In October 2014, I had the opportunity to participate in the HIVR4P Conference (the first international conference dedicated to biomedical HIV prevention research). I found myself gravitating to the sessions on PrEP for women, and Multi-Purpose Prevention Technologies (or MPTs), led by enthusiastic researchers and women's health advocates. Female-initiated MPTs would allow women, in one or more combinations, to:
- Avoid infection from HIV;
- Prevent and possibly treat other STIs; and/or
- Avoid unwanted or unintended pregnancy
- Sure, the oral contraceptive pill had an enormous impact on (some) women's equality starting in the 1960s. But it also set responsibility for contraception squarely on the shoulders of women. As the women's health movement has documented, the so-called side effects from birth control pills include blood clots, depression, nausea, fatigue, migraines, and lack of sex drive. One reason that there's no male birth control pill is that these side effects were seen as unacceptable for men (but tolerable for women). MPTs could also further entrench women's responsibility for sexual health, rather than promoting a shared responsibility. In other words, MPTs provide another way to make sex consequence-free for men.
- Some critical voices say that MPTs play into the medical establishment's control over women's bodies. All of the viable MPTs will be at least somewhat invasive, could have side effects, and require administration and monitoring by a physician. A history of unethical treatment by governments, health systems, and researchers has left a legacy of profound mistrust of any health innovations being offered to Black communities. Colonization has left the same legacy of distrust and alienation from the medical establishment, government and research institutions amongst Canada's Aboriginal peoples.
- Whether a woman is able to use any prevention product is a complex balance of whether she perceives herself to be at risk, understands how a product works, how she anticipates her partner will react, and how much control she actually has over her sexuality and fertility. Thus, use of NPTs, while technically under a woman's control, may not be possible in the face of limited decision-making power.
- Women around the world sometimes need to hide their sexual and reproductive health strategies from their male partners. Women around the world secretly use contraceptives, and are also looking for ways to take control of preventing HIV when they cannot trust their male partners to take the initiative. However, in some cases, women could face adverse consequences from their male partners if discovered, as the products might be seen as an affront to men's power and the traditional gender norms. And if women do disclose their desire to use an MPT, the discussions will be no different than condom use in raising doubts about fidelity and trust.
- MPTs would be part of a prevention spectrum, not "a magic bullet"
- We avoid portraying women as victims
- We know that technological tools cannot replace women's empowerment
- We recognize that user-initiated prevention doesn't necessarily imply covert prevention
- We include discussion of the female condom as an important HIV-prevention option and support increased access to and use of female condoms
- We recognize the need for complementary, but different, organizing strategies in different parts of the world.
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