On World AIDS Day—held across the globe on December 1—we look back on how far we have come in the fight against AIDS and examine the work still left to do. One thing is clear: Sexually active women around the world, and especially in countries with high rates of HIV and pregnancy-related deaths, need more and better options to protect themselves against both pregnancy and sexually transmitted infections (STIs). However, some of the most promising new technologies to achieve that goal, known as multipurpose prevention technologies (MPTs), are vastly underfunded.
MPTs are products that simultaneously protect against multiple risks, such as unintended pregnancy, HIV and other STIs. MPTs currently under development include vaginal rings, gels and fast dissolving films and tablets; injectables; and other novel technologies, such as nanofibers and plantabodies.
The need for preventing unintended pregnancy and infection with HIV and other STIs is clear. For many women, these health challenges are not independent problems. For example, in Sub-Saharan Africa, 12 million women aged 15–49 are living with HIV, and more than half of the women of reproductive age who want to avoid a pregnancy—55 million—are not using an effective contraceptive method.
Behind these startling statistics are real consequences for women and their families. Globally, HIV is now the leading cause of death among women of reproductive age. Unintended pregnancies affect maternal and child health and also extract a steep social and economic cost to women and their families.
MPTs could be a real game-changer for women living in the United States as well. Each year, about half of all pregnancies in the United States—some 3.4 million—are unintended. And women account for one in five new HIV infections. Black women in particular have been disproportionately impacted by the epidemic, accounting for 64 percent of all estimated new HIV infections among women. Black women have been particularly hard hit by other STIs too, with chlamydia rates over seven times those of white women.
A global collaboration of researchers, advocates, and policymakers have been working together to shape the MPT field, focusing on women’s product preferences and addressing some of the limitations of the contraceptive methods currently available. One goal, therefore, is that MPTs would cause few or no systemic side effects. Another priority is to develop a suite of products to meet the differing needs of women: Some could be used on-demand, around the time of sex, which may appeal to women who have sex infrequently; others could be long-acting for women who would rather not worry about remembering to use a method each time. The more choices women have, the better a woman can match a method to her current needs, and the more likely she is to use it correctly and consistently.
Early next year, scientists expect to announce the results of a study testing a vaginal ring for the prevention of HIV. Researchers are eagerly anticipating the results. For one, the ring may be a breakthrough for long-acting HIV prevention that has the potential to be a key building block for an MPT by combining it with hormonal contraceptives. Further, this research could yield important insights to help inform the array of MPTs currently in development.
Despite the compelling need for a broad mix of MPTs, their development has been hampered by insufficient private and public funding, combined with the inherent complexity of developing such innovative technologies. In particular, the lack of profit potential of drugs for use primarily in poor countries with high rates of HIV infection has meant that pharmaceutical companies are not actively participating in MPT development.
Supporting and adequately funding the development of MPTs should be a higher priority for the U.S. government, especially at a time when private sector support is missing. Unfortunately, current funding—while critical in advancing this important work to date—has not been sufficient. According to one analysis, investment in MPT research and development totaled $32 million in 2014. This compares to $841 million for HIV vaccines—which is already not enough. This inadequate funding may significantly hamper the timely development of MPTs that could be a huge boost to achieving an AIDS-free generation.
Boonstra is the Guttmacher Institute’s director of Public Policy. She is responsible for promoting the institute’s sexual and reproductive health agenda in federal law and policy. Holt is the director of the IMPT (Initiative for MPTs), a project of CAMI Health where she serves as executive director. CAMI Health is dedicated to the health empowerment of women and girls and is sponsored by the Public Health Institute.