AIDS Conference
Mexico City
3-8 August 2008
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Women's Rights Equals Women's Lives - from Mexico
  Thursday, August 14, 2008
Women's rights and gender based violence (GBV)seemed to be everywhere at Mexico 2008 - from the March to Zocolo square to the fashion range produced by sex workers as an income generation enterprise to the almost dazzling range of sessions on gender equality, gender based violence, sexual and reproductive health, women on the margins and stigma and discrimination. We heard that 61% of all cases of HIV in sub-Saharan Africa are still in women and that violence and HIV go hand in hand as parallel epidemics feeding off one another. There were calls for zero tolerance to gender based violence: as one speaker put it "when the world denies women their most basic human rights, the world is vulnerable to HIV".
Sessions on rape as a method of war in the DRC, Zimbabwe, Darfur, Rwanda and more recently in Kenya discussed some good NGO responses but ultimately pointed to the failure of UN Security Council Resolution 1325 and more recently UN Resolution 1820 to protect women and girls. Paula Donovan of "AIDS Free World", a US based advocacy group, was visibly outraged by the appalling levels of violence in Bukavu in eastern DRC and the corresponding levels of impunity afforded to perpetrators of these crimes. She called the recently signed Peace Accord "a triumph for impunity and a trading of women for peace" and ended by saying that the sad reality is that none of what has been agreed, declared or committed to has had an effect on a single girl in the Congo.
I went along to Paul Spiegel's talk on HIV rates in conflict settings knowing that his findings are controversial and while scientific, seem to defy logic. His study shows that there is no additional risk of contracting HIV in conflict despite the appalling levels of sexual and gender based violence in these situations. There are a number of possible reasons for this but none of it takes away from the need to provide full services and protection to women and men who suffer such a basic violation of their rights. Speakers from the floor commented that if the international community is having difficulty understanding the findings then surely there's a danger that the press will misinterpret them - which is a fair point.
Violence against women of course is not confined to conflict. Sex workers spoke of discrimination of women and abuse suffered at the hands of the authorities in Cambodia, where police are rounding up women in rehabilitation centres. They suffer many violations of their rights in these settings - cut off from medication and services and often subject to rape by police and prison officers. This story is repeated in many countries and points to the need for legislative change, adequate services and for groups to self-organise and be part of the solution. The criminalisation of transmitting HIV knowingly is also worrying - 15 African counties, including Sierre Leone and Zimbabwe, have enacted laws which extend to a woman who might pass the virus onto her child. Edwin Cameron from South Africa spoke of how this legislation will hit women hardest and far from protecting them will victimise and oppress them further.
Speakers also talked of the shared risk of gender based violence and HIV and the need to programme these areas together. The "Image Project" from the London School of Hygiene and Tropical Medicine linked a microfinance programme with one targeted at addressing HIV and GBV. The programme has been very successful at empowering women, reducing their risk to HIV and gender based violence and reducing poverty levels and is about to be scaled up. It's worth watching.
The academic presentations were fascinating but the women themselves could not fail to move you with their courage, resilience and commitment. We heard from a woman in Rwanda who had been raped in the genocide and went on to set up a peer support group, from HIV positive women in Kenya who organised themselves in camps to ensure that vulnerable groups received HIV medication and from the strong women living with HIV who wanted to get on with their lives, to invest in relationships and have children. A young woman from Argentina spoke of her desire to have a baby and the stigma she faced when she shared this news with family and friends. A man in the audience queried why there wasn't a man on the panel and commented that men struggle with the same issues as potential fathers - perhaps something for AIDS 2010?
There is little to report in the line of new methods to protect women. The microbicide and vaccine trials have failed. Male circumcision may have a long term protective effect for women as the number of infections decreases in men but does not have an immediate benefit for women. There is some concern that it does not require men to change their behaviour in a way that will support a woman to have greater control over her sexual health. The combination prevention that has been pushed so strongly at this conference is perhaps the best hope for women until the science catches up with their daily reality.

Gender-based Violence, Both Cause and Consequence of HIV and AIDS
04 August 2008
INTERNATIONAL AIDS CONFERENCE, Mexico City—Thoraya Ahmed Obaid and Inés Alberdi, Executive Directors of UNFPA, the United Nations Population Fund, and of the United Nations Development Fund for Women, respectively, co-chaired a session Sunday on the links between gender-based violence and HIV/AIDS. Ms. Obaid told participants that gender-based violence can be both the cause and consequence of HIV and AIDS.
