CHICAGO – Anne Philpott of the United Kingdom’s Department for International Development got curious as she scanned the program of this uniquely HIV-prevention oriented conference, and conducted a keyword search. She found:
- 996 references to PrEP (or Pre-Exposure Prophylaxis);
- 841 references to sex (including references to sexually transmitted infections);
- 219 references to ARV (or antiretroviral medicines that control HIV, averting illness, preventing transmission, and protecting against infection)
- 46 references to condoms, and
- 4 references to female condoms . . .
Philpott, who has led and written about efforts to make female condoms acceptable and accessible in settings where affordable protection against HIV, sexually transmitted diseases and pregnancy are essential was gobsmacked (as they might put it over at DFID). Female condoms, invented in 1990, rolled out in the beginning of that decade, and refined over the years since, were, after all, she noted, the second prevention measure known to prevent HIV acquisition, and still one of only two barrier methods. And over the years since, the slender synthetic (currently made of a substance called nitrile) accessory has shed a reputation as “a noisy plastic bag” to gain some acceptance as a reliable and even pleasure-adding addition to a woman’s reproductive health tool kit.
Philpott joined others this morning to discuss the steps necessary to ensure that public health innovations reach their intended consumers, and to remind public health responders not to forget existing innovations and products in grasping for the next “shiny new thing.”
The discussion, which included brief histories of the rollouts of medical circumcision, prevention of mother to child transmission measures, and vaccine rollout, carried common themes throughout. They included the need to plan for conditions at the end of the road products are bound for from the beginning. In the successful development of a vaccine against rotavirus, which has killed an estimated half million children a year, cooperation on the ground with health authorities in Nicaragua was a strength, Maggie Keane of the International AIDS Vaccine Alliance said, but “some product attributes were suboptimal” for the resource-limited setting they were bound for, including a need for cold chain storage. This example highlighted the need for a “TPP” — not a widely questioned trade deal, but a “target product profile.” That would be one that includes both “minimally acceptable and optimal attributes” to be usable where it will be used, Keane said.
The roll out of medical circumcision included painstaking steps to identify and address objections to and benefits of the procedure that lowers men’s risks of HIV infection by about 60 percent, Karin Hatzold of Population Services International, Zimbabwe recounted. Since the World Health Organization and UNAIDS recommended medical circumcision as a prevention measure in 2007, about 12 million men across 14 high-HIV incidence countries have undergone the procedure. In the process, programmers categorized acceptance and avoidance of the procedure among men, finding both lessons (honesty, for example, is the best policy about pain involved in the procedure) and advocates among men who stepped up.
Hairdressers and cab drivers helped spread the word of female condoms in some settings, Philpott said, while continued research and development addressed noise issues associated with use of the product. Still the problems the product has faced include “vaginaphobia” (a word Philpott admits she may have made up) that accompanies lack of experience with products that include tampons and diaphragms, but have been overcome with time. What hasn’t worked, she said, includes messaging that imparts overhype, fear of disease or shame.
Crucial to the journey for all innovation, Rangsima Loleka, who recounted the scale up of prevention of mother to child transmission in Thailand that eventually led to the country becoming the first in Asia to eliminate vertical transmission, is government support. Research that happens in the country where rollout will also happens adds to government buy-in she noted.
Still, as excitement mounts over the next “shiny new thing,” whether an HIV-preventing vaginal ring, or pre-exposue prophylactic use of antiretroviral medicines, one commenter this morning noted: “None of these things will happen to a functional degree without a functional health system.”