GCM speaks with outgoing Director, Lori Heise

Interview by Deborah Baron

You’ve been a women’s rights advocate long before working in HIV. What was the “aha” moment that got you focused on the need for female-initiated HIV prevention methods?

It was 1991, and I was working on domestic violence issues as they related to international health questions. I was just entering the HIV field, and looking at the role that violence played at compromising women’s ability to protect themselves from HIV. At the time, people believed that male condoms were the answer to the AIDS epidemic.

I was doing a workshop at a USAID conference on the implications of women’s economic and physical vulnerability on HIV prevention. Most of the conference focused on addressing the challenges of supply chain and getting enough condoms in Africa. There was no space for dialog on the broader issues, and they even slotted my workshop during the open bar reception. I didn’t think anyone would come. Instead, the room was packed with peer educators and others working on the frontline. It was the only space where women could discuss issues that reflected their reality on the ground.

One Ugandan peer educator articulated these women’s needs so eloquently. She stated simply, “that by asking women to use condoms, you are giving women the choice between not having children and not being exposed to HIV—which was really NO choice at all.”

I told her and the other women in the room that I would find out on their behalf what other HIV prevention options are possible. That was the moment I said to myself, “AHA---maybe we need a new tool to help women protect themselves.”

What are your top few moments in GCM history?

GCM’s greatest moments arise from our ability to anticipate and shape the field by talking about issues early and bringing them to the forefront. Then eight months later, people are talking about an issue and soon we have changed the field. For example, GCM has really grappled with issues around ethics of clinical trials and standards of care for trial participants. We pushed the envelope on community involvement. GCM was one of the first groups to make an evidence-based case around the potential public health benefit of partially effective products. We were able to show that a modestly effective product used consistently could be more effective than a highly efficacious product that is NOT used consistently.

Another big moment was when GCM got its first major grant for $1 million USD from the Ford Foundation in 2002. Up until then, we had been piecing together funding from individual donors. This grant was a huge organizational step for us, and allowed us to hire more staff and expand our programs.

Lastly, I’m really proud of the work we did to get all lubricant manufacturers in the United States to remove nonoxynal-9 (N-9) from sexual lubricants. It was probably the advocacy campaign that had the single greatest public health impact almost immediately.

As the microbicides field has evolved and matured over the past 15 years, what old challenges still remain? What new challenges are emerging?

One old challenge is the disconnect between the people doing cutting edge science and the reality of women’s lives. There are still too many assumptions about what women will and will not do, products they will and won’t use, and beliefs that women won’t use gels in certain societies, such as in places that practice dry sex. Evidence shows us otherwise, but we still need to do more to bridge science and the realities on the ground.

The new challenges emerging are around managing the special challenges of ARV-based products. If the most efficacious products require people to know their HIV status, that is going to present enormous challenges around scaling-up access to counselling and testing.

What are you planning to do next?

I’m planning to take time to finish my PhD in Epidemiology at the London School of Topical Medicine and Hygiene. 

Additionally, I want to concentrate with greater depth and focus on some of the research ethics issues that I first worked on at GCM. I’m particularly interested in developing a new framework related to inform and guide research related to public health and HIV prevention.

Historically, research ethics is grounded in medicine and therapeutic drugs for sick people. I want to scope out a middle area that addresses prevention research for healthy people.

What excites you about GCM’s incoming Director, Yasmin Halima?

Historically, the field has been quite small, with the same 10-20 people having conversations for the past decade. The notion of having new eyes and adding a new voice to the conversation is very exciting. Yasmin will add a fresh outlook to the field, bringing with her lots of lateral experience around PrEP and AIDS treatment.

I’m excited that we have a non-American at the helm of GCM. She’ll offer new ways to approach the work and the particular challenges of the field.

Our next issue will feature an interview with Yasmin Halima, GCM’s incoming Director!

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Research Update

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Materials Update