Contraception Called "Best Kept Secret" in HIV Prevention -- November 30, 2006

Washington — Used in new ways, several existing public health tools may dramatically reduce new HIV infections in developing countries, international HIV prevention experts say.

Among the most promising: using contraception to prevent births of HIV-infected children to HIV-positive women who do not wish to become pregnant, and circumcising men to reduce their potential for acquiring HIV. Contraception and male circumcision are widely practiced, but generally not as HIV prevention tools. Researchers are also exploring additional approaches, such as using oral antiretroviral drugs as pre-exposure prophylaxis (PrEP), to determine their effectiveness in HIV prevention.

The use of contraception by HIV-infected women and couples who do not currently wish to become pregnant is "the best kept secret in HIV prevention," says Ward Cates Jr., MD, MPH, president of research at Family Health International in Research Triangle Park, NC. Research shows that current use of effective contraception by HIV-infected women who do not wish to become pregnant prevents approximately 2.5 times as many infants from becoming infected each year as nevirapine (the standard drug) and other antiretrovirals have during the past seven years.

Dr. Cates will speak Nov. 30 at a National Press Club event on How HIV Prevention Technologies Will Change the Future Landscape of AIDS. He will be joined by Debrework Zewdie, PhD, director of the Global HIV/AIDS Program at the World Bank in Washington, from 10 a.m. to 11 a.m. in the First Amendment Lounge.

The need for identifying new prevention tools — or new uses for existing public health practices — is great. Although more than 1.6 million people are receiving antiretroviral treatment (ART) in 2006, for each person receiving ART nearly three more become infected with the virus. Even worse, the majority of these new infections are occurring in young people ages 15-24. "Do the math; we are losing the HIV war," Dr. Cates says.

In addition to expanding use of contraception to prevent new HIV infections, two other promising prevention tools will be discussed at the Nov. 30 forum: male circumcision and pre-exposure prophylaxis (PrEP), which is using AIDS treatment drugs for prevention of HIV infection.

Results from two National Institutes of Health studies of male circumcision will be evaluated next week. If these studies show similar levels of HIV protection as an earlier trial from South Africa, the global community will have a new tool available for HIV prevention — and prompt action will be required to support expanded access to safe, voluntary male circumcision services worldwide.

PrEP is another promising approach. Because these antiretroviral drugs are currently licensed by the Food and Drug Administration, they are already available to evaluate as prevention products. At the most recent International AIDS Conference, FHI and West African colleagues presented the first data from human PrEP studies, one of the most-cited abstracts at the conference. FHI's randomized trial evaluated the safety and preliminary effectiveness of a daily oral antiretroviral (tenofovir) in preventing HIV acquisition among uninfected women. The regimen was found safe and acceptable. Adherence to the daily dosing regimen was estimated at approximately 70 percent based on self-report and returned product. FHI's study has provided an important base for other research to determine if tenofovir or other antiretrovirals — in conjunction with other proven prevention approaches — can work.

Journalists are invited to cover this session, part of the National Press Club's "Newsmaker" series. To RSVP, please respond to media@fhi.org or call 703-516-9779, ext 371.

Family Health International (FHI) is a leading US-based, non-profit organization engaged in AIDS research and service delivery programs. Since 1971, FHI has been at the forefront of public health research, prevention, care and treatment in the developing world. Our cutting-edge research in reproductive health, family planning and HIV prevention technologies drives our field programs in family health and AIDS service delivery, helping millions of vulnerable people access comprehensive services. With nearly 1,700 staff globally, FHI has implemented programs in more than 100 countries.