Part of a Movement
to Change the World
It's a Long Road...
Correspondence from IRMA advocates
by way of India
M2008 memories and the path forward
M2008 memories and the path forward
by Nesha Z. Haniff
via Durban, South Africa
May 19, 2008
Where everyone knows its name
The conference was overwhelming - so many people all over the world gathered to discuss and inform each other about microbicides. I say to myself - so many people are here and so few people even heard about microbicides. When I speak about it in Jamaica and to my students in the U.S . who are in Women’s Studies or in the School of Public Health, no one has heard of microbicides, so to be in a place where everyone knows about it and debates it made me feel less lonely and part of a movement to change the world.
I was in India again after 25 years ,when I was there as a very young woman. Even though I didn’t get a chance to do very much, I could feel the difference in the Delhi-then and the Delhi-now. I felt that it was a place on the move, on the cusp, a city modern with a culture so
powerful that if it won’t rule the world, it is certainly at the moment profoundly influencing it. Everyone to me looked beautiful, even the poorest person was wrapped in color, I was constantly assaulted by the many beautiful sounds and sights. I was so appreciative to be in India and to drink it in. The questions around adherence
The conference itself was a classroom and I loved particularly the D track sessions (on advocacy and community engagement.) These were people on the front lines of the epidemic and their insights and experiences were instructive and demonstrated the disconnect between the science protocols and ethics and the practitioners on the ground. I remember a great debate about adherence and the use of incentives. How do you encourage participants to adhere with token rewards instead of solid monetary incentives? The crux of this question is still troubling and at the center of the current debate around the trial of giving monetary rewards to people who do not become infected. For me this question must be resolved. How can scientists who are the greatest beneficiaries of trials and interventions, whether they succeed or fail, ask the poorest people to participate for the greater benefit of their societies while the scientists reap immediate benefits, publications, grants, travel, promotions? This was not the exact debate but it was a very lively discussion about the problems of practitioners achieving adherence to study protocols with incentives that are not enough to sustain adherence.
I was especially informed by the pre-meeting that covered the new research on rectal microbicides and learned a great deal from those sessions. The work being done at the University of Pittsburgh and UCLA is impressive and innovative, although I would like to see more women participating in anal intercourse studies since this population is also at risk but notat this stage as present in scientific research. We cannot assume that the anal intercourse event is the same for men and women even if the physicality appears the same, and even this physicality must be challenged.
Old school ≠ irrelevance
The sessions on gender and new technologies were disturbing for all the papers reiterated the severe disadvantages that women face in the epidemic. The male paradigm of science and how it affects women’s health was highlighted in Catherine Hankins presentation in one of the opening symposiums. I thought that the re-examination of the diaphragm as a choice for women was important in advocating for already available technologies. The redesign of the diaphragm and the female condoms are necessary and immediate priorities. This “old school” technology is not irrelevant.
I was struck by the priority given to the scientific presentations as opposed to the praxis and cultural presentations. The venues were better, the presenters were on stage, the rooms were larger. I think to some extent it represented the schism in current microbicide work - the disjunction between privileging scientific studies over behavioral cultural studies. Unless the social sciences are more incorporated in microbicide studies then the problems of adherence will continue and social scientists will continue to feel marginalized over the big important science.
The emergence of ARVs
Perhaps the most interesting thing I got from the conference was the emerging viability of ARVs as a method of HIV prevention . The implications of this research meant that now HIV positive people can become involved in the development of this new method since drug resistance becomes pivotal, and that the complexities and difficulties of the vagina in developing a vaginal microbicide can be circumvented. This still leaves us with a paucity of studies on the vagina and again reveals the sexist nature of the current state of science and women in 2008.
I appreciate the support of IRMA in attending this conference and becoming one of the first John Shaw scholarship recipients. I was honored to be selected. Last week I gave an open lecture at the University of Zululand on new prevention technologies and gender. It was very well received. It has occurred to me that perhaps now the word is no longer "microbicides" but "new technologies." Somehow I think this is a tacit acceptance that the microbicides struggle is a long haul and that new technologies simply mean now a reworking of old technologies and the hope that ARVs will come to the rescue.
It is indeed a long road and I when it gets lonely I remember India and that we are part of a movement to change the world.
Read other Delhi Dynamo entries.
Check out IRMA's photo set from the M2008 conference here.
Did you attend M2008 and want to add your photos to our growing collection? Send Jim Pickett of IRMA a note with your photos attached and they will be included.
