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

Zero Tolerance for Intolerance

The week before Thanksgiving 2010 has been a busy one for NJWAN supported NJ legislators. First the state assembly pushes to restore life saving family planning funds and then NJ legislators pass an anti-bullying bill. This bill would require schools to have a zero-tolerance policy for bullying and harassment. What makes this bill a potential success, compared to the ambiguous 2002 anti-bullying law, is this bill outlines what it means to not tolerate bullying and the processes involved in ensuring all students feel safe and free from harassment. A zero-tolerance policy for harassment is key to promoting one of NJWAN’s favorite traits…tolerance.

This bill was introduced late the week of November 15th and quickly moved through both NJ state houses, passing 71-1 in the Assembly and 35-0 in the Senate. The bill now moves to Governor Christie’s desk where legislators are unsure of his intentions. If this bill is approved by Governor Christie, it will give NJ the strictest anti-bullying laws in the nation. This anti-bullying/anti-harassment measure is intended to fill the gaps of a 2002 law that encouraged NJ schools to have policies surrounding repercussions for bullying but did not require them. The new anti-bullying law mandates that public high school employees be trained to identify bullying and properly address complaints. The NJ State Board of Education will play a significant role in ensuring schools do not tolerate harassment by grading school districts on how they handle incidents of bullying, all of which must be reported by the school’s superintendents.

Fortifying anti-bullying policies has garnered increasing support in NJ after Rutgers University freshman, Tyler Clementi, committed suicide in September. Clementi’s death was in response to homophobic cyber bullying and was not addressed by the existing Rutgers policies and support systems. The Clementi family released a statement of support for this bill stating that it “reflects the public's increased awareness of the need for a renewal of values of respect for human dignity and personal privacy, particularly for young people in this time of rapidly evolving technology.”

While this bill will create a more secure environment in NJ’s elementary, middle and high schools, it does little for higher education institutions, like Rutgers where Clementi experienced harassment. Public colleges and universities will only be required to have an anti-bullying policy written into their code of conduct. While this is a step in the right direction, there is a great difference between stating that there is a zero-tolerance policy in place and enforcing that policy. Without actual support from university staff and student leaders, homophobic, racist, sexist and classist bullying can continue to plague adolescents and young adults. A quick glance at the comments below any online news coverage of this bill (http://www.northjersey.com/news/112210_Both_houses_to_vote_on_NJ_anti-bullying_bill.html?c=y&page=2 ) demonstrates the intolerance that perpetuates bullying.

Intolerant rhetoric furthers the need for anti-bullying policy, but it does not build confidence for us at New Jersey Women and AIDS Network in the efficacy of such measures. Schools are limited to preventing and punishing bullying that occurs on school property. While NJWAN understands it would be unconstitutional to prosecute bullying that occurs elsewhere, in this age of technology bullying is pervasive and can occur on our phones, computers and personal networking sites, as well as our classrooms.

NJWAN’s hopes that a zero-tolerance for bullying bill can shape younger generations to be more tolerant but remains concerned about other pervasive and intolerant influences. Stigma, whether towards people living with HIV or based in homophobia, is toxic and is killing people. As the holiday season approaches, please keep in mind those suffering from stigma and intolerance and be mindful of your own biases. We hope for younger generations to be more tolerant but the burden does not fall entirely on them.

Soap Box Ramblings of Monique

I am about to climb on my soap box. I won’t be long, but alas here I am. Today is World AIDS Day. Quite a significant day for a woman who is the executive director of the only female specific AIDS service organization in NJ, the New Jersey Women and AIDS Network. An organization that has been around since 1988: an organization that is still very small and exists under the radar of those in need. Many who need our services still do not know that we are around. That is because we are continually challenged by the economic downturn of funding agencies (even before the so-called recession) - it makes it challenging for NJWAN to grow and increase its services.