Panelists presented programmes, studies and policies from a range of countries, including India, Mexico, Nicaragua and South Africa, as a way to compare and analyze gender inequalities linked to the epidemic. They emphasized the need to include men in prevention efforts in order to achieve an effective response to both the medical and social scourges.
For many women, gender-based violence is a reality both in times of peace as well as in times of war. "We are talking about domestic violence, sexual abuse, human trafficking or kidnappings and rape as war strategies," said Ms. Obaid. "Violence against women is the most brutal evidence of gender inequality."
Male roles that call for men and boys to be tough, aggressive, sexually dominant, and risk-taking are often associated with behaviours that increase men's risk of contracting HIV. Such behaviours include having a high number of sexual partners, using drugs or alcohol, and refusing to seek medical care for sexually transmitted infections.
Studies indicate that the risk of acquiring HIV is higher among women who have been exposed to violence than those who have not. Violence against women is an obstacle to prevention efforts: it often prevents women from getting tested and limits their access to prevention and treatment. Hence, it also prevents them from making informed decisions about their health and their future. In many cases, victims of violence are afraid or unable to negotiate condom use.
"Therefore, it is crucial that we are here today to analyse this problem. We need to share lessons learned so that we can improve our response to HIV and AIDS," Ms. Obaid concluded.
Contact information:
Trygve Olfarnes
Cell Phone: + 52 1 55 1353-8451
Email: olfarnes@unfpa.org

Linking the Twin Pandemics: HIV and Gender-Based Violence
Elisha Dunn-Georgiou on August 6, 2008
In the session, "Women's Rights Equals Women's Lives," advocates and researchers came together to discuss the twin pandemics of gender-based violence (GBV) and HIV. Researchers Charlotte Watts from the London School of Hygiene and Claudia Garcia-Marcos of the World Health Organization, noted that while the body of evidence on direct biologic linkages between HIV and GBV is limited, the evidence we do have demonstrates an extremely strong correlation between the two. Not only does the evidence tell us that women who experience gender based violence are more likely to be at risk for transmission of HIV, but we also know that many of the risk factors for gender based violence are the same as those for HIV-- including gender inequities, poverty, lack of financial independence and lack of education. While the risk of HIV from gender-based violence is often limited to a discussion of the risk of rape as a transmission factor, Watts stressed that there are many forms of gender based violence beyond rape, including perpetration by an intimate partner (spouse, boyfriend, etc.) rather than a stranger.
Other panelists discussed the implications for GBV among specific populations, namely sex workers, people living with HIV/AIDS and men and boys. For sex workers, violence, not only from partners, but also perpetrated by the state, is a particular issue in HIV prevention, treatment and care. Policies that promote brothel raids and detention of sex workers contribute to violence and can cause sex workers to lose their homes, interrupt their ARV regimens and shatter any security they might have.
Panelists agreed that interventions to fight these two pandemics must be complex and long-term. Policymakers must remove laws that criminalize sex work or same-sex relationships and must work to change gender perceptions and increase accountability for the perpetration of violence. Part of this change in perceptions can be brought about through comprehensive sexuality education. Importantly, these interventions should not be limited to the HIV arena but should involve domestic violence, women's rights and other advocates.

Sexual violence against sex workers by police and military in Sud-Kivu, Democratic Republic of Congo: implications for HIV transmission and access to treatment
At IAC Mexico City Presented by Anna-Louise Crago, Hungary.
A. Mihigo Ombeni1, C. Sifa Kanyenche1, A.-L. Crago2
1ALCIS, Bukavu, Congo, the Democratic Republic of the, 2Private, Montreal, Canada
Issues: Sex workers in DRC-Congo have no status as workers and face systematic violations of their basic human and socio-economic rights, including their right to work. High levels of sexual violence targeted at sex workers by police and military pose a direct risk of HIV transmission and interfere with access to treatment.
Description: ALCIS, an NGO based in Sud-KIVU, Democratic Republic of Congo documented incidents of sexual violence against sex workers by police, military and the general public and their consequences on sex workers' health and working conditions.
