Currently, women who want to both avoid an unplanned pregnancy and prevent HIV and other sexually transmitted infections (STIs) have no choices other than the male or female condom. But there are new forms of female-focused methods in development that combine contraception with the prevention of STIs – including HIV – and they’re called Multipurpose Prevention Technologies (MPTs). Public health leaders expect that they will change the face of women’s global health.
These new tools could help both Nandi and Stella (whose names have been changed): they live half a world apart, but both face high risks for unplanned pregnancy, HIV and other STIs, and both have limited options for easy-to-use prevention.
Nandi lives in Cape Town with her husband and young son and must travel a significant distance to access her preferred method of birth control – a long acting injection. Nandi knows that the injection leaves her unprotected from HIV and other STIs, but condoms are not an option as she fears her husband will think she has been unfaithful or that she distrusts his fidelity. (The desire to avoid HIV stigma runs higher than the fear of HIV in her community, and is a major obstacle to HIV prevention.)
Stella, who lives in Los Angeles, is single and uses condoms with new boyfriends. But when a given relationship gets serious, Stella, like many women, tends to stop using condoms at all (only 8% of committed couples worldwide use condoms) and starts using birth control pills. Negotiating condoms hasn’t always been easy – and Stella did contract a genital wart-causing strain of Human papillomavirus (HPV) from a boyfriend while on the pill. (If left untreated, some strains of HPV can cause cancers and may increase HIV risk.)
Despite 50 years of contraceptive research and over 20 years of prevention research on HIV and other STIs, half of the worlds pregnancies are unplanned, every day a million people are infected with an STI, and every minute a young woman becomes infected with HIV. Combined prevention is a common-sense solution because of the interlinked risks of unprotected sex.
Multipurpose Prevention Technologies (MPTs) can prevent unintended pregnancy and STIs (including HIV) – at the same time. Many of the newest MPTs in development are female-initiated, and can be used discretely. Integrative MPT products can deliver an end run around stigma that can be a barrier to HIV prevention.
Some of the numerous products in development include gels, films, injectables and devices, such as a vaginal rings that combine hormonal contraception with anti-HIV and anti-herpes medications, and a one-size-fits-most diaphragm combined with an anti-HIV & anti-HSV gel, Tenofovir, currently in late-stage clinical trials. Additional STI prevention combinations are being developed.
Because one single product cannot satisfy the needs of all – or even most – women, developers aim to create an array of broad-spectrum products to maximize the impact of MPTs. International researchers and women’s health advocates are already collaborating to advance their research, development and uptake. The Initiative for MPTs (IMPT), of which I am a coordinator, brings together researchers, women’s health advocates and funders across HIV, contraception and STI research and prevention fields to create a comprehensive field of prevention science. This collaboration is working to ensure that the input and feedback of women from around the globe is included throughout the product development process, so that the MPT products which come to market are ones that women will want to use.
Compelling research from Ipsos Healthcare and funded by the Bill & Melinda Gates Foundation shows a very strong preference for MPT products among women in sub-SaharanAfrica. The research on MPT acceptability and sexual and reproductive behavior and attitudes among women in South Africa, Uganda and Nigeria found that 98% of respondents would prefer an MPT over a single action HIV or contraception product.
Studies published recently in BJOG: An International Journal of Obstetrics & Gynaecology point to similar findings. Researchers in South Africa and China conclude that offering HIV prevention in the form of MPTs in family planning contexts will increase HIV prevention uptake.
MPTs offer a powerful tool to improve women’s global health. If these technologies were in women’s hands (and bodies), public health specialists would expect to see reductions in HIV and in other sexually transmitted infections – including drops in the rates of HPV, HSV and other infections, all of which increase the risk of contracting HIV and can cause infertility and cancers if left untreated. With MPTs, we would expect to see both a reduction in unintended pregnancies and related improvements in maternal mortality and morbidity rates.
These new tools to help women manage their reproductive health can and will improve the lives of women, children and families – and, as women are better able to plan and space their children and stay healthy, they are more likely to attain higher levels of education and economic stability.
MPTs are revolutionizing how we approach prevention and the options that women will have. These technologies have the potential to be a true game-changer in improving the lives of women and their families, wherever they live in this big world of ours.
