Multipurpose Prevention Technologies: Finding the right fit
Last Friday the 2012 Global Health Mini-University was a successful exchange of best practices and new innovations. I attended one particularly interesting presentation about the development of multipurpose prevention technologies—new methods that simultaneously prevent pregnancy, HIV, and other STIs, such as HPV (human papillomavirus), HSV (herpes), syphilis, chlamydia, and others. Currently options for multipurpose prevention are limited to the male and female condom, but these methods do not meet the needs of every person, in every country, and in every situation.
The portfolio of currently available family planning methods, including implants, injectables, IUDs, pills, and many others, allows women and couples to choose the very best method for them. A married couple who wants to wait before having children may choose injectables, but a woman who has infrequent sex and wants to avoid taking regular hormones might prefer to use condoms or a diaphragm at the point of sex. However, for women and couples who are at risk of HIV and STIs in addition to unintended pregnancy, there are not as many options to keep them healthy and happy.
Around the world, nearly one million people contract an STI, including HIV, every day, and about 222 million women have an unmet need for family planning, so multipurpose prevention methods have huge potential to improve global health. But no matter how effective they are, inconvenient and ill-suited methods will fail to have a significant impact.
Building on the success of the CAPRISA Tenofovir gel trial, which showed reduced risk of HIV and herpes (HSV) infections in women who used the vaginal microbicide gel, USAID is funding several technologies, including gels, vaginal rings, and a one-size-fits-most diaphragm, that will prevent pregnancy in addition to HIV and other STIs. These new technologies will begin to meet people’s more diverse needs than male and female condoms alone can do.
For example, the SILCS diaphragm is a reusable barrier contraceptive that can also deliver microbicide gel. This diaphragm is more attractive and easier to use than its predecessors and does not need to be fitted by a provider. The diaphragm is controlled by the woman, discreet, and free of hormones and the associated side effects. The woman places it before sex and removes it afterwards.
USAID is also funding the development of long-acting vaginal rings to prevent pregnancy, HIV, and some other STIs. Once a woman inserts a vaginal ring, it can offer protection for several weeks or potentially months. It is also controlled by the woman and discreet.
Think about what kinds of methods would be useful and most appropriate in your country. What are the top priorities: preventing pregnancy, HIV, or other STIs? Which STIs have the greatest public health impact? Would women and couples prefer a method delivered through injection, pill, IUD, vaginal ring, diaphragm, implant, or another means? Would women and couples prefer a method that is used at the point of sex, once a day, or once for an extended period? These questions will guide future research and significantly affect the uptake of new methods.