With pregnant women facing higher chances of acquiring HIV and greater dangers of life-threatening complications as a result of HIV, in addition to risks of passing the virus to their children, some of the most ambitious and promising developments in HIV prevention will be those that allow women to protect themselves both from the virus and from unplanned pregnancies, researchers at the HPTN annual meeting said.
“Unless family planning is increased in Africa, eliminating mother-to-child transmission will not be met,” FHI 360 President Emeritus Ward Cates said. Even with 90 percent antiretroviral therapy coverage, unintended pregnancies would still result in 40,000 infants being born with HIV every year, he added.
That’s why, Cates called the CHOICE study “the family planning equivalent” to HPTN 052, the groundbreaking study that proved antiretroviral treatment prevents transmission of HIV. Published last year in the New England Journal of Medicine, the study found women given the opportunity to choose from several family planning methods who chose longer-lasting contraceptives, such as an IUD, over short-acting contraceptives such as birth control pills, patches, or vaginal rings, saw a twenty fold lower risk of unintended pregnancy. The study also saw a cut in abortion rates at the population level.
If women can more successfully control their family planning with long acting methods they control, what are the ramifications for HIV prevention? International Partnership for Microbicides chief executive officer Zeda Rosenberg followed Cates to talk about “multipurpose prevention technologies” – single products that address at least two sexual and reproductive health concerns, including pregnancy, HIV, or other sexually transmitted disease prevention.
“Every woman knows she’s at risk for pregnancy,” said Rosenberg “Not every woman knows she’s at risk for HIV.”
One multipurpose possibility under development is a contraceptive diaphragm combined with the antiretroviral tenofovir. The CAPRISA 004 trial established a proof of concept that an antiretroviral drug applied topically can prevent acquiring HIV.
In addition, Rosenberg said a number of sustained release products, that can remain effective over time, including vaginal rings or long lasting injectables, are also in development. Vaginal rings intended to prevent both pregnancy and HIV acquisition for 90 days and 60 days are under investigation now.
Whether successful or not, they will be part of an evolving search, according to Rosenberg and Cates, who emphasized more choices are key in both the advancement of family planning and HIV prevention.