The Need for Broad-Spectrum STI and Pregnancy Prevention Methods Is Clearer Than Ever
by Bethany Young Holt, CAMI Health RH Reality
December 1, 2014 Imagine the impact on women’s lives if people who wanted to prevent a pregnancy and steer clear of sexually transmitted infections (STIs) could use one product that simultaneously did both.
Imagine if women who were the most at risk of HIV but worried about the stigma associated with HIV or negotiating prevention with their partners could have access to a variety of products to choose from—devices, gels, injectables, or drug combinations—so that women could choose one that made sense for their own circumstances. Multipurpose Prevention Technologies, or MPTs, are products on the horizon that offer this kind of broad spectrum prevention.
Why are MPTs important?
Some MPTs could combine contraception with STI prevention, including HIV. Others would allow women to get pregnant while still preventing HIV and other STIs.
Today, if women want to protect themselves from unintended pregnancies and STIs, they can use condoms (male or female), which offer “all-of-the-above” prevention. Both male and female condoms require male partner cooperation, however, and while condoms are extremely effective if used consistently and correctly, couples overwhelmingly forgo them once they are in a more committed partnership. In fact, only 8 percent of couples worldwide use condoms, leaving millions of women who use alternative kinds of birth control in danger of contracting STIs.
Furthermore, there are many millions of women worldwide who want to avoid or delay having children but who lack access to modern contraceptive methods—increasing their chances of unplanned pregnancy or, depending on the contraceptives available, contracting an STI.
It is clearly time to create new, female-initiated products that offer multipurpose prevention of HIV, other STIs, and unplanned pregnancy.
MPTs and Better Uptake
Recently, specialists at Ipsos Healthcare released research showing that an overwhelming number of women surveyed would prefer prevention methods that offer combined protection from unintended pregnancy and STIs. Ninety-eight percent of women interviewed in Uganda, Nigeria, and South Africa said that if they were hypothetically given a choice of methods, they would choose the one that offered broad spectrum prevention rather than simply an HIV prevention tool or a contraceptive.
There was no consensus on preference among the respondents, suggesting that no single product will address the needs of most women. It is therefore critical to develop a suite of MPTs that could protect through different mechanisms. One thing is for certain, though: With MPTs in women’s hands, we could expect significant dips in HIV rates in high-risk regions as preventing STIs becomes easier and more accessible.
In addition, we would expect to see reductions in the 86 million unplanned pregnancies worldwide and improvements in maternal mortality and morbidity. And when contraceptive efficacy increases, so does the quality of life for women and children: As women are better able to plan their children and stay healthy, they are more likely to attain higher levels of education and economic stability.
Women’s Input at the Heart of MPT Development
The international collaborative of researchers, policymakers, and advocates known as the Initiative for MPTs (IMPT) has already succeeded in transcending a number of barriers to innovation, not the least of which are the silos traditionally separating HIV, contraceptive, and STI research. Until recently, funding for each of these fields, primarily from the governmental sectors and private foundations, was separate and disconnected—a great challenge for collaboration. Now, agencies working in these areas are starting to work together. This is reflected in the recent formation of the IMPT Supporting Agency Collaboration Committee, which is tasked with identifying and addressing priorities and gaps in the MPT field.
Furthermore, it is important to note that product development has occurred primarily in labs; scientists traditionally have not sought women’s opinions and feedback until later-stage clinical trials. The work of the IMPT is changing the paradigm so that women’s input is sought at the get-go and social-behavioral research that informs whether women will actually use a given product is meaningfully integrated into the biomedical research. To ensure that women’s input is incorporated into the product development process, the initiative is working with agencies, including those within the National Institutes of Health, to develop product development criteria that reflect feedback from women in different regions of the world.
As IMPT partners have shared findings, reduced redundancies, and created a more streamlined and efficient field, we have already made some noteworthy advances. We have developed an MPT product development database, for example, where anyone can find out details about which products are currently in development. An MPT expected to be available within the next few years is a silicone one-size-fits-most diaphragm that can be combined with a gel that will simultaneously prevent unintended pregnancy and HIV. This is currently in the final trial phase to confirm its efficacy.
This is not to say that there aren’t significant biomedical challenges ahead in the development of MPTs—there are. But the progress made to date in the field, in combination with the potential cost savings and efficiencies offered by MPTs, makes for a compelling case for funding innovation and the international collaboration that is moving all aspects of the field forward.
On World AIDS Day this December 1, we hope you will learn more about the Initiative for MPTs and push to support MPT development as both a meaningful tool in the fight against AIDS and a potential game-changer for women’s global health.