Let's elevate women's leadership in health, a key driver in the triumph over HIVAids

Dr Vincent Muturi-Kioi and Dr Norah Obudho.

In a world where HIV/AIDS continues to cast a long shadow, science has made remarkable strides, offering hope and progress on a global scale. Yet, as we navigate this ongoing battle, one glaring truth stands out: women's leadership is not just crucial; it's the missing piece in our quest to eradicate HIV/AIDS. While scientific breakthroughs have brightened the horizon, the critical role of women in shaping the future of this fight cannot be overstated

The intersectionality of women's roles in health leadership is profound and complex. While women constitute 70 per cent of the healthcare workforce, they are notably underrepresented in its leadership, holding only about 30 per cent of high-level positions. The gap widens further within the upper echelons of global health institutions. This discrepancy is not merely a matter of equity; it substantially hinders the efficacy of global health systems

At IAVI and WomenLift Health, in our quest to advance global health solutions, including in HIV vaccine research, we have seen firsthand the transformative impact of women's contributions. Our collective experience shows that inclusive leadership - incorporating women and their unique perspectives - not only enhances organisational performance but also leads to better health outcomes.

Empowering women's leadership in health transcends the goal of correcting social inequities; it is also fundamental to fostering the ingenuity required for medical advances, like the development of an HIV vaccine.

For more than 25 years, IAVI and its global network of partners have been working to develop a vaccine for the prevention of HIV. This goal remains important today, with current estimates from the Joint United Nations Programme on HIV/AIDS indicating that over 1.3 million people acquired HIV worldwide in 2022. Without additional progress in reducing HIV transmission, the HIV/AIDS epidemic of inequalities will likely worsen as the largest generation of young people in Africa and around the world enters the age at which they are at the highest risk of HIV acquisition.

There are numerous scientific challenges to developing a HIV vaccine. The genetic variability of the virus, its ability to quickly establish a persistent lifelong infection are some of the obstacles researchers face in trying to understand how to induce protective immunity against the virus. Given this complexity, traditional approaches to vaccine development that led to many of the licensed vaccines in use today for the prevention of other diseases are either impractical or have so far failed to result in effective vaccines against HIV. Because of these challenges, IAVI's scientists and their collaborators are pursuing innovative strategies to design vaccine immunogens capable of activating both arms of the adaptive immune response - antibodies and T cells - to induce durable immunity against HIV. These strategies are currently being assessed in several early phase clinical trials, some of which have demonstrated the vaccines' ability to elicit desired immune responses.

Our experience in East Africa reveals that while recent studies have achieved targets for women's participation in vaccine research, significant challenges remain. Social and cultural barriers still significantly influence women's choices to join these studies. To ethically develop and deliver vaccines, we must confront these issues to achieve fair participation.

Historically, women have been underrepresented in clinical trials, which has serious implications. Given that women are biologically more susceptible to HIV infection, it is imperative that research not only includes but emphasizes their participation. This ensures that findings are relevant and beneficial to women, taking into account their unique physiological responses to treatment and prevention methods.

Addressing the vulnerability of women to HIV requires a multifaceted approach that considers social, economic, and legal factors. These considerations are not just academic; they have real-world implications for the recruitment and participation of women in clinical research studies. Researchers must navigate these complexities with sensitivity and care to ensure that no community is left behind.

The indignation that girls and women continue to bear the brunt of the AIDS epidemic is palpable and justified. The stigma and discrimination faced by women living with HIV in various aspects of their lives are unacceptable. It is a stark reminder that our work is not done.

Yet, there is hope. The push to eliminate new HIV infections among children is spearheaded by women. More women are receiving antiretroviral therapy compared to men, with positive ripple effects on families and communities. Educating young women has proven to have a profound impact on health outcomes, and is associated with greater gains in reducing new HIV infections among adolescent girls and young women, fewer unintended pregnancies, and increased participation in the workforce.

In the quest to empower women's leadership in health, creating safe, inclusive workspaces is non-negotiable. Safe spaces encourage the free exchange of ideas, foster innovation, and nurture the confidence of women to lead boldly. Inclusivity means not just the presence of women at the table but the respect and weight given to their voices. It is in these nurturing environments that the groundwork for HIV vaccine research thrives, benefitting from the full spectrum of women's expertise and insight.

Building on resolves from the International Conference on AIDS and Sexually Transmitted Infections (ICASA), in Harare, Zimbabwe, we must commit to supporting the rightful place of women in public health for the manufacturing of HIV/AIDS vaccines. We must advocate for their equal representation in leadership roles and their active participation in clinical research. The path to defeating HIV/AIDS is inseparable from the path toward gender equity. Our progress on one front will propel us forward on the other.

Let's commit to action-to support the educational, economic, and social empowerment of women, to ensure that they lead and inform the research that will one day allow us to eliminate HIV as a global public health threat. This is how we remember. This is how we commit. This is how we will win the fight against HIV/AIDS.

Dr Norah Obudho is the Health Integration & East Africa Director at WomenLift Health and Dr Vincent Muturi-Kioi is a Senior Medical Director at IAVI