A Message From The Creator

A Message From The Creator

Women’s Health: Listening to Women’s Voices on HIV Prevention

Women’s Health: Listening to Women’s Voices on HIV Prevention

A Message From The Creator

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Women’s Health: Listening to Women’s Voices on HIV Prevention

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Mitchell Warren

Executive Director, AVAC

Earlier this week, researchers announced the results from a large HIV prevention trial among African women. What they found was both disappointing and instructive: none of the prevention methods tested in the study made a difference in HIV infection rates, because few women actually used them as directed.

Women and girls have been at the center of the HIV prevention research agenda for more than a decade. Women account for half of new HIV infections worldwide, in part because there are too few prevention options that they can control.

But the latest trial results show that we still have a lot to learn about what women really want and need in HIV prevention. The women in the trial are telling us something that is true for every group at risk for HIV: to help more people avoid infection, we need to offer prevention tools they will actually want, demand and use.

The trial, known as VOICE, included over 5,000 women in South Africa, Uganda and Zimbabwe. It examined two HIV prevention strategies. One involves taking a daily pill and is known as oral pre-exposure prophylaxis (PrEP). The other is a vaginal gel, or microbicide, also meant to be used daily in this particular trial. Both contain a commonly-prescribed antiretroviral (ARV) drug called tenofovir.

The VOICE results reinforced what we know from previous studies — namely, that tenofovir-based gel and pills can only help reduce HIV risk if they are actually used. In earlier trials of these options among heterosexual women and men, and gay men and transgender women, more consistent use of the products corresponded to higher levels of protection from HIV.

While most of the women in the VOICE trial came for their regular clinic visits and tests, they did not use the study products consistently enough to gain any benefit. In fact, fewer than 30 percent had evidence of the study drug in their bloodstream. And compared to both older and married participants, young, unmarried women were much less likely to use their study products and much more likely to acquire HIV.

Clearly HIV prevention is never just biomedical — behavior is key. Using an HIV prevention tool every day can be a daunting challenge for many people. It may be especially difficult in societies where HIV is heavily stigmatized or for people who are treated — as women and girls often are — as being less deserving of care and protection.

At a more basic level, daily PrEP and vaginal gels may just not fit into the realities of many people’s — especially young people’s — lives. This is not only true for women. Another study published last week showed that young gay men in the U.S. also struggled to adhere to daily PrEP. Their most commonly cited reason was “being away from home,” a sign of the mobility and uncertainty that marks many young people’s lives.

After years of exciting news on the biomedical prevention front, the VOICE results underscore that it is time to get serious about the behavioral side of new HIV prevention options.

First, it means figuring out how to identify those who are most likely to use and benefit from PrEP and other emerging options. We know daily PrEP can make a potentially life-saving difference for many women and men at risk for HIV right now, and we have a responsibility to reach them with new methods and with the support they need to use them.

My organization, AVAC, is repeating its call for a comprehensive package of demonstration projects that can help practitioners and program designers determine how to deliver and support the use of PrEP for those women and men at-risk who are able to use a daily option. These studies are critical, but few are planned or underway so far.

Second, we need to redouble research into additional options that women can control, want and use. Several promising approaches are already being studied, including vaginal rings and injections that may only need to be administered every month or quarter, as well as less-than-daily dosing schedules of pills or gels, which may be preferable to some. In addition, research and development resources are urgently needed for combined contraceptive and HIV prevention methods, which would address many women’s needs more comprehensively.

Similarly, research to find HIV vaccines, which would overcome many of the issues around adherence, also needs an aggressive push. Vaccine research has been complex and challenging, but it is at its most promising point in decades.

For many women, especially in Africa, the need for action on these fronts is even greater than ever. In the VOICE study, almost 6 percent of women became infected with HIV during each year of the trial, a much higher percentage than researchers had anticipated based on past data. Among unmarried women under age 25, the rate of infection was even more alarming with nearly 1 in 10 women infected each year.

We need to listen to the women of VOICE and other recent studies. That means designing prevention options based on a deeper understanding of women’s reproductive and sexual health needs and desires, their perceptions of their personal risk for HIV infection, and their willingness and ability to use the products on offer.

On International Women’s Day this Friday, we can honor the thousands of women around the world who are partners in the search for new options, by making real our commitments to women’s health and well-being. We owe it to the millions of women and girls who remain threatened by HIV worldwide to work with them to develop and deliver prevention options they truly want, need and can use.

