Putting Prevention in the Hands of Women: Combining Contraception with HIV & STI Prevention
By Bethany Young Holt — March 8, 2017
This International Women’s Day, it is clear that the global community needs to act boldly to maintain progress we have made in improving the health and well-being of women worldwide. The potential for losing ground on health advances that have improved millions of lives is all too real. One arena of action that can strengthen women’s resiliency in the face of social, economic, and health challenges is a commitment to better sexual and reproductive health prevention.
When women cannot control if and when they have children, when they cannot space and plan births, and when they cannot prevent the range of sexually transmitted infections (STIs), then a series of negative health consequences can compound, creating a pile up of negative health and economic burdens.
Over the past decade, we have seen marked progress in global women’s sexual and reproductive health, especially in the realm of maternal and infant mortality. However, considerable disparities still exist between wealthy and poor communities, with high rates of unintended pregnancy and HIV transmission among some of the world’s most vulnerable women. In Sub-Saharan Africa, rates of HIV among women and adolescent girls remain intractably high, and worldwide over 225 million women have an unmet need for contraception. Rates of unintended pregnancy remain between 40-50% of all pregnancies both in the U.S. and globally. Every day, one million people around the world contract an STI, which can lead to infertility, cancer, and death when left untreated. The impact on children born to mothers with untreated STIs is profound, deadly, and on the rise in areas of the U.S.
To address these challenges, and to prevent maternal and child mortality and morbidity, we must commit to developing new prevention methods that address women’s interlinked health risks. This is not a simple task. To be effective, we cannot simply flood the market with new products and hope women will use them. Instead, we must listen to the needs and preferences of women and adolescent girls themselves and innovate products that address the challenges and barriers that they face in their daily lives.
The Promise of MPTs
Multipurpose Prevention Technologies (MPTs) are an innovative field of sexual and reproductive health prevention products that can deliver varied combinations of HIV prevention, other STI prevention, and contraception.
Due to low rates of condom use between long-term couples worldwide and the added challenge of partner negotiation, it is widely recognized that condoms work for some but are not enough to effectively address the diverse prevention needs of women and adolescent girls. MPTs in development offer a promising array of solutions, with some combining contraception with HIV prevention; others offering prevention of HIV and other STIs while allowing for pregnancy; and others providing contraception as well as protection against various STIs, including herpes simplex virus, which is highly prevalent in the United States. MPTs aim to put discreet, broad-spectrum prevention into the hands of women and girls, empowering them to address multiple health risks at once.
One of the ongoing problems for current prevention efforts in many parts of the world is the stigma that women face when trying to access HIV prevention services, which ultimately deters prevention uptake. While we do have PrEP, it can be expensive, inaccessible, and stigmatizing for many. MPTs offer a promising method for bypassing these challenges. A number of early studies suggest that because contraceptive services may be more desired, acceptable, and normalized for many women, MPT combinations that include contraception and HIV prevention that are delivered in family planning settings could increase HIV prevention uptake.
Currently, there are nearly a dozen MPT products being tested in various stages of clinical trials. If we have learned one thing from decades of work in family planning, it is that there is no one-size-fits-all product for women’s health prevention. The product development pipeline includes designs such as vaginal rings, fast-dissolving vaginal films, vaginal inserts, and gels that can address multiple indications. The goal of the field is not to develop one single product, but to provide an array of options that reflect the diverse circumstances that women face worldwide.
The IMPT: Creating a Field, Not a Product
In order to actualize not just one or two new products that offer combined indications, the Initiative for MPTs (IMPT) was born in order advance the development of a full array of methods and options. By bridging the traditionally autonomous HIV, STI, and contraception fields and bringing together over 1,200 experts from across 15 countries, the IMPT harnesses the collective expertise of a diverse set of partners. Through a product-neutral, collaborative approach to coordinating the MPT field, the IMPT has been able to advance MPT science in a way that puts women’s needs and preferences at the forefront. Moreover, by serving as a platform for collaboration, the IMPT provides a mechanism through which MPT funders can collectively maximize the cost-effectiveness of their investments.
There is an urgent need for pioneering governments, foundations, and philanthropists to invest in better prevention for women and girls. Sexual and reproductive health champions such as Melinda Gates have committed to advancing access to contraception, while others have pledged to reduce the HIV transmission rate. It is time to create greater connection between women’s interlinked health risks by better integrating HIV prevention, STI prevention, and family planning, and MPTs offer a promising approach to addressing these interconnected concerns.
The health of women and children should not be up for debate. We cannot afford to go backward on the progress we have made over the past decade. MPTs promise to improve women’s ability to plan pregnancy while avoiding HIV and other STIs, and will bring better prevention to women at home and abroad.
Bethany Young Holt, PhD, MPH is an epidemiologist who leads the global collaboration of researchers, funders, and advocates working toward a new field of women’s health prevention that can deliver broad spectrum prevention: contraception in combination with HIV and other STI prevention.