New HIV Vaccine and Microbicide Advocacy Society
Adolescent girls keep rating the need to prevent pregnancy higher than the need to prevent HIV infection. Pregnancy outside marriage causes a lot of stigma in Nigeria. Pregnancy outside marriage is not welcome in most home in Northern, eastern and western Nigeria. Yet access to sexual and reproductive health commodities that will help prevent pregnancies are not easy to come by.
Despite the shame that comes with being pregnancy, teen pregnancy is not a rarity. It is a growing problem for many communities, especially rural communities where procurement of abortion from professionals comes with lots of challenges. Lots of girls who leave school are increasingly finding it difficult to be engaged productively due to low rates of admission into higher institutions, poor access to vocational training and low competency to start small scale businesses. Being idle increases their risk of frolicking around with the opposite sex and engaging in sex.
A good number of adolescent girls enjoy having sex. They discover its pleasure and do not want to discontinue. They want a way to enjoy sex without becoming pregnant. Sadly, adolescents’ awareness about contraception options is poor. For the few that are self-educated about possible contraception use, access to contraception is also poor. Health care workers are usually very unwilling to provide adolescents with contraception. Many are often limited to the use of condom – a device that is dependent on the boy’s willingness to use the product and to use it correctly and consistently.
The prevention of HIV infection is not a priority for many adolescent girls. HIV infection may well be hidden for many, many years. Pregnancy cannot be hidden. The shame and consequences come rapidly – drop out from school, increased risk of not getting a suitor in the community, further hardship for the girl and the family to name a few, and the stigma and shame the entire family has to face in the community.
Yet the risk for HIV infection for adolescents who starts having sex at a young age is high. She is likely to change sex partners multiple times, have challenges negotiating the use of condom, and risk selling sex to be able to have access to some needs in life. Adolescent girls need easily accessible products that can help prevent or reduce the risk of pregnancy, sexually transmitted infection and HIV infection. HIV prevention is as equally important as the prevention of unwanted adolescent pregnancies.
The clear need for the development of technologies that will enhance the ability of adolescent girls to prevent pregnancy, HIV and sexually transmitted infection was highlighted very clearly by Pauline Irungu, the Policy and Advocacy Manager at PATH, during the Biomedical HIV Prevention Forum that held on the 3rd of December 2017 in Abidjan at part of the 2017 ICASA Conference.
Pauline noted that 66% of global maternal deaths and 66% of the new HIV infections in 2015 occurred in sub-Saharan Africa. While progress has been made in reducing mother to child transmission, much more remains to be done including the need to address the unmet need for contraception for 25% of women. Sadly, a growing number of young people aged 10–24years are living with HIV in the region. These young persons living with HIV have particular needs and challenges related to their sexual and reproductive health and rights.
Pauline noted that there are ongoing research to develop new biomedical interventions that could allow women and young girls to address multiple sexual and reproductive health issues with one product. For example, a product could combine protection against unintended pregnancy and at least one sexually transmitted infections.
The only approved multi-purpose technology we currently have is the male and female condoms – they prevent pregnancy, STI and HIV infection. The closest other innovation is the result of the
groundbreaking CAPRISA-004 trial that demonstrated the efficacy of vaginal tenofovir 1% gel in reducing the risk of HIV1 infection by 39% in heterosexual women. The product was also demonstrated to reduce the risk of acquisition of herpes simplex virus type 2 – an organism that causes sexually transmitted infection.
There are a number of multipurpose technologies in development. These include:
An intra-vaginal ring (IVR) that stays in for 90 days and releases the hormone, levonorgestrel (LNG) for contraception and tenofovir for HIV and HSV2 prevention being developed by CONRAD. A biodegradable film that delivers protection against HIV and HSV2 being developed by Mapp Biopharmaceutical Inc. A 90-day and intra-vaginal ring that stays in the vagina for 90 days and releases levonorgestrel for contraception and Dapivirine for HIV prevention being developed by IPM. There is also the fast-dissolve vaginal tablet with tenofovir alone or tenofovir and emtricitabine for HIV and HSV2 prevention being developed by CONRAD.
We need these tools now more than ever. Advocates need to increase demand for financing, coordination, and strategic investments in research and development of multi-purpose technologies by governments. They equally have to start asking for and facilitating processes that streamline regulatory processes to accelerate licensing of safe and effective technologies.
New market-based incentives need to be developed to encourage private industry investments in research and development of multi-purpose technologies. There is also a need to increase local capacity for research and manufacturing of new products. The time to start preparing for a feasible new future is now.
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