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In this section you will find information about Gynuity’s work in the following areas:
Perhaps the highest-profile health problem of recent years is AIDS, the deadly syndrome caused by the Human Immunodeficiency Virus (HIV). This disease – until recently fatal for almost 100% of those contracting it – is ravaging large parts of the world, especially sub-Saharan Africa. For both biological and cultural reasons, the disease hits hardest among women and the young: WHO estimates that 30% of the 40 million people living with HIV worldwide are between the ages of 15 and 24, and that, in sub-Saharan Africa, there are 13 women living with HIV for every 10 men.
Given Gynuity’s focus on health technologies, we have chosen to address this major health issue through its relationship with existing and possible drug treatments, as described below.
> Relationship of Hormonal Contraceptive Use to HIV Transmission
For about a decade now there has been speculation that use of hormonal contraception might increase a woman’s susceptibility to HIV. Were this association to be demonstrated, it would have major implications for women’s health: Hormonal contraception is widely used (indeed, in some countries it is the most popular form of contraception) in the sub-Saharan African region, where chances of contracting HIV are already high. Any increase in susceptibility due to hormonal contraceptive use would be bad news for the region’s women. In response to this potential problem, Gynuity convened a meeting of top experts in the field in May 2005 to review existing evidence and come to a consensus on what we know, on what the implications of what we know are for reproductive health and HIV programs, and on priorities for future research. The goal of the meeting was to come to consensus on:
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The current evidence for and against an effect of hormonal contraception (or particular types of hormonal contraception) on the transmission of the HIV virus to and from women and on the progression of disease in women who are already infected. |
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The specific research needed to answer any questions which remain on this topic, as well as strategies to avoid the many methodological pitfalls which beset such research. |
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The implications, in terms of best practices, of the available evidence for professionals involved in the provision of family planning services, particularly in the developing world. |
Findings from a large population-based study of hormonal contraception and HIV were released in early 2007. This study found no increased risk of HIV acquisition among the general population of women using hormonal contraception (either combined oral contraceptives or DMPA). Although there continue to be issues worth exploring regarding this topic (for example, findings from different studies that both commercial sex workers and women who have not been exposed to herpes simplex virus-2 who use hormonal contraceptives are at increased risk), for the moment the evidence is that most women who use hormonal contraception may continue to do so without fear of increased danger from HIV.
| Read about meeting outcomes |
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| Download information on this topic |
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> Woman-controlled HIV Preventatives
Perhaps the most eagerly hoped-for development in HIV prevention is a method whereby a woman could protect herself from HIV acquisition without the cooperation of her partner. At the moment, the only widely available means for sexually-active people to protect themselves from HIV is the correct and consistent use of the male condom. But assuring correct, consistent use of condoms is difficult for any number of cultural and practical reasons – and, in any case, a woman cannot, on her own, choose to use a male condom. She must have the cooperation of her partner – cooperation which, all too often, is not forthcoming.
Gynuity has recently initiated research on a woman-controlled HIV preventative. This work is just at the beginning stages, and it will take time to see both if the method is effective and if it is practicable. We hope that in the long run, however, our work will help lead to a time when HIV is a minor, contained problem rather than the scourge it is today.
HIV has many similarities with, and links to, other sexually transmitted infections (STIs): Not only is it contracted (and prevented) in similar ways, but the presence of other STIs is universally considered to be a major risk factor for the acquisition of HIV. Thus, the work we do on HIV is relevant to, and points in the direction of, work on other STIs. As Gynuity’s work develops in the future, we expect that STIs will become an area of important focus.
> Vaginal and Rectal Carriage of Clostridium Sordellii & Perfringens
Clostridial species, sordellii and perfringens specifically, have emerged recently as serious pathogens among women of reproductive age. Since 2001, these bacteria have claimed the lives of 13 previously healthy women in the United States. While extremely rare, such infections are nonetheless alarming, because they strike healthy women and also, because of their rapid, fatal course, in the absence of traditional signs of infection. The most publicized of the Clostridia cases have followed medical abortions, and as a result, some clinics in the United States have changed their policies for offering the procedure. Available clinical and epidemiological research does not show a specific causal pathway linking use of mifepristone or misoprostol to development of clostridial infection. In general, data on the prevalence and correlates of clostridial colonization are lacking, and information on the etiology and lethality of clostridial pelvic infection are insufficient to guide recommendations for safe and effective treatment or prevention. In order to fill this knowledge gap, in collaboration with the Centers for Disease Control and Prevention, Gynuity has developed a large project to establish the epidemiology and character of vaginal and rectal clostridial colonization among women of reproductive age in the U.S.
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