Lessons learned: Between February and April 2007, ALCIS documented the cases of 15 sex workers who were kidnapped and submitted to sexual violence by military officials and of 14 sex workers unlawfully detained and submitted to sexual violence by police for periods of up to two weeks. ALCIS documented the cases of 39 sex workers who were assaulted by non-state actors during the same time frame.
Between February and April 2007, ALCIS assisted 63 sex workers who survived sexual violence to receive medical care. Of these, 27 sex workers tested HIV-positive following attacks. Sex workers reported that the high level of state violence targeted at them has forced them to work in more clandestine settings. This has resulted in increased social isolation and more dangerous working conditions and has severely compromised many sex workers' access to medical care and treatment.
Next steps: Many of the incidents described constitute torture and are in contravention of UN Conventions. UN agencies and the Global Fund must emphasize the crucial role of preventing violence against sex workers, in particular by police and military, in limiting HIV epidemics. Projects that rely on sex worker-leadership and solidarity to advocate for sex workers' human rights are key to fighting HIV and must be supported.

Gender-related barriers to emerging HIV prevention methods: a review of post-exposure prophylaxis (PEP) policies
At IAC Mexico City Presented by Britt Herstad, United States.
B. Herstad
Constella Futures, Washington, DC, United States
Issues: Women and other groups facing gender-based violence are increasing vulnerable to acquiring HIV, highlighting the need for post-exposure prophylaxis (PEP) as an HIV prevention method. While PEP has been recommended to prevent transmission of HIV following sexual exposure, policies to implement this recommendation are limited. Without these policies, victims of sexual assault face a severe risk of acquiring HIV.
Description: This study assessed current policies on PEP following sexual exposure-specifically sexual assault-in relation to the latest WHO and CDC guidelines. The study analyzed the extent, content, and implementation of PEP policies in developing countries. The analysis identified gender-based constraints that affect access to PEP information and services. Eligibility was examined to determine how policies account for PEP provision related to sexual assault, including whether or not policies specify victims as being male or female. To complement the developing country review, research also included comparative analysis of PEP policies from selected developed countries.
Lessons learned: Access to PEP is an emerging theme in HIV prevention, yet few specific PEP policies exist. Where PEP policies do exist, they frequently prioritize occupational exposure over sexual exposure and their implementation is limited. Policies that account for PEP as a result of sexual exposure often do not address the specific circumstances of sexual assault, which can greatly impact a woman's or man's ability to access PEP. For example, some countries require that victims of sexual assault report the assault before being able to receive PEP. Such policies deter people from coming forward to seek needed assistance and serve to limit access to PEP.
Next steps: Further research should examine the effectiveness of existing PEP policies and identify recommendations for policymakers based on best practices and input from stakeholders. These recommendations should account for specific gender barriers, especially those related to sexual assault.

Women's property rights as a response to HIV and AIDS - lessons from community interventions in Binga, Zimbabwe
At IAC Mexico City Presented by Brigitte Elisabeth Markham, Zimbabwe.
B.E. Markham
Ntengwe for Community Development, Executive, Binga, Zimbabwe
Issues: Zimbabwe's Intestate Succession Act (1997) protects property rights of women and girls. But in reality, gender and cultural constraints prevents female property ownership.
Description: Ntengwe for Community Development, a non-profit organization in Binga and Victoria Falls, Zimbabwe, seeks to improve the lives of women, youth and orphans, advance their equality and human rights, and contribute to broader economic and social well-being. Ntengwe's work comprises research, strategic communication and capacity building through arts-based programs on issues affecting the economic and health rights and social status of the target groups. Recognizing the importance of community-driven AIDS response, Ntengwe implemented a program to document and test community interventions to secure women's and girls' property rights. Participatory community research examined property grabbing and factors that limit women and girls from realizing property and inheritance rights. Women and girls were trained as peer mobilizers in Legal Rights and Advocacy of change agents. "When the Cows Come Home", the docudrama film tracks women and girls in Binga discovering and reclaim their property. Over 600 women have so far re-gained their property. Presenter, Ntengwe Director, Elizabeth Markham is devoted to ensuring the availability of comprehensive legal rights information, supported and tracked by government and the traditional leadreship, to grant rights to women and girls as individual rights holders and as a special interest group.
