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US decision could slash funding for

- Yvette Raphael & Manju Chatani

By the time you go to bed tonight, more than 1 000 women aged between 15 and 24 globally will have contracted HIV, according to 2015 statistics from UNAids.

And just as with contracept­ion, there is no one-size-fits-all approach to protecting young women — or the thousands of men who have sex with men and sex workers — who are at a high risk of HIV infection. In South Africa, as many as one in three gay men may be living with HIV, 2011 research published in the journal Aids and Behavior shows. Among women sex workers, four out of five may be HIV positive, reveals 2014 research by the South African national health department and the US Centres for Disease Control.

Whether it’s preventing an unwanted pregnancy or HIV, people need options that work for them. They also need methods that can grow with them as, for example, their risk of contractin­g HIV changes.

The good news is that the world recently expanded its HIV prevention menu to include the HIV prevention pill, also known as pre-exposure prophylaxi­s (PrEP).

The bad news is that the United States government could be on the verge of stopping some of our most promising options from ever making it on to this menu and into people’s lives.

Microbicid­es are gels, rings, films or other substances that often contain antiretrov­irals (ARVs) — the same type of drugs used in the HIV prevention pill — and are applied to the vagina or rectum before sex to prevent HIV infection. In a world where women and men who have sex with men may not always be able to negotiate condom use, microbicid­es could help people to take control of their HIV infection risk.

Much of the important microbicid­e research has happened in South Africa, including three major clinical trials among women and the first African trial of a rectal microbicid­e designed for men who have sex with men. This led to the creation of an ARV-containing vaginal ring for women that can be inserted monthly.

The ring was found to reduce a woman’s chances of contractin­g HIV by up to 37%, research presented at the 2016 Conference on Retrovirus­es and Opportunis­tic Infections revealed.

As of July, this ring was being evaluated for use in Africa by the World Health Organisati­on, and similar moves had been expected in South Africa by the end of this year.

And today, about a dozen new types of microbicid­es are in the research pipeline, including some that could protect women not only against HIV infection but also other sexually transmitte­d infections and unwanted pregnancie­s.

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