Targeting women ages 18-29, the pre-conception counseling project is part of a five-year Women’s Interagency HIV Study (WIHS) for which Miller School HIV researchers were awarded a National Institutes of Health grant in 2013. The purpose of the Miami WIHS is to identify and understand the risks and causes associated with acquiring and transmitting HIV among Miami women with HIV infection and at risk for HIV infection — and the broad range of health outcomes associated with the virus.
“The reaction to the WIHS study has been positive. Many women were shocked that anyone cared,” said renowned HIV expert Margaret Fischl, M.D., professor of medicine, Director of the Miami AIDS Clinical Research Unit and Co-Director of the Miami Center for AIDS Research.
Fischl, who heads the WIHS Miami program at UM, said “Family planning is a critical component to providing comprehensive care to women living with HIV.”
Participants are paired with a counselor who informs them of the precautions they need to take to protect their partners from contracting the virus and the special prenatal vitamins and viral suppression medication needed to prevent mother-to-child transmission if they do become pregnant. Most important, counselors stress adherence to their medication.
Study collaborator Deborah Jones Weiss, Ph.D., M.Ed., research professor of psychiatry and behavioral sciences and co-chair of mentoring for the development core at the Center for AIDS Research, said there was a need to reach teenagers and young women who are living with the virus and will likely go on to have children and families.
“While many of the younger HIV-positive women weren’t yet thinking about the prospect of having children, or about their future in general, we found that they also weren’t using protection or birth control during sex, or disclosing their status to their partners,” she said.
Jones, who launched the counseling project in September and hopes to reach even younger teenagers, said the initiative has been a great addition to the broad range of HIV testing and treatment programs that UM provides for the community.
Miami not only has the highest incidence of HIV in the country, it has the most diverse population of people with HIV. Minority women are disproportionately affected and represent the majority of new cases.
Pre-conception counseling has revealed many of the barriers that younger minority women with HIV face.
Poverty and domestic violence are common among women entering the study.
“Many of the women lack the financial means to change their situations and to make healthier life choices,” said Jones, noting that fear of stigma has been an obstacle to some receiving treatment and medication.
Studying diverse aspects of HIV and long-term affects among women is the intended purpose of the national WHIS program, which is celebrating its 20th anniversary. UM joined the project as part of the NIH’s expansion of the study into the southern U.S. region.
Funded with an $8.5 million grant, the Miller School is one of four new WHIS sites in the southern region and was an ideal satellite location given its vast experience, expertise and contributions to HIV and AIDS research.
Overall, 150 HIV-infected women and 40 women at risk for infection will be enrolled in the Miami WHIS. Its broad range of focus areas include epidemiology, social and behavioral issues, substance abuse, long-term impact of HIV medication, prevalence of co-infection with other opportunistic diseases, such as hepatitis B and C, early onset of menopause, vaginal health and other scientific insight.
“We’ve been treating women in the Miami-Dade community for several decades,” said Fischl. “The WHIS project is giving us an all-around better understanding of the long-term impact of HIV, and the needs of women who are infected or at risk for infection.”
In addition to developing pre-conception counseling, another WIHS research component led by an interdisciplinary team of UM HIV experts is researching how the practice of vaginal douching increases the risk for women contracting HIV and transmitting it their partners.
The study’s lead investigator Maria Luisa Alcaide, M.D., associate professor of clinical medicine, explained that douching breaks down the vaginal cell structure and causes bacterial vaginosis. This leaves women more vulnerable to contracting HIV. For HIV-positive women, it causes increased amounts of the virus to form in the vagina, particularly around the cervix, which increases chances for transmitting the virus to their partners.
“Women, regardless of their HIV status, are generally unaware of the harmful effects of douching,” said Alcaide. “One of the study’s goals is to discourage women from douching and warn them of its risks, especially as it pertains to HIV.”
University of Miami