PrEP

Pre-Exposure Prophylaxis: A New Tool in the HIV Prevention Toolbox

Can a pill really be taken that will prevent HIV infection? Some new studies say “Yes.” The use of pre-exposure prophylaxis (PrEP) is not a new concept; for years malaria drugs have been given to travelers visiting areas where there is a high risk of contracting the disease. However, the use of PrEP has never before been looked at as a prevention method for contracting HIV.

So what exactly is PrEP and how does it work? Current studies are testing the effect of using a daily regimen of antiretroviral treatments to prevent infection with HIV. Two drugs are currently being tested for this purpose in clinical trials: tenofovir and Truvada (a combination of tenofovir and emtricitabine). In November 2010 the National Institute of Health released the results of the iPrEx clinical trials. These studies were conducted with men who have sex with men in six different countries. In the study, there was an overall 44% reduction in acquisition of the virus in men who took a daily oral regimen of Truvada. Additionally, blood samples showed that there was a 90% risk reduction in men who faithfully took the drug daily.

In two more recent studies, PrEP has been shown to be effective in reducing the spread of HIV between heterosexual partners as well. The Partners PrEP study compared tenofovir and Truvada regimens in heterosexual partners where one was HIV positive and the other was HIV negative, in Kenya and Uganda. In this study, tenofovir was 62% effective in preventing HIV infection while Truvada was 73% effective. In another study, TDF2, researchers looked at a Truvada regimen in heterosexual men and women in Botswana. This study found Truvada to be 63% effective in preventing HIV infection. Although the adherence in both studies was somewhat high, 97% and 84% respectively, the researchers noticed that the adherence was higher in couples, especially when they received adherence and sexual health counseling together. Therefore the drug appears to be more effective when it was taken along with practicing other safe sex methods.

What do these new findings mean for combating the AIDS pandemic? Firstly, they give medical practitioners another tool to fight the disease. Previously, condoms and abstinence were the only ways to prevent the spread of HIV. However, more recent discoveries have given us other ways to help curb the spread of the disease: vaginal microbicides, immediate ART treatment to prevent HIV transmission and now PrEP. Combing these new prevention methods with the traditional prevention strategy of condom use could be an extremely effective way to reverse the trends of the current pandemic.

Second PrEP allows individuals, especially women, to have more control over what happens to their bodies. Many women may not be a position to negotiate condom use, for example if they are in abusive relationships or live in societies where women have no self autonomy, and PrEP would give them another way to protect themselves against HIV. Unlike a female condom which is visible to the eye, a woman could potentially be on a PrEP regimen without their partner ever knowing.

Despite the potential benefits of PrEP, there are still a few major concerns. One problem with such a breakthrough is that it may discourage the use of other safe sex practices. If someone knows they can greatly decrease their chance of getting HIV by taking a pill they may forgo the use of condoms altogether. Not only does unprotected sex increase the chance of pregnancy, it also opens one up to a whole host of other sexually transmitted infections (STIs). STIs increase the chance of acquiring HIV, as well as lead to infertility and reproductive cancers. The most effective use of PrEP would be in conjunction with condom use and continual HIV testing.

Another issue with PrEP is cost and access to the medication. Condoms are cheap, drugs are not. Condoms can be handed out on the streets while drugs would require a doctor’s visit and a prescription. In areas where funds are already scarce, such as in Africa, who would have access to this prophylactic treatment? Would it only be for partners of HIV infected people? In the United States would the drug only be aimed at the entire population or only at high risk populations, such as minority communities? The same communities who currently have little access to healthcare and could most likely not afford such a long-term drug treatment? In order for PrEP to have the widespread positive impact it has the potential to have, it needs to be handled with caution. PrEP needs to be marketed not as a “cure” for AIDS but as a tool to be used in combination with condoms and other prophylactic treatments to curb the spread of the disease. PrEP also needs to be distributed in populations where it will do the most good and for little or no cost to the user. The HIV/AIDS pandemic shows no signs of stopping and the more ammunition we have to combat the disease the better.

New Jerseyans: Where Were You?