Lessons learned: Reaching women, girls and their communities empowers them. Also essential is addressing the social and cultural environment - norms and practices that influence people's decisions concerning property. Advocacy film projects work - drawing on the experiences of communities to simultaneously create relevant messages and affirm the value of their lives. The creaitve experience, in itself, enriches those lives.
Next steps: Use the film as a tool for advocacy, train community paralegals, and establish a referral and support system implemented via watchdoggroups tracking progress.

Financing and Resourcing Gender Equality and Women's Empowerment In the Context of HIV and AIDS
At IAC Mexico City Nyaradzai Gumbonzvanda, Switzerland
Given that in many regions of the world HIV and AIDS disproportionately affects women and girls, all responses must invest in changing social, cultural and economic factors that put women and girls at risk. While governments can be held accountable for HIV responses through agreed indicators including levels and quality of financial resources invested in HIV, the extent to which specific manifestation of gender inequality is addressed as part of the total response to HIV is unclear. Although women's organisations and grassroots groups have been responding to HIV and AIDS, recent reports indicate various challenges in accessing quality sustainable resources for their work on AIDS. Yet, financing women's empowerment and gender equality is essential in reversing the impact of the HIV pandemic. Investing in women and girls includes allocating flexible and adequate funds to organisations that reach women and girls, providing them with appropriate services and ensuring they have equal opportunities. This event will focus on the architecture of funding for women's organisations and address the challenges and opportunities in financing gender equality and women's empowerment in the context of HIV and AIDS. Through discussion, the session will inform participants on: » Financing women's organisations: highlights from reports - the AWID report on 'Where is the money for women's rights', a report from the Women Wont Wait Campaign 'Show us the Money' and the DAW Expert Group Meeting report (2007) » Donor government priorities in applying gender budgeting approaches in the AIDS response: how funding organs create mechanisms to fund women's organisations » Innovative approaches to financing women's empowerment: Women's organisations at the grassroots need proper resourcing to address HIV and scale up work on HIV and AIDS » Aid effectiveness and implications for financing gender and HIV and AIDS: Holding governments accountable, addressing social practises that perpetuate the struggle women's organisations face in securing financial resources.
World YWCA
Presentations in this session:
SUSAT4501 Welcome Remarks
Susan Brennan, Switzerland
Ines Alberdi, Spain
SUSAT4502 Community experiences and challenges in accessing resources
Kousalya Periasamy, India
SUSAT4503 Aid effectiveness and implications for financing gender and HIV and
Lydia Alpizar Duran, Mexico
SUSAT4504 Summary of event and key recommendations
Neelanjana Mukhia, South Africa
SUSAT4505 Innovative approaches to financing women's empowerment
Zonibel Woods, Canada

More AIDS risked as poor women trade sex for food
Mon Aug 4, 2008
By Mica Rosenberg
from JUles: during his talk Clinton said he would ask for a UN Women's agency.
MEXICO CITY (Reuters) - Rising food prices around the world are likely to drive poor women to trade sex for basic goods like fish and cooking oil, raising the risk of new AIDS infections, U.N officials said on Monday.
Delegates at a major AIDS conference in Mexico cited the cases of fisherwomen in the Pacific and women in Kenya desperate for food being forced to sell their bodies, adding to concerns of a new twist in the spread of the deadly pandemic.
"Food is such a basic need that you can see people really going to great lengths," said Fadzai Mukonoweshuro of the U.N.'s Food and Agriculture Organization in southern Africa.
Climbing food prices -- due to increased use of biofuels, the growing demand for grains to feed a booming Asia, droughts and market speculation -- caused 50 million more people to go hungry last year compared to the year before, the United Nations said.
"That might lead to various distress responses, one of which on the part of women is having transactional sex to feed their kids," Stuart Gillespie of the International Food Policy Research Institute said.
"Recent studies in Botswana, Swaziland, Malawi, Zambia and Tanzania have shown associations between acute food insecurity and unprotected transactional sex among poor women," he said.
Overfishing of tuna in the Pacific has forced Papua New Guinea fisherwomen to abandon their smaller craft and join the crew of larger boats, where they trade sex for food scraps, the officials and delegates said.
