By Bridgette Picou, LVN, ACLPN
There are always fascinating things to learn – and areas of improvement to identify – at the world's premier HIV research meeting. The 31st Conference on Retroviruses and Opportunistic Infections (CROI 2024) took place in March 2024 as a hybrid conference in Denver, Colorado, and online. Members of The Well Project's team were on hand, in person and virtually, to document findings and other happenings at this unique gathering.
Every now and then there is a session at a conference that really grabs me – either as a result of the information being given, the speaker and their mannerisms, or a combination of both. This year it was a plenary presentation by Nelly Mugo, MBChB, MMed, MPH, a senior principal clinical research scientist at the Kenya Medical Research Institute in Nairobi and an associate research professor in the Department of Global Health at the University of Washington. Mugo is a renowned reproductive health specialist known for conducting impactful research rooted in strong values. Her presentation, titled "Shall We Reach Human Papillomavirus Elimination in the Face of Inequity?" was informative, down to earth, and lovely to listen to.
Human papillomavirus (HPV) is by far the leading cause of cervical cancer in women. Strains 16 and 18 are the main culprits, but for context, there are about 150 total strains and about 40 affect the genital area. HPV is also treatable with low-cost interventions, and can be prevented with a highly effective vaccine series. While the recommendation is for two injections, Mugo pointed to scientific evidence supporting that even one injection can reduce incidence of HPV in girls and young women. Given the tools available, HPV could conceivably be eliminated, sparing millions of lives lost to cancer-related mortality. But the challenge, Mugo stresses, is implementation.
As Mugo illuminates, cervical cancer is a disease marked by inequity. The numbers are stark and disturbing: More than 90 percent of women who die from cervical cancer live in low- and middle-income countries (LMICs). Only one in 10 girls around the world are vaccinated against HPV. The talk served to make clear not only the effects of HPV on women, but also how the intersections of inequity, misogyny, and apathy contribute to healthcare systems' failures to serve women. I was also thrilled to hear Mugo speak to the crucial link between community and science, and the ways community engagement helps drive innovation. An article written by Mugo for The Telegraph in the UK that mirrors her talk somewhat (though it was published several months before CROI) is available here.
A quote I loved from her, which highlights the disparity between innovation and implementation of science, used the example of long-acting injectable cabotegravir for PrEP (CAB-LA): "CAB-LA still has a skewed access by high-income and low-income countries. My concern is these disparities will reach a time when we stop looking for interventions when it is only those from low-income [countries] who carry the burden of disease." In other words, if the implementation needs of high-income countries are sufficiently met while LMICs still struggle to access existing interventions, will pharmaceutical companies or others be motivated to come up with new ones that serve the world's most high-need populations? Her quote is referencing the fact that long-acting injectable PrEP has been proven effective, but limitations in its availability to LMICs mean that efficacy has little meaning there.
LMICs do not have the same access as do we here in the US, for example. However, medications may be frustrating to acquire in the US because of limitations and hoops to jump through with insurance or the healthcare setting. The reality is that many communities face barriers to access even here, in the richest nation in the world.
More from The Well Project on the 31st Conference on Retroviruses and Opportunistic Infections (CROI 2024)
- Understanding Breast Milk Through an HIV Lens: A Recap from CROI 2024 by Olivia G. Ford
- Unpacking the Latest in HIV Research and Community Engagement: An Overview from CROI 2024 by Bridgette Picou, LVN, ACLPN
- Key Community Takeaways From CROI 2024 (HIV.gov)