On June 20th as I walked up to the statehouse in Trenton, I could hear the crowd before I even saw it. As I got closer a sea of women in pink shirts filled my field of vision. The more I looked around though, I realized the chanting was not coming from this group of women. Instead, further down the street a much larger, more rambunctious crowd had gathered to protest proposed cuts to health care benefits and pensions for the state’s public employees. As I looked around at the crowd gathered in support of women’s health, I wondered, “Is this it? Where are all the signs? Where is all the chanting?” Cuts to the state’s family planning budget have the potential to affect half of states adult population, not counting their families. So where was everyone?
Maybe my expectations were too high. Never having been to a political rally before the only visuals I had to go on were of what I had seen on TV or had read about in history books: The March on Washington, the Million Mom March or the National Equality March. Knowing that this was a state versus federal rally meant that my expectations were lowered, but not by much. I expected to see hundreds of women wearing various organizations’ t-shirts, carrying signs emblazoned with slogans such as “Stop the War on Women” and “Women’s Health=Family Health,” chanting for women’s rights and listening to leaders of the movement expounding on its progress and what we must do to continue the fight.
In reality, the rally was much smaller and tamer than I anticipated. Yes there were t-shirts: bright pink with “I stand with Planned Parenthood” written on the front. Yes, many of the movement’s leaders gave excellent speeches and promised to continue the fight to restore the family planning budget. And yes there were a few signs and some chanting. However, I think what disappointed me the most was the somewhat small turnout. Don’t get me wrong, everyone who turned up was amazing for doing so and I applaud the organizers of the rally for all of the support garnered for the cause. But seriously, New Jerseyans, where were you? These cuts will directly affect your health and the health of those that you care about. I am especially disappointed in college age women, my peers, many of whom rely on Planned Parenthood and other family planning centers for the most basic healthcare. If we do not care enough about our own health to fight these budget cuts why should we expect anyone else to care?
However, maybe I am being too hard on this rally in particular and instead am making a comment on women’s rallies in general. In this society, when women gather they are expected to be calm and collected. As evidenced by only the two State Police officers stationed outside the statehouse, no one expected a group of women to get out of hand. Along with this assumption another can be deduced: no one expected men to even attend. Why is it that men are not expected to rally for a “women’s” cause? Men do not exist in a women-less bubble; they are surrounded by their mothers, sisters, wives, daughters, friends, etc whom they care about and whose well-being is at stake. A woman would be expected to support her husband in a rally against pension cuts, so why shouldn’t he be expected to support his wife in a rally against threats to her health? Because of the relatively “calm” nature of women’s rallies and the lack of male presence these rallies are often missing another crucial component: press coverage. Without press coverage how will the legislators know that anyone cares? How will other women and men know that they can join in the cause? Women’s rallies need to continue to be taken seriously if they are ever to affect the change necessary ensure our rights.
Nevertheless, my first political rally was a positive experience. It was exciting to see other people gathered for a cause that I feel so strongly about. Hearing all of the speeches made me realize that other people truly care about my health and will continue to fight for my well-being. My only wish is that in the future more young women like myself will be able to experience what I did yesterday and will join in the fight for women’s health and in essence, women’s rights.

NJ War on Women

The “War on Women” Has Reached our Shores

As New Jersey State Senator Loretta Weinberg (D-Bergen) puts it, the “war on women” has begun. What started out as an attack on women’s rights at the national level has managed to land on New Jersey’s shores and permeate into the heart of the state government. Last year, Governor Chris Christie slashed $7.5 million in family planning funds from the state budget. As a result, six of the state’s 58 family planning centers have been forced to close while even more centers have been forced to lay-off staff and limit operating hours.
These changes will have detrimental effects on women’s health throughout the state of NJ. Not only do these centers provide birth control and other family planning services, for many low income women such centers are their only source of primary healthcare. Without access to primary care, many women will go unchecked for HIV and other STDs, as well as for important signs of pre-cancer. In 2010, clinics in NJ provided family planning and preventative care for 126,903 women and 9,461 men, overall serving 97,129 uninsured women and men throughout the state. However, it must be noted that these centers are open to serving all of NJ’s women, no matter their socio-economic status, insurance status, race, age or other differentiating factors. Therefore these funding cuts do not discriminate in the types of women they have the ability to harm.
The problem here is not one of fiscal responsibility but of political ideology. In the long run, funding the state’s 58 healthcare centers will be much cheaper than paying for increased emergency room visits as well as treatment for more advanced cancers and other diseases. Currently by providing contraceptives, these centers save New Jersey around $156 million Medicaid dollars that would go to pre- and postnatal care, delivery, and infant care. By providing the $7.5 million for family planning, the state saves $4 for every $1 spent. However, the idea that these centers are hotspots for abortion has clouded Governor Christie’s good judgment. Of the remaining 52 clinics, 29 are run by Planned Parenthood and only three of these clinics provide abortions, using no state money to fund the procedure. Instead of sending a message against abortion, Christie is in effect saying that he does not care about the health and reproductive rights of women, particularly women of color or low income women.
In truth these centers are much less about providing women with safe abortions than they are about providing healthcare for uninsured and poor women. In a state with the highest proportion of women living with AIDS in the country, these closures are a serious threat to women’s health. Without access to affordable HIV testing, many women will remain unaware of their serostatus and will not begin receiving life saving anti-retroviral therapy at the earliest possible time. Not only do ARTs extend a woman’s healthy life years between contracting HIV and developing AIDS, they also, according to recent studies, help decrease the transmission rate between partners when taken at the earliest possible time after contracting the virus. The only way that women will be able to protect themselves against HIV is by having the necessary information about the virus as well as the tools to prevent transmission of the disease. By barring women’s access to affordable family planning services we are going back to a time when women were not deemed “intelligent” enough to make decisions about their own health and we are instead allowing a patriarchal state government to make all of the important health decisions for her.