Such "fish for sex" deals are also common in Kenya on the shores of Lake Victoria, where women fish traders meet incoming boats and sleep with fishermen for a favorable price.
Experts at the conference, a biennial gathering of global medical experts and government officials, also said malnutrition increased the risks for people already infected with AIDS, experts added.
HIV drugs can upset the stomach if taken without food and AIDS patients, many also infected with tuberculosis, need more nutrients and calories. Without enough food they are more likely to die, said Martin Bloem, chief nutritionist at the World Food Program.
Soaring food and other commodity prices might hinder the fight against AIDS.
"We really need to watch this very carefully. We are in a situation of rising oil prices, rising food prices and at the same time the cost of AIDS is going up along with new infections," said Kevin De Cock, director of the anti-AIDS program at the World Health Organization.
Attacking both hunger and the disease at the same time can bring special challenges. In Zimbabwe, some villages will reject food aid if they think it is destined for AIDS patients, claiming it is contaminated, Mukonoweshuro said.
The human immunodeficiency virus infects 33 million people globally, half of them women, and kills 2 million annually.

Mexican sex workers want place at AIDS conference
Sun Aug 3, 2008 2:38pm EDT
By Tan Ee Lyn
MEXICO CITY (Reuters) - A global AIDS conference that opens in Mexico City on Sunday is meant for people infected with HIV, but transsexual sex worker Elma Delea cannot get inside.
She will be protesting on the fringes of the six-day biennial event.
"They (Mexican health authorities) said they had no money for everyone who wanted scholarships. We are very angry," said Elma Delea, as she stood at the junction of Calle de Alfredo Chavero and Calzada San Antonio Abad, a stretch of road where transsexuals wait all night to be picked up by customers in passing cars.
Her friends nodded, citing other explanations given by organizers, such as not being able to speak English.
Some 25,000 people are expected at the event, which draws scientists, international agencies, government officials, non-government organizations and the media.
But people most at risk of the disease, such as sex workers, homosexuals and intravenous drug users, are least visible. Most are poor and cannot afford registration fees.
"The conference is a place to exchange opinion but now, only those in power have a say," said Elvira Madrid, an activist working for the rights of sex workers in Mexico City.
At one point, passengers in a passing car hurled eggs at the group standing on a street corner, narrowly missing.
"This is common. One time, some men shot paintballs at us, and it hit my thigh," said Orchidia Montenegro, as her colleague Martha de Juarez nodded in agreement.

Those infected by HIV say they are shunned in hospitals.
"We are told to stand far away and open our mouths from three feet away," said another sex worker. "And when they do examinations, they use the same tools without disinfecting first."
The AIDS virus infects 33 million people globally, 1.7 million in Latin America. In Mexico, $23 million was spent on keeping blood safe in 2005 and $5 million on prevention and care among men who have sex with men, but less than $1 million on sex workers.
"Interestingly, although prostitutes are considered to be victims, they are also viewed as wanton, debauched and morally weak," reads a UNAIDS report on sex workers.
Delea, who had been hoping to speak at the conference, said it was important for society to acknowledge sex workers, starting with the police, who often detain prostitutes when they find them with condoms. This makes it harder for the workers to practice safe sex.
"We also want the government to reduce prices on HIV drugs, which are 13 times more expensive than in Brazil, Guatemala and Honduras," said Delea, who heads the sex worker group Angeles en Busqueda de la Libertad or Angels In Search of Freedom.
Prostitution is illegal in Mexico but widely tolerated everywhere from grimy street corners to swanky brothels. Police can easily be bribed to turn a blind eye to sex workers.
Delea's group wants to coach women on how they can protect themselves when customers refuse to use condoms.
"We have to be very creative when using condoms. We have to start looking at them as tools of eroticism instead of disease prevention," said transvestite sex worker Chrisna.
"We are able to put condoms on our customers with our mouths without them even knowing, so that they even think we have swallowed their semen. But we have it in a bag to go," she said with a laugh.

PrEP Has Arrived-Researchers Look to Daily Pill to Avert H.I.V.
NY Times
Published: August 4, 2008
MEXICO CITY — Can a pill a day help prevent infection from H.I.V., the virus that causes AIDS?
