On the front page...
HIV testing is usually a confidential process. Yet
Staci, a vigorous 22-year-old mother of two, has consented to being
filmed while she receives her results
When the mobile clinic first came round her neighborhood — well,
why not get the test? "If I have something," she says sturdily, "I
would like to know, keep myself healthy." The most important thing
in her life, she says, is her kids.
|Dr. Betsy Herold
|NIAID's Dr. Mary Fanning outlines the scope
of the HIV/AIDS problem in women and girls.
And now HIV counselor Eric Thornhill reads the results. Staci
"You mean I have AIDS?!" She tries to bolt, but Thornhill gently
"My kids!" she cries. She presses her hand to her heart.
This scene comes from the documentary Hidden Crisis: Women
and AIDS in America, produced by Moxie Firecracker in 2003
for the Kaiser Family Foundation. It profiles three women living
with HIV/AIDS and was screened for viewers in Lipsett Amphitheater
on Mar. 10, the first National Women and Girls HIV/AIDS Awareness
The video attacks the fallacy that the AIDS epidemic is retreating:
Increasingly, the epidemic affects women. Moreover, by any measure,
the average woman with AIDS is likely to be worse off than her
Staci in New York, Betty in Mississippi, Tammy in Florida — these
are the faces behind the numbers. Many in the audience wept at
seeing their stories.
To place the dramas in epidemiological and scientific context,
NIAID's Dr. Mary Fanning and Mount Sinai School of Medicine's Dr.
Betsy Herold outlined the problem, which is stark. Globally, women
now comprise almost half of the 42 million cases. In 2004, among
all AIDS cases in the U.S., 27 percent occurred in women, up from
7 percent in 1985.
In the U.S., women of color are particularly hard hit. From 2001
to 2004, the vast majority — 83 percent — of newly
diagnosed women were African American or Hispanic. Young women
are also increasingly burdened. Among people under age 25 who were
diagnosed in 2001-2004, females accounted for 38 percent of them;
in people 25 years and older, females made up 27 percent.
Women are biologically, socially and economically more vulnerable
to HIV than men. Most women who acquire AIDS have one sexual partner — their
spouse. Women are more susceptible to HIV infection; they suffer
disease progression at lower levels of virus; their metabolism
and response to drugs differ from men's. Meanwhile, social and
economic factors may complicate women's disease management. HIV-infected
women often have difficulty accessing health care, and may carry
the burdens of family and child care in the absence of any social
support. They also tend to be diagnosed and enter health care services
at later stages of infection than men.
|Herold charts current progress in translating basic research leading to development of microbicides.|
In response, NIAID supports the Women's Interagency HIV Study
and other clinical research on gender-specific differences in HIV
disease progression, complications, treatment and prevention.
Herold, a professor of both pediatrics and microbiology, outlined
current progress in translating basic research into microbicides;
these drugs are designed for vaginal and rectal application. "In
many areas," she said, "condoms are seen as taboo, as signs of
infidelity, and vaccines are in the future. We need something now
for pre- and post-exposure prophylaxis." We need microbicides,
she said, and there are none on the market.
NIAID funding for topical microbicide research rose from $27 million
in fiscal year 2001 to an estimated $52 million in FY 2006.
Herold explained how HIV and genital herpes infections (HSV-2+)
overlap and feed into each other; how microbicides work; ideal
microbicide characteristics; current phase IIb/III trials funded
by NIH; limitations on studies; and promising trials in progress
that are moving forward to phase III.
"There is nothing past phase III," she said. "We wish we had phase
She noted that "microbicides do have the potential to empower
women to battle HIV/HSV. NIH will establish microbicide trials,
develop new drugs and identify pre-clinical and clinical markers
that predict effectiveness and safety.
"By the time this event [in Lipsett] is over," she said, "800
more women will be infected." The need, she emphasized, is urgent.