Read More:  http://www.huffingtonpost.com/mitchell-warren/listening-to-womens-voice_b_2829570.html?utm_hp_ref=womens-health

Women’s Health: Life Expectancy for Women Declines: It’s Our Wakeup Call

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Dr. Suzanne Steinbaum

Cardiologist, Author

A few days ago, a startling story came out in the news media. One network reported it this way: “Female Life Span Decreasing: Some Possible Reasons for the Bizarre Trend.” The statistics: Women 75 and under are dying at higher rates than in previous years, in the United States.
This surprised the researchers, but it doesn’t surprise me. It does, however ignite urgency in my mission. As a doctor who specializes in preventing heart disease in women, and knowing that heart disease is the number-one killer of all American women, these statistics are jarring. The statistics tell an even more specific story: The areas experiencing this trend most dramatically are rural areas and the southern and western regions of the country.

Researchers say the reasons are “unknown.” They say it’s “confusing” and “bizarre.” I spent years researching and writing my book, only to see an increase in unhealthy lifestyle issues, especially for women under the age of 55. The notion that unhealthy behavior and poor lifestyle choices lead to early death isn’t new. A study published in 2005 called the INTER-HEART trial determined that nine factors were responsible for 90 percent of heart disease. These included: high cholesterol, high blood pressure, diabetes, abdominal obesity, smoking, poor diet, lack of exercise, excessive alcohol consumption, and psychosocial risk factors such as stress and depression. Analyze any one of these risks and you’ll see that they are all due to the lifestyle choices we make. So let’s break this down. If the lifestyle choices we make are responsible for the number-one cause of death, and more young women are dying, then how hard is it to connect the dots? I would hardly call it “bizarre,” although I would call it frustrating.

Saying that women are dying younger is a mystery does women a great disservice. Obesitydiabetesheart disease, and the increasing stress women experience in the modern world that exacerbates all these conditions are the reasons, and we already know these are all more prevalent in the areas that report the highest incidence of this increasing death rate. We are missing an opportunity. We can change those statistics, if we pull our collective heads out of the sand and admit that we know exactly why women aren’t living as long.

I use the phrase “live from the heart” often. What it means is to empower yourself to take charge of your health, to not join the statistics. As a country, we are too lax, and too easily accept what is happening. Instead, we can change ourselves, one heart at a time, if we step back and look at the big picture of women in the world today. So, what is the big picture? What are the bigger issues? Women are the jugglers, playing all roles for everyone and trying to make it all work. With the economic realities as they are, the pressure to earn a living, the need to provide, and the ability to take care of everyone and everything take their toll. The stress itself can contribute to high blood pressureatherosclerosis (blockages in the arteries), and obesity. It can also lead to destructive health behaviors such as smoking, drinking too much alcohol, not sleeping or sleeping too much, and overeating. Heart rates are increasing. Death rates are increasing. We can accept this fate, or we can commit to living from the heart and start taking care of ourselves first. Otherwise, I’m concerned that the death rate will continue to rise.

“Living from the Heart” isn’t an “initiative.” It’s not a national health plan. This is not a public health policy, because it is a uniquely individual approach. It’s a “you policy.” It’s a way you can live to step out of the system and get healthy despite the trends. It’s about changing your behavior. Living from the heart means making choices that nurture you instead of hurt you.

Our hearts crave health. When we move, we feel better. When we make food choices that nourish us, we feel energetic. When we do things that make us laugh, or spend time with the ones we love, we flourish. When we manage our stress — not by giving up our power or position, but by balancing exertion with relaxation — then is living from the heart.

Nothing will change what women can do and what they have already done in this world. Nothing will remove all your stress, either. There is a reality to life — a reality to the economy, to working, to keeping schedules, doing laundry, shopping for food, cleaning, paying the bills. But what can change is how we nurture ourselves. Make today the day you decide to listen to, to really hear, what your heart is telling you. Stop one unhealthy behavior and see how you feel. Quit the diet soda, or stop the sugar-sweetened beverages. Get rid of the potato chips. Completely rid your home of anything whose labels are uninterpretable and unreadable. Go for a walk. Put down your smartphone and spend some focused time with your child, a friend, even your pet. Then breathe, and just listen. Listen to your heart. How does it feel when you take care of yourself and give yourself what you need?

I believe that we need to change the paradigm so women start living longer again, but the only way to do this is one individual at a time. We will never go back to the way things “used to be,” whatever that means. We need to look forward and decide where we are headed and who we really want to be in this future of strong women doing it all. We need to embrace our strengths and strengthen our weaknesses, too, in a self-nurturing way.

So don’t worry when you hear these frightening statistics, but let them be a wakeup call. They are a manifestation of us forgetting what it means to be healthy. Of forgetting our very selves. Then, make small changes, minute by minute, breath by breath, bite by bite, step by step. Let’s take back our health, our wellness, and our longevity with this simple prescription: Listen to your heart.

Read More:  http://www.huffingtonpost.com/dr-suzanne-steinbaum/women-heart-health_b_2850852.html?utm_hp_ref=womens-health

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