Let me tell you why I am on my soap box. I am very frustrated and I dare to say angry beyond belief. Today my office telephone did not ring, there were no camera crews outside the office building waiting to interview me or the staff. Once again, the issue of HIV as it relates to women has gone unnoticed, swept under the carpet like dust bunnies. NJWAN used to receive at least one inquiry from someone in the media, but today, nothing. Where is the outrage? NJ has the highest proportion of women living with AIDS in the nation and the only female specific AIDS service organization did not receive an inquiry from the media? I attended a Worlds AIDS Day Event in Trenton this evening: it was a great event. But there were very few new faces. I call it preaching to the choir. No new questions, no new issues, no real challenges. I challenged the group to bring two new people each next year. I hope it works. The mayor of Trenton didn’t even stay for the entire event: the state capital, where according to one Trenton journalist’s suggested T-Shirt campaign. “In Trenton, every black person does not have HIV/AIDS — but we’re working on it”. Where is the political attention to HIV? It has fallen off like the media attention. Occasionally HIV receives some media attention, however, the attention usually is focused on the global issue not the domestic crisis. As we move closer to healthcare reform, it appears that HIV will be considered a chronic manageable disease. Is it really a chronic manageable disease? What other chronic manageable diseases are infectious? Which chronic manageable diseases can you contract from engaging in unprotected sex or can be passed from mother to child? Which others carry the stigma that HIV carries? Which chronic manageable diseases have a treatment regimen that involves such significant side effects?

Why are we being quiet as HIV ravishes our families and communities? Why, after 30 years of living with HIV do most individuals only talk openly about HIV one day a year? How long did it take to move from saying “The Big C” to actually saying Cancer? Was it 30 years? When will we realize that silence and shame truly do result in death? When will we move from using terms like high risk behaviors to describe the specific behaviors that place an individual at risk of contracting HIV: anal, oral vaginal sex and needle sharing. When is sex a high-risk behavior? How many people assess their behaviors as high-risk? If you do not assess your behaviors accurately then you will never realize your risk of contracting HIV.

What are the solutions? What are the answers to my questions? I have no idea what your answers are but this day is about recommitment. Today, December 1 2010, I will commit to NJWAN continuing to work hard to address the negative stigma associated with HIV/AIDS. NJWAN will continue to try to mobilize communities around HIV issues. NJWAN will continue to address the social justice and reproductive issues that are the foundation of HIV infection. Finally, I will continue to lead NJWAN and make as much noise as possible about the impact of HIV in our lives. What will you do? Won’t you join us?

Here I am, stepping off my soap box…..for now.

Monique

Still Fighting For NJ's Family Planning Funds

Monday November 21, 2010

NJ Democrats, led by state Senator-elect and Assemblywoman Linda Greenstein (D-Plainsboro) put forth a valiant effort to restore state funding for women’s health and family planning services. This legislation was passed in the NJ state assembly 44-25 and now moves to a vote in the state senate. To date, Governor Christie has been adamantly opposed to this bill as it requires the governor to apply for expansion of Medicaid coverage for women's health and family planning. This legislation would provide the state with nine federal dollars for every State dollar spent.

Monday’s vote was the latest of three attempts by NJ legislators to restore a portion of the $7.5 million cut from family planning services. In July 2010 Governor Christie vetoed legislation that would have restored the full $7.5 million despite the fact that funding for family planning services was found in the budget. An attempt to restore this funding failed again in September 2010 when seven republicans, who originally voted in favor of restoring the money, voted in opposition. However, earlier this month, the Assembly Appropriations Committee approved two bills that would restore $5 million for family planning services, targeting untapped money from other inflated funds. In order to restore the $5 million, the state will be required to apply for federal matching dollars for Medicaid-eligible health care consumers.

According to the New Jersey Star Ledger, restoring NJ’s family planning budget would fund 58 women’s health clinics. These clinics provide vital services such as birth control, breast and pelvic exams, HIV testing, pregnancy testing and treatment for sexually transmitted diseases. In NJ, these services are vital as NJ has the highest rate of HIV infection amongst women in the United States. Family planning services exist as a barrier to growing HIV rates, something NJ cannot forego. Based on budget cuts, the number of women who are able to afford family planning services is expected to drop 40% and many clinics throughout the state have already closed their doors or reduced hours of operation.

These clinics are vital for NJ’s working and financially struggling as they provide affordable health services, including basic gynecological care. A reduction in services is detrimental to the women and families who work inflexible hours and depend on this health care. Not only is family planning money essential to NJ healthcare but investing money in family planning makes good financial sense. Studies cited in the September vote found that for every $1 spent on family planning services, the state saves $4 in other programs. New Jersey Women and AIDS Network is dedicated to advocating for policies that reduce the rate of HIV infection in NJ. Family planning money is essential to reducing the affects of HIV on NJ’s women. NJWAN will not stop fighting for the restoration of family planning funds and asks that you do the same. Please contact your legislators by clicking on the link below and ensure that he or she knows how important family planning money is to NJ.

http://www.njleg.state.nj.us/districts/njmap210.html