Empowering Women to Fight HIV: An Interview with South African Dr. Sengeziwe Sibeko

via AllAfrica.com, interview with Dr. Sengeziwe Sibeko

What makes a young African doctor decide to devote her career to helping women fight HIV? Dr. Sengeziwe Sibeko is a 37-year-old medical researcher with a degree in obstetrics and gynecology from the University of KwaZulu Natal (UKZN) in South Africa, an MSc in epidemiology from Columbia University in the United States, and is about to take up a fellowship to study for her PhD at Oxford University in the United Kingdom. AllAfrica's Julie Frederikse interviewed Dr. Sibeko at the community women's reproductive health clinic run by the Centre for the Aids Program of Research in South Africa (Caprisa) in Durban.

When I did my internship back in 1998, I went to the rural northern part of KwaZulu Natal (the South African province where she lives and works) and I was really looking forward to saving lives - yet that was not what was happening at the time. People were dying. You came in each morning to see people die rather than to be able to save lives. But when I went on to do my community service (a two-year requirement for all South African medical students), I really enjoyed obstetrics and gynecology, so when I had the opportunity to specialise I knew that was what I wanted to do.

But over the five years of my specialisation, that changed too. It was no longer just about babies being born - women were coming in because they were sick and babies were dying. I found it to be a depressing situation, and this was further compounded by staff shortages due to people leaving the health system.

Given the depressing effects of Aids that you witnessed, how did you develop your passion around protecting African women from HIV?

My actual turning point came when I went overseas. I got a fellowship in 2006 (from the Fogarty International Clinical Research Scholars and Fellows). That meant that for the first time - I remember this so clearly - I was removed from the everyday numbing situation that I had been in back in South Africa.

So it was only when the National Institutes of Health (NIH) in Washington DC brought all the global health experts together, and their presentations showed me that this is how Asia is doing with the HIV and Aids situation, this is how the United States is doing, and this is you in sub-Saharan Africa - I almost collapsed! I never realised that this is the situation in the region where I'm from. It made me decide that I'm going to go home and be part of the solution.

So what did you do next?

I thought, we can't be waiting for women to come to the clinic, to be sick and to die - there's got to be a way to prevent women getting HIV in the first place. I wanted to do something major, and I saw that it must be through the public health route. So I went into Caprisa and met Dr. Quarraisha Abdool Karim. The time that I joined coincided with a conference on the potential of microbicides to fight HIV. So I thought, wow, I'm in the right place, this could save women's lives. I became the overall gynecologist of the study, so I like to think of it as my baby.

When I joined the field there hadn't been any success stories with microbicides. There were lots of negative trials and the field was almost dying. I remember talking to Dr. Henry Gabelnick (head of Caprisa's research partner, the U.S. reproductive health group, CONRAD) who is the greatest proponent of microbicides, and I told him, if you give up on this concept you give up on women. Because I see this as a woman-empowering strategy. It gives women the opportunity to be in control when they can't negotiate other safe sex practices.

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

Keep up the fight for microbicides

via AllAfrica.com, by Julie Frederikse

Africans tracking the worldwide HIV epidemic have not found much to celebrate since Aids began ravaging the continent 30 years ago, but researchers are optimistic that they are learning as much from their failures as their successes.

Sub-Saharan Africa still carries the biggest burden of HIV worldwide, and while there has been a significant improvement in access to antiretroviral treatment in recent years, scientists searching for a gel or vaccine that can prevent HIV infection ride a rollercoaster of hope and disappointment.

Take the case of a husband and wife team from the University of KwaZulu-Natal in South Africa. Professors Salim Karim and Quarraisha Abdool Karim head up a research unit that has been at the forefront of clinical trials to find a safe and effective microbicide to protect women from HIV.

In July 2010, delegates at the last World Aids conference gave the couple a standing ovation when they announced the results of one of the most promising studies on HIV prevention to date. Their team at the Centre for the Aids Program of Research in South Africa (Caprisa), showed that a vaginal gel called tenofovir was able to reduce sexual transmission of the virus by 39 percent overall and 54 percent in women who used it consistently.

But the euphoria over this breakthrough has dissolved into disappointment, with the unexpected finding of a wider sub-Saharan African study that the microbicidal gel, when prescribed daily, does not prevent HIV infections. This has led to the suspension of tenofovir in the Vaginal and Oral Interventions to Control the Epidemic (Voice) trial.

Tenofovir is an antiretroviral drug that is taken successfully by many people living with Aids to suppress the virus. The hope had been that tenofovir could also be used to prevent HIV infection. Women are twice as likely as their male partners to acquire HIV during sex and account for 60 percent of adult HIV infections in sub-Saharan Africa. An effective microbicide would give women the option of applying the vaginal gel themselves before sex, without necessarily informing their partners.

