The Editorial in the April issue, Antiretroviral gels: facing the FACTS, describes the HIV community's collective disappointment regarding the FACTS trial's negative results.1 However, the conclusions that gels are not “practically feasible” and vaginal rings may be the “usable prevention strategy” that women need is misguided. Oral pre-exposure prophylaxis (PrEP) is more promising than ever for women: the HPTN 067 ADAPT trial and Partners PrEP Demonstration Project, both presented at the same conference as FACTS, confirmed that women want HIV prevention methods and adhere to daily oral dosing, especially when open-label products known to be effective are used.2, 3 What is needed next is diversification of prevention methods and implementation strategies responsive to the contexts of women's lives. Why did women in FACTS and some other HIV prevention trials not use study drugs? Research with unproven products, placebo arms, and blinding coupled with stigma around PrEP use may contribute. An ecological model of social determinants of health provides additional explanations.4 When considering the individual, social, cultural, economic and environmental factors that effect a woman's risk of HIV, a simple switch from gels to rings cannot circumvent the powerful forces at play. No single intervention can take on the complex factors leading women to disproportionately carry the HIV burden in sub-Saharan Africa. Rather, various prevention choices and multipronged interventions addressing social determinants are needed to promote every woman's agency in managing her sexual and reproductive health.
We declare no competing interests.
- The Lancet HIV. Antiretroviral gels: facing the FACTS. Lancet HIV. 2015; 2: e115
- Bekker LG, Hughes J, Amico R, et al. HPTN 067/ADAPT Cape Town: a comparison of daily and nondaily PrEP dosing in African women. Conference on Retroviruses and Opportunistic Infections; Seattle, WA, USA; Feb 23–25 2015. Abstract 978LB.
- Baeten J, Heffron R, Kidoguchi L, et al. Near Elimination of HIV transmission in a demonstration project of PrEP and ART. Conference on Retroviruses and Opportunistic Infections; Seattle, WA, USA; Feb 23–25 2015. Abstract 24.
- Institute of Medicine Committee on Assuring the Health of the Public in the 21st C. The Future of the Public's Health in the 21st Century. National Academies Press, Washington (DC); 2003