Redefining Rape to Restrict Abortions

Apparently “no” doesn’t mean “no” to Congressman Chris Smith of NJ and the other 173 Congressmen who support H.R 3 “No Tax Payer Funding for Abortion” Act. The claimed purpose of the bill is to ensure no federal money is spent on abortion. Under the Smith bill, individuals who purchase health insurance coverage that includes abortion will face tax penalties, as will small businesses that offer such comprehensive health insurance. The bill has manifested as an extreme piece of legislation that does not protect women and redefines rape for the purpose of reducing the number of abortions that can be performed on rape victims. This act would restrict rape victims from using their health insurance for an abortion if the rape is not considered “forcible” enough.

There is no legal definition behind the term “forcible rape,” it is an arbitrary term Congressman Smith uses in his bill to ban insurance coverage of abortion, even private insurance purchased with one’s own money. This bill would prevent abortions from occurring in situations of statutory rape, incest, coercion through drugs or alcohol, rape of those who are mentally unfit to give consent, date rape and any rape situation where the victim did not take her case to court to prove that the rape was forcible.

Apparently a lack of consent no longer implies rape but the measurement of physical force used by the rapist does. How is that force going to be measured? By the number of bones broken or will cuts and bruising be enough evidence of a struggle?
Taking rape charges to court is a grueling process and many women are actually advised against it. When pursuing pressing charges, rape victims are given legal counsel to not go through with the charges unless they are positive they will be able to emotionally handle being slandered by the defendant’s lawyer. It is the defending lawyer’s job to prove that the woman was promiscuous, didn’t say no loud enough. The jury only needs to have doubt or confusion about whether or not there was consent in order to side with the defendant. In a perfect world sexual consent would be black and white, the defendant’s job however is to emphasize the gray.

According to One In Four, a national organization that develops rape prevention programming and performs advocacy work on behalf of rape victims, one in four women will survive rape or attempted rape. Live Strong Foundation estimates that 80% of rapes occur between people who know each other. This kind of rape is different than the image that Representative Smith has conjured up of a masked bandit hiding in bushes with a weapon. This is the kind of rape that goes unreported because she knows him, she knows his family, she doesn’t know what happened because she was drugged or coerced or she said no, meant no and was forced anyway. All of the above is rape, but will not be recognized as rape under H.R 3. Neither will the statutory rape of a 13 year old by a thirty year old or the rape of a woman who has been drugged and is currently unconscious. Those rapes don’t require enough force for the 173 Congressmen cosponsoring this bill.

NJWAN understands that pro-life politicians are entitled to represent their pro-life constituents by supporting pro-life legislation. However, dragging unrelated issues, such as rape, into the argument is an act of violence against women. This bill has the potential to set rape legislation back decades to before marital rape was illegal an. The power of laws that currently condemn marital rape or consider rape to be a human rights violation would be reduced by the new “forcible” qualifier. H.R. 3 could establish the foundation for a dangerous legal precedent to exist in both rape and abortion legislation.

NJWAN will continue to speak out against H.R. 3 as we advocate for women’s rights to have ownership over their own bodies. Self-determination is a critical component of NJWAN’s mission as is advocacy for the women NJWAN represents. Legislation that restricts women's access to safe abortions promotes unsafe alternatives that endanger women. This bill strives to redefine rape as a means to an anti-abortion end. Dragging rape into the abortion argument is despicable. H.R. 3 not only redefines rape and restricts abortion rights but raises taxes on any individual or small business that purchases health coverage for an abortion with their own money. Please, contact your Congressmen and tell them not to support H.R. 3 because it does not support women: https://writerep.house.gov/writerep/welcome.shtml