A critical component of a response to AIDS should include female-controlled prevention tools that women would be able to use with or without their partners’ knowledge.

Seth Berkley:  It’s interesting. When we talked about this purely as a prevention strategy issue, there was a lot of discomfort about it. People didn’t want to talk about sex. They didn’t want to talk about drug use. They didn’t want to talk about homosexuality. There were all these different things. One of the things that working on vaccines or other treatments brings to the table is it makes it more scientific. It’s about a science challenge. It’s less judge-matic. We still and should and must deal with those other issues because they are the drivers. I’m not saying we shouldn’t but sometimes politicians who say “My god, I find it uncomfortable to stand up and talk about prostitution, talk about these things,” finds it less uncomfortable to stand up and talk about taking science and technology to create a better tool to try to solve this problem. So in that case, it’s been very useful. An example of this is some of the work we did earlier in India, where at the beginning, it was a very conservative government who really had a hard time dealing with some of these issues but was very pro-science, pro-technology, pro-biotechnology and so the idea of trying to develop these types of tools fit in well with their mission and vision and in a sense, they didn’t have to say these are for this group or that, but it’s for anybody who might be at risk. And that’s an important point because although we talk about risk groups, the truth is, is that in some sense, anybody’s at risk for this disease. They can be at risk from sexuality, from blood transfusions, from using drugs, so there’s a lot of issues and what we need to do is create tools that are useful for everybody, particularly women, and we should come back to that as well.

Topic: The Gender Divide

Seth Berkley:  One of the interesting things is that people say we already have a vaccine; it’s called morality or other things like that. But the interesting thing about that is that it’s one thing to say a male has the option to use a condom or not to use a condom and even that under circumstances may not be the case, but in general, people assume that people might have that choice. If you’re a female and particularly if you’re a married female, you in some societies might not have the option to demand that. So in places -- and Thailand’s one example of this -- where we’ve seen a lot of transmission occur that has been the man goes out and has extra partners comes home, the wife is married and monogamous and has sex with her husband, that puts her at risk for HIV. She can’t negotiate for condom use in that circumstance. She doesn’t have access to testing and so she needs a mechanism that she can use to protect herself. So a microbicide, which is a chemical you can use in the vagina to protect yourself, a vaccine is obviously the ultimate in a sense because nobody has to know that you’ve had that, these types of tools that would be available to women. In an ideal circumstance, of course, you want a situation where the gender dynamics are such that you can always negotiate, you can always talk about there’s not a risk. But until that happens, we really need approaches that are going to be female friendly and we just don’t have any right now.