The world became a better place recently when world leaders adopted the Sustainable Development Goals (SDGs), a milestone United Nations statement that will shape world policy for the next 15 years to reduce poverty and set us on a more equitable and sustainable trajectory. Sewn centrally into this extensive policy fabric is improving the status of women through expanding reproductive health and rights, achievements that clearly impact equity, educational attainment, and the well-being of women and families. Women’s ability to determine the timing and spacing of children and to avoid sexually transmitted infections (STIs), including HIV, is key to ending poverty and fulfilling the range of interlocking SDGs that shape our interconnected futures.
Current sexual and reproductive prevention methods have significantly improved the health and well-being of women and their families, but they are not sufficient. Worldwide, there are 85 million unplanned pregnancies, 21.6 million unsafe abortions, and nearly 300,000 maternal deaths from complications related to pregnancy and birth every year. In addition to the personal costs, unplanned pregnancies impose a formidable economic strain for individuals and governments. In 2010, in the United States alone, the public cost of births, abortions, and miscarriages resulting from unplanned pregnancies nationwide totaled $21.0 billion.
Furthermore, HIV remains the leading cause of death of women of reproductive age worldwide, with the highest burden in Sub-Saharan Africa. And while antiretroviral drugs are effective treatments, half of the women living with HIV in resource-limited settings cannot access them. Women’s HIV prevention technologies remain limited and their use is often outside a woman’s sphere of control.
Enabling women to maintain good reproductive health requires innovative and improved prevention technologies. A revolutionary class of women’s sexual and reproductive health (SRH) prevention products in development may prove to be the linchpin for achieving the SDGs.
New Methods Of Prevention
Multipurpose Prevention Technologies (MPTs) are a new class of product in development that deliver varying method combinations to simultaneously prevent HIV, STIs, and unplanned pregnancies. There are many innovative MPTs in development. Some combine contraception with STI prevention, while others provide women who want to get pregnant with protection from HIV and other STIs. Many do so in discrete forms that do not require partner negotiation. Some are designed to be used just before or at the time of a sexual encounter while others are long-acting products. Without increased investment in MPT research and development, however, these powerful new prevention methods may never reach women’s hands.
The SDGs prioritize regional and international cooperation to expand science, technology, and innovation — a strategy that has been pivotal in the growth of the MPT field. It is the cooperation and collaboration of international stakeholders in research, funding, advocacy, and policy that have enabled the progress of the MPT field as a whole and can perhaps serve as a collaboration model to advance science while respecting intellectual property. This international collaboration, called the Initiative for MPTs (IMPT), was launched in 2009 to bridge the formerly autonomous disciplines of contraception, HIV, and other STI research. The IMPT has grown to include over 120 members in eight countries and is the strategic driver of this new field through the establishment of public-private partnerships, streamlining and shaping research and funding priorities, and spurring innovative technology development.
Prevention Plus Prevention — The Power of MPTs
The goal of the MPT field is to create an array of broad-spectrum prevention methods from which a woman can choose to best suit her circumstances. MPT innovations currently in development include: vaginal rings that release both hormonal contraception and an HIV prevention drug; vaginal films and tablets that prevent HIV and herpes (HSV); rectal suppository MPTs offering HIV and STI prevention for anyone engaging in anal sex; new bio materials that will feel more like skin to make better feeling condoms; and other innovative technologies.
Prevention Is Still The Best Medicine
The intersecting nature of SRH risks is especially apparent in areas of the world where women have the least access to modern contraception and face the highest HIV and STI risks. Reducing non-HIV STIs at the same time as HIV and unplanned pregnancy will save additional lives and reduce health costs. Left untreated, STIs such as HSV, chlamydia, and HPV can result in infertility and cancers. Moreover, HSV and HPV also put women at greater risk of acquiring HIV. And the problem affects high-income settings as well. Annually in the United States, there are nearly 20 million new STI infections resulting in $3 billion spent on direct medical costs.
It is no secret that improving women’s ability to plan and space children improves the economic well-being of families, saves millions of lives, and saves billions of dollars. Reducing the incidence of HIV and STIs also offers clear and well documented benefits to women, families, and economies. Doing it all at the same time will magnify these benefits.
Aligning Our Investments With Our Priorities
Women, providers, and advocates are enthusiastic about MPTs because combining prevention benefits into one product will not only be more efficient, but it will also increase the number of women who are covered by this umbrella of prevention. Early market research shows an overwhelming preference for prevention products that can address multiple SRH risks as compared to single indication products.
Researchers, health care providers, and funders from around the globe, including China, India, Kenya, South Africa, and the United States have forged in-country collaborations to ensure that MPTs will be desirable and accessible to those at greatest unmet need. Additionally, peer-reviewed research indicates that HIV stigma is a barrier that prevents many of the world’s women from seeking HIV prevention and suggests that combining HIV/STI prevention with contraception and delivering it in family planning settings will increase HIV prevention uptake for many women.
As the Guttmacher Institute’s Policy Director Health Boonstra argued in a recent policy report, despite the compelling need and demand for MPTs, their development has been hampered by limited private and public funding.
We have a unique opportunity to improve the status of women and impact a range of the intersecting Sustainable Development Goals by giving women better, more effective tools through which they can plan pregnancies, space children, avoid the dangers of unsafe abortions, protect themselves from HIV and other STIs, stay in school, be healthier, and have healthier children. The social benefits of MPTs are far reaching, from educational attainment, to reducing child mortalities, to improving incomes and reducing inequity, to positive environmental impacts.
MPTs are complicated to develop, but are technically feasible. Since the launching of the MPT field and the IMPT six years ago, the field has evolved from an innovative concept to over 20 MPT products currently in development, and nearly a dozen products in clinical trials.
The next steps require increased funding to support the multidisciplinary collaborations and research and development that will ensure that MPT products are not only safe and effective, but are acceptable and accessible to the women who need them. Funding agencies can begin to integrate MPT development into their HIV and reproductive health prevention priorities and policy. Time and lives will surely be saved if regulators, ministries of health, and other key stakeholders involved with product approval, delivery, and access engage with the IMPT now to pave the way for introduction of these new technologies in advance of their market entry. Leveraging funding and political will from governments and private sector partners can advance the development of MPTs, make important strides towards achieving the SDGs, and improve the lives of women and families around the world.