No one knows. But researchers in a number of countries are conducting trials and planning others to test the unproven strategy that a daily pill, or a combination of drugs, can prevent H.I.V.
By mid-2009, more people will be enrolled in such trials than in all of those for H.I.V. vaccines and microbicides, the AIDS Vaccine Advocacy Coalition said in a report issued here on Sunday at the start of the 17th International AIDS Conference.
Initial findings of the safety and effectiveness might come early next year, although researchers do not know how they will compare to the disappointing results of recent tests of H.I.V. vaccines and microbicides, chemicals that women can put in their vagina to prevent H.I.V. infection.
In the face of those bleak findings, some AIDS experts say testing the prophylactic use of antiretroviral drugs, called PrEP, for pre-exposure prophylaxis, is now the most promising research in H.I.V. prevention efforts as scientific investigation of vaccines and microbicides continues.
The Centers for Disease Control and Prevention, which released a report on Saturday showing that the number of people newly infected with H.I.V. in the United States in recent years was 40 percent higher than has long been reported, said that PrEP was among the strategies that needed to be developed to substantially reduce the incidence of H.I.V. An estimated 2.7 million people become infected each year worldwide.
"We cannot wait for the study results to begin to prepare for the optimal use and delivery of PrEP," said Pedro Goicochea, an investigator in a PrEP study under way in Peru and Ecuador. "Instead, we should look ahead to consider all of the possible outcomes of these trials and make real plans for making PrEP available to those who can benefit from it, as quickly and safely as possible if it is proven effective."
The United States Agency for International Development, the C.D.C. and the National Institutes of Health are paying in part for all of the trials. The Bill & Melinda Gates Foundation is paying for part of two. The organizations have undertaken the trials because of the success in giving antiretroviral drugs to pregnant women to prevent H.I.V. infection in their infants and drugs to prevent malaria.
In 2007, Family Health International completed a similar study of the antiretroviral drug tenofovir for H.I.V. prevention among young women in Ghana, providing the first data showing such use was both safe and acceptable among uninfected users. But the study did not indicate if PrEP was effective in preventing new infections.
Studies in a small number of nonhuman primates hint that PrEP can reduce the risk of infection of a simian form of H.I.V. in nonhuman primates.
Initial PrEP studies are testing tenofovir, either alone or combined with another drug, emtricitabine.
Infected people taking these licensed drugs have shown limited side effects like nausea, vomiting, diarrhea and intestinal gas. But the safety of the drugs must be established among noninfected people as well as among participants who become infected in the study.
Trial participants include gay and bisexual men, heterosexual men and women, couples in which one partner is H.I.V. infected, and sex workers.
Up to 15,000 people are expected to be participating in trials by mid-2009. Sites of the trials include Botswana, Brazil, Ecuador, Kenya, Malawi, Peru, South Africa, Tanzania, Thailand, Uganda and the United States.
Male circumcision has proved effective in a significant percentage of H.I.V.-negative people in trials in Africa.
Because PrEP might also work in a significant percentage of uninfected users, the advocacy coalition and other researchers say now is the time for governments, health officials, donors, researchers and advocates for AIDS research to prepare for the maximum public health benefit if the pill-a-day strategy works.
One reason for the immediacy, they say, is that even if a PrEP strategy proved successful, it would not be a silver bullet. PrEP would need to be combined with standard prevention measures like safer sex practices, use of condoms and clean needles, and counseling.
v Governments would need to prepare for global procurement of PrEP, arrange adequate staffing to deliver the drugs and provide counseling and determine who will pay for the costs, said the coalition, which describes itself as an international nonprofit, community- and consumer-based organization.
Provisions would also need to be made for participants who do become infected, and findings from a number of trials would be needed before PrEP could be widely recommended.
Results may be hard to interpret because the tests are being conducted in different ways and so may produce varying findings, the advocacy coalition's report said. Statisticians could face challenges in pooling the data from the trials.
The report also said that the initial findings were likely to raise questions needing further study, like whether taking pills intermittently — like just before a sexual act — can be effective. The report is available online at www.avac.org/prep08.pdf.
Researchers conducting the studies said they were taking longer than initially expected. Among the problems are recruiting volunteers and addressing the real or perceived stigmatization of those who participate.