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

Current State of Microbicide Research

via Cold Spring Harbor Perspectives in Medicine, by Robin J. Shattock and Zeda Rosenberg

Microbicides represent a potential intervention strategy for preventing HIV transmission. Vaginal microbicides would meet the need for a discreet method that women could use to protect themselves against HIV. Although early-generation microbicides failed to demonstrate efficacy, newer candidates are based on more potent antiretroviral (ARV) products. Positive data from the CAPRISA 004 trial of tenofovir gel support use in women and represent a turning point for the field. This article reviews current progress in development of ARV-based microbicides. We discuss the consensus on selection criteria, the potential for drug resistance, rationale for drug combinations, and the use of pharmacokinetic (PK)/pharmacodynamic (PD) assessment in product development. The urgent need for continued progress in development of formulations for sustained delivery is emphasized. Finally, as the boundaries between different prevention technologies become increasingly blurred, consideration is given to the potential synergy of diverse approaches across the prevention landscape.

An effective microbicide may be one of the best ways to address a central gap in current HIV prevention strategies: lack of a discreet method that women can use to protect themselves from infection. Recently, the World Health Organization reported that AIDS is the leading cause of death among women of reproductive age globally, and particularly in sub-Saharan Africa (World Health Organization 2009). Methods available to prevent HIV include condoms, male circumcision, and behavioral interventions, but data indicate that they are insufficient to protect women. Among women in sub-Saharan Africa, one of the highest-risk factors for acquiring HIV is being in a stable long-term relationship where condom use is low (Shattock and Solomon 2004).

Condoms are impractical for women who want to conceive children or who cannot persuade their partners to use them. Next to an effective vaccine, microbicides (topical preexposure prophylaxis [PrEP]) and oral PrEP have the greatest potential to provide women with protection they can control. Both could be configured to protect men and women from transmission of HIV during unprotected anal intercourse.
Microbicides are topical PrEP products, such as gels, capsules, tablets, films, and intravaginal rings (IVR). They are designed to be applied either around the time of coitus, used on a daily basis (gels and films), or to deliver product over a prolonged period

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

South Africa's Health Services: An Interview with CAPRISA's Dr. Quarraisha Abdool Karim

via AllAfrica.com, interview with Dr.Quarraisha Abdool Karim

Dr. Quarraisha Abdool Karim is an infectious diseases epidemiologist and associate scientific director of the Centre for the Aids Programme of Research in South Africa (Caprisa). AllAfrica's Julie Frederikse spoke to the 51-year-old and asked her about the challenges facing her team as they search for effective ways to prevent HIV and other sexually transmitted infections.

We appreciate that there are many challenges. To simply walk in and say, doctors and nurses, you must now provide this or that - it won't work. We are aware that services are very strained in the public health sector. Morale is low, staff feel overwhelmed, and nurses often don't get sufficient support in the implementation of policy decisions.

So we have been working with the family planning nurses, using a Quality Improvement Strategy model that's been used extensively to improve the quality of health care delivery and access to important health interventions. It's similar to Paolo Freire's work in education, in that we aim to work with health care staff using empowering and enabling approaches.

How would you assess the government's sexual and reproductive health services in South Africa?

This country has one of most enviable lists of contraceptive methods available at no cost, yet the main method used is Depo Provera (which a recent study has shown to double the risk of transmission of HIV to women). There are IUDs and implants, which may be much better, safer options. So why are they not being promoted? Even with the injectables, there is NET-EN (norethisterone enanthate), which has a lower dose of progesterone and has a favourable safety profile for use by young people.

The point is that we have as policy on our essential drug list an extensive group of fertility control methods, so why is this not translated into access at point of delivery? The answer relates to the fact that the normal interaction time between a health professional and a client is very short, sometimes as short as 30 to 40 seconds. This doesn't leave time to consider other contraceptive options. We know you can't change people overnight, especially when their prescribing patterns are limited to just giving an injection, and perhaps asking a question like, 'do you know your HIV status?' But we know that we've got to change health care provision - to include HIV testing, screening for STIs and cervical cancer, just to mention a few. It's got to be part of a comprehensive model for prevention and treatment - but the challenges are in how to integrate this in over-stretched clinics.

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

Measuring condom usage and ART coverage in South Africa

via Journal of the Royal Society, by Leigh F. Johnson, Timothy B. Hallett, Thomas M. Rehle, and Rob E. Dorrington

This study aims to assess trends in human immunodeficiency virus (HIV) incidence in South Africa, and to assess the extent to which prevention and treatment programmes have reduced HIV incidence. Two models of the South African HIV epidemic, the STI (sexually transmitted infection)–HIV Interaction model and the ASSA2003 AIDS and Demographic model, were adapted. Both models were fitted to age-specific HIV prevalence data from antenatal clinic surveys and household surveys, using a Bayesian approach. Both models suggest that HIV incidence in 15–49 year olds declined significantly between the start of 2000 and the start of 2008: by 27 per cent (95% CI: 21–32%) in the STI–HIV model and by 31 per cent (95% CI: 23–39%) in the ASSA2003 model, when expressed as a percentage of incidence rates in 2000. By 2008, the percentage reduction in incidence owing to increased condom use was 37 per cent (95% CI: 34–41%) in the STI–HIV model and 23 per cent (95% CI: 14–34%) in the ASSA2003 model. Both models also estimated a small reduction in incidence owing to antiretroviral treatment by 2008. Increased condom use therefore appears to be the most significant factor explaining the recent South African HIV incidence decline.

Read the full article here.


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