Mapping Pathways is a multi-national project to develop and nurture a research-driven, community-led global understanding of the emerging evidence base around the adoption of antiretroviral-based prevention strategies to end the HIV/AIDS epidemic. The evidence base is more than results from clinical trials - it must include stakeholder and community perspectives as well.

22 May 2012

Developing multiple HIV prevention strategies - In conversation with U.S.-based Jessica Terlikowski

Original content from the Mapping Pathways blog team

“We must build the political will for investment in each these HIV- prevention strategies”

Jessica Terlikowski is director of regional organizing at AIDS United based in Washington, D.C. and was most recently a policy manager at the AIDS Foundation of Chicago. Both organizations are Mapping Pathways partners. Jessica is co-founder of the Chicago Female Condom Campaign, and coordinates the National Female Condom Coalition. She was recently honored by the AIDS Legal Council of Chicago  as “Advocate of the year” for outstanding work in making a difference in the lives of people with HIV and AIDS. 

 MP: How did you get involved in the field of HIV prevention?

JT: I got involved in the field of HIV prevention through my commitment to women’s reproductive health and rights, which is where I got my professional start. I have been a staunch reproductive rights advocate ever since I can remember.  When I moved to Chicago, there was a position available at the AIDS Foundation of Chicago and microbicide education and advocacy education was a part of the job.  I didn’t have an in-depth knowledge of the field at the time and was eager to learn.  

 MP: Is there a prevention strategy that you are especially passionate about?

JT: I think the key is to have as many prevention strategies available as possible. I am, however, extremely passionate about female condoms as they are an important tool for any receptive partner—woman or man—to reduce their risk of HIV and other STDs. They are particularly important for women though as female condoms are the only HIV and STI prevention options that also prevents unintended pregnancies. The global South has recognized the value of this tool for quite some time and the U.S. is starting to get there now too. We are seeing more and more community based organizations, clinics and health departments prioritize female condoms as a result of increased advocacy from a handful of us. The U.S. female condom movement is growing and building momentum.

What I am really concerned about is making sure that people are aware of what prevention strategies exist, so they know what is out there and can access what they need when they need it. We owe it to the communities to push for both existing tools like male and female condoms, sterile syringes, PEP, as well as emerging biomedical tools like microbicides and PrEP.

MP: What Mapping Pathways activities have you and AIDS United engaged in recently?

JT: We adapted the analyses from stakeholder interviews and online survey the Mapping Pathways team conducted in 2011 and created a PowerPoint slide deck which provides  a strong overview of the Mapping Pathways methodology, definitions of ARV-based prevention terms and an overview of ARV-based prevention strategies (read more about the presentation here). We conducted community input sessions with stakeholders at the CDC’s National HIV Prevention Conference and with a number of stakeholders at and AIDS United convening of southern grantees.  

A key finding  was that when we talked about ARV-based prevention strategies, people’s minds would go straight to PrEP instead of thinking of the full portfolio of ARV-based prevention strategies—TLC+, vaginal and rectal microbicides, and PEP. We also learned that there is a real need for developing a common vocabulary around these options to ensure we are all talking about the same thing. At times stakeholders would interpret use the term “treatment as prevention” to refer to PrEP when it is actually referring to TLC+.

A major theme arising from the stakeholder interviews, the survey outcomes as well the community input sessions was that though people are excited about the possibilities of ARV-based prevention strategies as a whole, they are also concerned about how the vast majority of the people who need these options could pay for them.

MP: What are some of the issues, financial and otherwise, that keep coming up in the field of HIV prevention?

JT: I think one of the biggest issues that keep coming up is that of resource allocation. Many are asking where the HIV field can and should invest its resources in order to have the most impact. Since HPTN052, some say that we should pull resources from traditional prevention programs to invest in TLC+ and suggest that people don’t use condoms anyway. Others say that due to resource limitations, it simply isn’t feasible to get everyone who is HIV-positive on treatment.

The reality is that there is no magic bullet that is going to turn the tide on the epidemic in the U.S. or around the world.  We need as many options available as possible and we need to scale up the interventions that we know to work, including increasing availability to sterile syringes and male and female condoms, while also continuing to invest in research for emerging options ensuring that HIV-positive people who need treatment can access it. We can’t afford to play either/or here. Instead, we must build the political will for investment in each these strategies.

Check back next week for part II of the interview in which Jessica discusses ways we can make HIV prevention and treatment a reality for the people who need it most.

[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

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