The fourth annual National Women and Girls HIV/AIDS Awareness Day reminds us of the special risks that HIV/AIDS poses for women and girls. In response to the unique issues they face, we renew our resolve to help women and girls protect themselves from the virus and the disease.
Women and girls represent more than a quarter of all new HIV infections in the United States. More than 278,000 women and adolescent girls in this country are living with HIV;nearly 94,000 American women and girls with AIDS have died since the epidemic began. Globally, half of the estimated 33 million people living with HIV are female, but in sub-Saharan Africa, women make up almost 60 percent of the HIV-infected population.
Here in the United States, minority women and girls bear a disproportionately heavy burden of HIV/AIDS, accounting for 80 percent of U.S. females living with the virus. African-American women acquire HIV at nearly 15 times the rate of white women.Consequently, although African-American women represent 13 percent of the female U.S. population, they account for 65 percent of all American women infected with HIV and 62 percent of all U.S. female AIDS cases. Hispanic women in this country also suffer disproportionately from HIV/AIDS, becoming infected with HIV at nearly four times the rate of white women.
It is critical that women and adolescent girls learn the HIV status of their male sexual partners and regularly monitor their own infection status. This is essential because 80 percent of new HIV infections in American women and girls result from sex with an infected male partner, and one-fifth of all Americans living with HIV infection do not know they are infected. Early diagnosis of HIV allows for counseling and prompt treatment. Potent HIV therapies prolong life and reduce the risk of further HIV transmission by dramatically lowering the amount of virus in the blood and other bodily fluids. Knowing one?s HIV status also creates opportunities for women to make informed choices about childbearing and to adjust their behavior to avoid infecting others. The National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, strongly endorses testing for HIV during the routine medical care of adults, adolescents and pregnant women, as the Centers for Disease Control and Prevention and the American College of Physicians recommend.
Women and girls often acquire HIV in situations where it is difficult or impossible for them to refuse sex or negotiate condom use. For this reason, NIAID places a priority on developing HIV prevention tools that women can implement independently. One such method under study is a microbicide-a gel, cream or foam intended to prevent the sexual transmission of HIV when applied topically inside the vagina or rectum. A recently completed NIAID clinical trial of a microbicide called PRO 2000 (http://www3.niaid.nih.gov/news/newsreleases/2009/HPTN_035_gel.htm) found the experimental product to be 30 percent effective. Although this result fell just short of statistical significance, it was the first indication that a microbicide might work in people. More definitive results will come from a larger clinical trial of PRO 2000 being conducted by the Medical Research Council and the Department for International Development of the United Kingdom and scheduled to conclude later this year. Meanwhile, NIAID will begin clinical tests of a different microbicide, one that contains the antiretroviral drug tenofovir. Many other NIAID studies of microbicides at earlier stages of development also are under way.
Another mode of HIV prevention, one that women and girls at high risk for HIV could implement independently, would involve taking antiretroviral drug regimens to protect themselves from infection. NIAID-sponsored studies are testing this experimental approach, known as pre-exposure prophylaxis (PrEP), with the first clinical results expected this year.
In addition to studies of such HIV prevention tools, NIAID supports research on HIV/AIDS treatment, complications and disease progression among women and girls. For example, several NIAID-sponsored clinical trials aim to optimize HIV/AIDS therapy for women who previously took certain antiretroviral drug regimens to prevent passing the virus on to their children during pregnancy or birth.
National Women and Girls HIV/AIDS Awareness Day reminds us of the female face of HIV/AIDS and its challenges. NIAID is committed to developing HIV prevention tools that empower women and girls to protect themselves. I encourage women and adolescent girls to embrace routine HIV testing, to learn the HIV status of their sexual partners when possible, and to employ "safe sex" practices (http://www.nlm.nih.gov/medlineplus/ency/article/001949.htm). The abhorrent racial disparity among new HIV/AIDS cases in the United States and the gender disparity of HIV/AIDS in sub-Saharan Africa demand our attention as national and global communities. By recognizing and responding to the unique risks that HIV/AIDS poses for women, we will go far toward curbing the epidemic.
Each year, the NIH Office of AIDS Research (http://www.oar.nih.gov/) produces a Trans-NIH Plan for HIV-Related Research that identifies strategic priorities for all areas of HIV/AIDS research. The plan is developed in collaboration with experts from the NIH institutes and centers, other government agencies, non-governmental organizations and HIV/AIDS community representatives. The Fiscal Year 2010 Trans-NIH Plan for HIV-Related Research (http://www.oar.nih.gov/strategicplan/fy2010/index.asp) contains a section on microbicides and a chapter specifically devoted to research addressing HIV/AIDS in special populations, including women and girls.
Dr. Fauci is director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health in Bethesda, Maryland.
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