If you're not directly involved in HIV/AIDS research, prevention or treatment, the word microbicide probably means as much to you as, say, integrase inhibitor S/GSK1349572. (For the record, that's an anti-HIV drug that's in clinical trials.) But, as Colorlines recently reported, microbicide researchers have brought us one step closer to an HIV prevention method that women can use--strictly on their terms. It's potentially revolutionary.
Scientists have been trying out different forms of microbicides for some 15 years. Those tests, which were publicly funded for the most part, have failed to stop HIV transmission. But at last summer's International AIDS Conference, South African researchers unveiled a clear, odorless, flavorless gel form of the HIV-fighting drug tenofovir that women can insert into their vaginas with a plastic applicator. In their multi-year trial of nearly 900 sexually active South African teens and women ages 18 to 40, those who used the gel 12 hours before and after sex reduced their risk of contracting HIV by up to 54 percent. (The gel also reduced participants' risk of contracting herpes by 51 percent; that's important because having herpes doubles the risk of contracting HIV.) If a second trial is successful, microbicides could hit the global market as soon as 2014.
That's a scientific victory that's been hailed as a potential turning point in the global epidemic, but it will also be of particular importance to black folks in the United States, who make up nearly half of all new HIV infections but only 13 percent of the population. And black women--who are most often infected through sex with men--are 15 times more likely to be diagnosed with HIV than white women. Among AIDS cases in women ages 13 to 24, black women make up a staggering 62 percent. This Monday was National Black HIV/AIDS Awareness Day, which is meant to call attention to these disparities.
This year marks 30 years since this epidemic officially began. During that time, it's become an increasingly black one for many complicated reasons. As Kai Wright wrote earlier this week, HIV preys upon poverty globally, and poverty rates are remarkably high in black America. So are rates for myriad other preventable health problems--why should we expect HIV to be any different? Studies have long established that black people overall have less access to care than other Americans, and that the care they get is poorer. That poor care echoes through HIV in many ways--less testing so folks don't know they're positive and, thus, are less likely to protect their partners; more undiagnosed STDs among young women in particular, which spikes the likelihood of HIV infection.
Then there's the tipping point theory. HIV, like other infectious diseases, spreads exponentially--in close-knit communities like many black neighborhoods, the more infection that's out there, the more new infections there will be. And all of that's before you get to the many social factors that conspire with poverty, incarceration rates and misinformation to fuel the fire.
In short, black America could stand some help from prevention science. Enter, microbicides.
"For 20 plus years, HIV prevention initiatives to address women's and girls' distinct vulnerability to HIV has been based on having them be 'empowered [enough]' to get their sexual partners to put a condom on a sex organ that is not their own," says Tracie Gardner, the founder and coordinator of the Women's Initiative to Stop HIV/AIDS NY at the New York City-based Legal Action Center. "Because this is inherently backwards, we should not be surprised that in 2011 black women and girls bear a disproportionate burden of HIV/AIDS in this country and all over the world."
Black girls and young women are growing up in an era still defined by misinformation about sex--abstinence-only education alongside a hyper-sexualized media; the AIDS-as-chronic-manageable-disease assumption; the constant drumbeat about the threat of so-called "down low" black men; the related and ever-present cultural obsession with the alleged dearth of eligible black men. In this chaos, an easy-to-use HIV prevention method that doesn't require sophisticated negotiation and communication skills is critical.
Tarana Burke, who has done in-depth sexuality and self-esteem workshops with African-American girls ages 12 to 18 in Selma, Ala., and Philadelphia, says she would incorporate an effective microbicide into her curriculum if one became available. Her girls, as she calls them, are dealing with an onslaught of adult-sized problems, from familial sexual abuse to physically abusive boyfriends to lack of consistent health care to cripplingly low self-esteem due to colorism. Of particular concern, says Burke, the co-founder of a grassroots girls-centered organization called JustBEInc., are the advances of grown men who "manipulate and exploit" her already-vulnerable girls.
"In my workshops, I've had girls who are literally being paid for sex," says Burke. "I'll never forget one 14-year-old I taught who admitted that she was meeting up with a 20-year-old man once a week at a hotel. He would pay her cell phone bill, get her nails and hair done, and take her to the Olive Garden; she would have [unprotected] sex with him. That manipulation is too common among the girls I've worked with."
In this kind of situation, it's easy to imagine how all the efforts in the world to empower a young woman to insist upon condoms wouldn't get far.
"For too many [black] women, especially those living below the poverty line, the mere act of saying, 'Look dude, you need to use a condom' and that actually happening, isn't a reality," says Kellee Terrell, an HIV/AIDS activist and the news editor for TheBody.com. "To have this gel that a woman could discreetly inject could give her some sexual autonomy."
Disproportionate HIV risk isn't limited to black girls and young women. African American women over 50 are among the fastest growing populations living with HIV and AIDS. And many 50-plus women are also making decisions that make them vulnerable to the virus.
Take Brenda, 64, an HIV-negative Philadelphia retiree who recently became engaged to a truck driver five years her junior. For the first three months of their relationship, he refused sex saying he wanted to wait until marriage. But Brenda insisted. "I got tested before we were intimate to show him that I was clean. It was like, 'See, I'm free of disease. I don't have shit. Give me some please,' " she jokes. When she and her beau finally had sex, they used condoms.
But while Brenda scheduled an HIV test for her man at a local black AIDS service organization, he never got around to it. Then, once they got engaged, they started having condom-free sex. "I know it sounds foolish, but for me it's a trust thing," she admits. "I know the stereotype about truck drivers--that they pay for sex. And I know all about AIDS, but I know that he's being monogamous and that he's not wild."
For women like Brenda, an effective microbicide wouldn't be a magic bullet. It wouldn't address the underlying emotional factors or guarantee that she'd stay HIV free. But they would certainly give her another tool to protect herself without suggesting she doesn't trust her fiancee. And that, says Gardner, is the point here.
"The same way we pushed and won acknowledgement of the drugs that interrupt [mother to child] HIV transmission and the clean syringe to interrupt HIV transmission due to inject drugs, we must prioritize the research on and advocacy of microbicides. To continue the silence on this means that black women and girls don't matter and that no one cares about them. That is unacceptable to me."