New reports show that HIV-positive women may face more gender-based violence than HIV-negative women.
Women make up 50 percent of the 34 million people living with HIV-AIDS globally, and the vast majority of HIV-positive women acquired the infection as a result of heterosexual sex.
World AIDS Day 2011, says the United Nations (UN), is about meeting a 2015 target to reach “zero new HIV infections, zero discrimination and zero AIDS-related deaths.”
An increasing number of studies associate gender-based violence with HIV. Ensuring that at least half of all national governments address the HIV-specific needs of women and girls, and “zero tolerance for gender-based violence,” are both included among the 10 UN goals for World AIDS Day 2011.
Some reports have also suggested that intimate partner violence — including domestic rape — could increase the risk of HIV for women, and similar associations have been made for men who have sex with men.
In seven countries in East and Southern Africa, one recent research article looked at HIV among heterosexual couples where one partner was HIV-positive and the other HIV-negative. When previously HIV-negative partners became positive they were more likely to report violence in the relationship.
Although there were no robust associations between violence and becoming HIV-positive, slightly more intimate partner violence was reported by partners who did become HIV-positive.
However, overall data on this issue remains inconclusive. Another study, conducted in 10 low and middle income countries including Haiti, India and Kenya showed no associations intimate partner violence and increased risk of HIV.
In recent years, public efforts have focus on women having greater control in preventing HIV using microbicides — lubrication, or spermicides that also fight against HIV.
Such microbicides could help women who are being forced to have sexual intercourse, particularly by their spouses, or who do not have the power in the relationship to request that he use a condom. The jelly may be inserted without the spouse noticing it, yet still protecting the women from HIV.
However, a current research study on these microbicides by the Microbicide Trials Network, entitled VOICE, will be stopped prematurely.
The previously heralded CAPRISA trial showed 39 percent reductions in new infections with use of a similar tenofovir-based microbicide. But, the VOICE found completely different results.
While the VOICE researchers revealed that the drug is safe, there were no benefits in preventing HIV among the 2,000 women studied.
“This is truly disappointing news,” commented Yasmin Halima, director of the Global Campaign for Microbicides. ”[And] disappointing for all those who strive to develop tools for HIV prevention, and most of all, for women around the world, particularly those most vulnerable to HIV.”
Following recent reports that hormonal contraceptives may make women twice as likely to contract HIV during heterosexual sex, female microbicides in combination with hormonal contraceptives provided much promise.
While there is much to celebrate in HIV/AIDS achievements in research and progress in combating the epidemic over recent years; many hurdles remain and progress can often be halting.
As female-controlled tools to prevent HIV and protect this vulnerable subset of the population, anti-retroviral therapy-based microbicides may well need to be reconsidered. Further research on microbicides are yet to come.
“It’s not the answer we had hoped for,” added Halima of the VOICE trial results. “But, it will provide more information to help us better understand what may or may not work.”