By Tomika Anderson
BAI Contributing Writer
DURBAN — Whether they’re in Durban or Detroit, in cities around the world Black women and girls grapple with disproportionately higher HIV rates than their peers. A devastating mix of gender power imbalances, poverty, intimate partner violence and sexism contribute to the high infection rates. Researchers say that while a series of new studies released at the 21st Annual International AIDS Conference (AIDS2016) this week show promise, without tackling the conditions Black women and girls face, their troubling rates of HIV will persist.
There is some good news, however. A recent analysis of the historic ASPIRE vaginal ring study shows a high level of HIV protection among young women in South Africa who are particularly at risk. According to new data from UNAIDS, girls and women in Sub-Saharan Africa account for one in five new infections globally. Part of three new studies released by the Centre for the AIDS Programme of Research of South Africa (CAPRISA), the latest research shows that when the dapivirine vaginal ring is used properly, it can protect 72 percent or more women from the virus, reducing HIV risk overall by at least 56 percent. Older women experienced the greatest risk reduction because they used the ring the most.
Still, experts believe lowering the HIV/AIDS rate among young African women remains extremely difficult. Many girls and young women engage in relationships with older men—who either don’t know their HIV status or have no access to treatment—making it hard for the women to negotiate safer sex and avoid the virus. In South Africa, researchers say treatment acceptance and lower levels of adherence remain tremendous barriers. Untreated bacterial infections make matters worse.
“Reducing new HIV infections in young women is one of the greatest challenges in Africa,” says Salim Abdool Karim, M.D., Ph.D, director of CAPRISA. “Based on our results, implementing targeted prevention interventions to break the cycle of HIV transmission while effectively treating bacteria vaginosis could reverse the devastating impact of the HIV epidemic of young people in Africa.”
Experts on an International Women’s Health Coalition-organized panel last Tuesday at AIDS2016 agreed but argued that science is hardly enough.
“We’ve heard a lot about the vagina in the previous discussion about the CAPRISA studies, but I do think we also need to talk about the girls to which these vaginas are attached,” said François Girard, the president of the International Women’s Collective. “We need to really zoom in on the relationships they’re having.”
The power dynamics are extreme.
“The girls are engaging in relationships that are characterized by very traditional gender norms, where they are socialized to be demure, to do what it is expected of them to keep a man,” Girard explained. “Their worth has been associated with having a man and keeping a man.”
Male gender roles also come into play. “A man has been socialized since he was a young boy to be dominant, to score, to have multiple partners and to prove his masculinity through violence,” Girard added. ”That’s the conflict of these sexual relationships that these girls are operating in. As a result you have unwanted pregnancy through these sexual relationships and a whole host of issues connected with sexual violence. So if we’re going to unravel AIDS, we have to unravel gender norms.”
And, in an era where money for HIV research, treatment and capacity building has repeatedly fallen short of the need, funders must be more strategic about the ways in which the precious dollars are directed. “PEPFAR needs more money, everyone needs more money, and most importantly, these countries need more money to afford all of the vehicles they need,” says Mark Dybul, executive director of The Global Fund. “We’ve got to go where the infections are and use the interventions related to that epidemic. I firmly believe if we are smart, if we invest well and learn and monitor and switch between methods in real time we will have the resources to end the epidemic.”