In his 2016 World Aids Day message, UNAIDS Executive Director Michel Sidibe said young women face a triple threat: “high risk of HIV infection, low rates of HIV treatment and poor adherence to HIV treatment.” The result, according to the 2015 UNAIDS report, is that while the number of new HIV infections and AIDS-related deaths is declining globally, girls and young women in sub-Saharan Africa are still being infected at rates two to five times higher than boys and men their age.
As researchers work on trying to figure out the reasons why young women are more vulnerable to contracting HIV, the search for a reliable way to stop the spread of the virus continues. One potential solution, say health experts, is the HIV vaccine, which could give girls and women the means to protect themselves from infection in countries where they have little say over what happens to their bodies.
In November 2016, a new clinical trial for an HIV vaccine was launched in South Africa, where approximately 7 million people are currently living with HIV. Women & Girls recently sat down with Ntando Yola, spokesman for the Cape Town-based Desmond Tutu HIV Foundation, which is part of a global network involved in HIV prevention trials, to discuss what is being called the largest trial of its kind since 2009 and the promise that a vaccine holds for young women in the sub-Saharan region.
Women & Girls: Could you give us a brief history of the development of the HIV vaccine and where we are now?
Ntando Yola: Since the discovery of HIV [in the 1980s], there have been many attempts to find a vaccine. As with any other disease, we researchers will always try to find ways of treating the disease and ways of preventing it from infecting those who do not have it as yet. As such, a lot of work has gone into finding a vaccine. However, due to the nature of HIV, this has proved to be a difficult task. The closest that we have come to finding a promise of a vaccine was through a trial that was conducted in Thailand in 2009, which showed a prevention rate of about 33 percent. This vaccine was then imported to sub-Saharan Africa to see if it will work in this region.
It’s really exciting, because this is the most promise that we have. The trial will last five years and involves 5,400 men and women in six of the nine provinces in South Africa.
Women & Girls: Why is a vaccine so important in the fight against HIV?
Yola: I will give the example of polio, which is a virus we have virtually eradicated because of the use of a vaccine. So I would say a vaccine is the ultimate product in terms of fighting disease. The fight against HIV is greatly affected by a number of factors, which include behavioral and structural factors such as poverty and a lack of adherence. A vaccine requires very little adherence and effort by the population. If you compare it to condoms, for example, that require people to change their behavior and be aware and make sure they use the condoms every time they engage in sexual activity, a vaccine requires very little effort and adherence.
In addition, the hope is that the vaccine, once realized, will either be a one-time solution or a product that will be taken periodically. We also have a mathematical model that tells us if a vaccine that has a 50 percent prevention rate is given to 30 percent of the population, it would prevent roughly 5.6 million new infections over a period of 15 years. This is the kind of hope that a vaccine can bring.
Women & Girls: Why do you think young women in sub-Saharan Africa have been “left behind” when it comes to the decrease in new infections?
Yola: There is a lot of research that has looked into the provision of treatment for women, and women have been at the forefront in ensuring there is investment into HIV treatment and prevention methods targeted at women. So we cannot really say that women have been left behind in terms of research.
However, because of their biological makeup, women are more at risk of HIV infection as compared to men, and in most cases are infected by men. In addition, one of the things we discover when we work with women is that across all diseases, women tend to bear the most burden. If we talk of sexually transmitted infections, women are the ones who are also most at risk. And women also usually bear the burden of contraception. As such, women tend to be most affected by diseases and the burden of treatment and prevention.
Women & Girls: What makes young women in sub-Saharan Africa so vulnerable to HIV infection?
Yola: In addition to the biological makeup mentioned before, there are also issues of power dynamics between men and women, as well as societal norms brought about by our traditional patriarchal societies. In Africa, decisions are usually made by men. This coupled with cultural norms and gender-based violence limits the power of women to prevent infection and puts them at greater risk.
Women & Girls: How would the vaccine change the story for vulnerable women?
Yola: If you look at polio, children are vaccinated early on in life and do not have to go back for [a booster] due to the effectiveness of the vaccine. We do not know as yet whether an HIV vaccine would be as effective. However, it would lessen the burden of women having to go out to seek healthcare options regularly. The best-case scenario would be a one-time vaccination, but other scenarios could be a vaccination every five years or annually, which would still ease the burden on women.