Does adherence to using a product intended to prevent HIV acquisition depend on willingness, or ability to use the product? What are the factors — whether thoughts, beliefs, structural obstacles or social barriers — influencing both?
The challenges that women have faced since the recognition of HIV in protecting themselves from getting the virus by asking for condom use or refusing sex impelled the search for methods of prevention they could control. But do the new products, promising in the laboratory, and then in some trial settings, meet those challenges? Do new products highlight unrecognized and unaddressed challenges? In all of that, where are the opportunities to take a pivotal moment in biomedical answers to HIV, and ensure their promise is realized?
These are some of the questions a new supplement on Women and ARV-based prevention: Opportunities and challenges from the Journal of the International AIDS Society sets out to answer in a tour of the current landscape of microbicide and pre-exposure prophylaxis development targeting the needs of women in high HIV incidence settings.
Following both questions and answers presented by a series of clinical research trials and qualitative studies of HIV-prevention products meant to be controlled by women, the articles highlight conundrums. Central among them is that the products would be acceptable if shown to be effective — but proving them effective is hindered by lack of acceptance.
In addition to providing comprehensive updates on developments in the field, the supplement explores barriers to acceptance. They include:
- The challenge of communicating the difference and overlap of treatment and prevention when a prevention product bears the same name as treatment for those already infected;
- “Low risk perception” — including among women who deemed their odds of being infected with HIV nonexistent just four weeks before testing positive for the virus;
- Male partners’ objection to the use of vaginal products that include “unwanted vaginal wetness;”
- Challenges to keeping, and taking a supply of antiretroviral pills to prevent acquisition, when a family member needs them for treatment.
That is just a sample. The subject of stigma — surrounding HIV and treatment — as well as a sense that the virus is inescapable raise old questions in new lights. Together, the articles in the supplement underscore that the questions and challenges raised in the quest for female-centered HIV prevention will have to be answered collaboratively, by those in the laboratory, and those who will use the technology, for science to realize the promise of the moment.