Tenofovir/Emtricitabine Gel Protects Female Monkeys From SHIV 3rd International Workshop on HIV Transmission: Principles of Intervention July 31-August 2, 2008, Mexico City
Mark Mascolini
All 6 pigtail macaque monkeys treated with vaginally applied tenofovir/emtricitabine (FTC) before exposure to simian HIV (SHIV) remained free of infection after 20 challenges [1]. Ongoing trials are testing oral tenofovir/FTC (Truvada) as pre-exposure prophylaxis in humans, and a separate study at this workshop showed that oral tenofovir/FTC partially protected male monkeys from rectal SHIV exposure [2]. A vaginal tenofovir/FTC gel has yet to be tested in humans.
Vaginal microbicide research in humans took a recent setback with reports that two products did not protect women from HIV infection. But neither of those microbicides-- Carraguard and cellulose sulfate--used antiretroviral agents to ward off HIV.
Urvi Parikh and colleagues at the US Centers for Disease Control (CDC) and Emory University randomized 14 female pigtail macaques to three study groups: 2 received no gel, 6 received a placebo gel (hydroxyethyl cellulose only), and 6 got the tenofovir/FTC gel (5% FTC plus 1% tenofovir, which is equivalent to one Truvada dose, in 2% hydroxyethyl cellulose). The tenofovir/FTC gel was clear, odorless, viscous, and stable at 37 degrees Celsius for 6 months.
Technicians applied the gels vaginally 30 minutes before challenging the monkeys with SHIV, a simian immunodeficiency virus with an HIV coat, at a dose of about 1,160,000 RNA copies. After exposure the investigators used blood tests and polymerase chain reaction to search for SHIV in plasma. The challenges occurred twice weekly for 10 weeks.
Both monkeys who got no gel and 5 of the 6 who got the placebo gel became infected after a median of 3.5 challenges (range 2 to 11). All 6 pigtails treated with tenofovir/FTC before SHIV exposure remained free of infection after 20 changes (P < 0.005 versus control groups). The CDC team could detect no viral RNA, no proviral DNA, and no viral antibody in any of the 6 tenofovir/FTC-treated animals.
Parikh and coworkers detected low levels of FTC (median 67 ng/mL) and tenofovir (median 22 ng/mL) in plasma samples 30 minutes after vaginal application. Those findings, the investigators proposed, suggest "rapid drug absorption with relatively higher levels of drug remaining in vaginal tissue."
An earlier study of 1% tenofovir without FTC applied rectally in a single high dose found only a 60% protection rate [3]. Double therapy clearly did better in this vaginal trial, but Charles Boucher (Erasmus University, Rotterdam) worried about the wisdom of developing drugs for both prevention and treatment because acquired resistance could compromise use of those and other drugs.
Transforming the National AIDS Response: Mainstreaming Gender Equality and Women's Human Rights into the 'Three Ones'
UN Development Fund for Women
The "Three Ones" principles for the coordination of national AIDS responses — one national AIDS action framework, one national AIDS coordinating authority, and one system for monitoring and evaluation — are intended to achieve the most effective and efficient use of resources, and to ensure rapid action and results-based management. However, attention to gender in the "Three Ones" remains inadequate, despite progress in recognizing gender inequality as a driver of HIV and AIDS and in strengthening laws that protect women's rights. This publication highlights approaches and examples that ensure that the three principles promote and protect gender equality as a key element in strategies to prevent and treat HIV and AIDS. The first chapter examines why gender equality and women's human rights are central to the principles of the "Three Ones." The next three chapters cover each of the principles, analyzing proposed entry points for integrating gender equality and women's rights. The final chapter contains recommendations on strengthening gender equality in AIDS actions and strategies.
The guide includes tools and checklists that can provide guidance on how to conduct gender and human rights audits and analyses to inform HIV and AIDS policies and frameworks and their implementation. There are also case studies illustrating successful local, national, regional and international initiatives that demonstrate how incorporating a gender equality perspective into HIV and AIDS programmes and policies can yield positive results and transform the national AIDS response.
The guide is designed for use by members of national AIDS coordinating authorities; government ministries and departments involved in the national AIDS response; members of legislatures, especially those on committees addressing HIV/AIDS; members of UN Country Teams; and civil society groups involved in the national AIDS response.
The publication will soon be available in French and Spanish.