Paula Donovan Answers Infrequently Asked Questions: For Women, Is It Guilty Until Proven Innocent?
By Paula Donovan
FHI announced Monday that it had discontinued a clinical trial designed to determine whether women at high risk of contracting HIV could be protected against infection by taking the antiretroviral drug Truvada. Interim findings showed that the once-a-day pill hadn’t worked. Nearly 2000 women were enrolled in the study between 2009 and mid-February of this year, and divided at random (and without participants’ knowledge of their assignments) into one group that would receive Truvada and another that would take a placebo. An independent data monitoring committee found that 56 participants had become infected with HIV — an exactly equal number in each group. The study was halted, given the strong indications that, unexpectedly and for reasons not yet known, daily Truvada will not prove effective at preventing HIV in women.
Clearly, the findings are terrible news; hopes were high, especially given good results from an earlier trial that tested the same drug’s effectiveness in preventing HIV infections among men who have sex with men.
Equally clear was the bias against women boldly displayed by media outlets worldwide that reported today’s news — and indeed, by the authors of a statement released to the press by FHI, which led the study. No one yet knows why the trial failed, but that absence of scientific evidence didn’t deter any of the journalists, nor FHI, from casting doubt on the women who took part by focusing first and foremost on the possibility that they messed up. Each first clarified what is true — that no evidence has yet revealed the reasons for the study’s failure — and then proceeded to theorize. And with shocking consistency, in every single case (though no scientist has reason yet to lean toward one theory over another), the very first possible cause that FHI and then reporter after reporter listed was the likelihood that the women had done something wrong. No news article among the dozen I read gave any other untested theory top billing: every account of the study’s heartbreaking findings made women Suspect Number One.
“There are four possible explanations for the failure of the study…” reported the Washington Post. “One is that the women weren’t taking the medicines as instructed, despite assertions they were.”
Of course, scientifically, that’s illogical; since no cause for the failure of the study has been identified or excluded, we’re left with an infinite number of possible explanations.
“Why did the drug do well with men but not women?” asked an editorial in the San Francisco Chronicle. “Did the women take the drug faithfully as required?”
The Associated Press (which may well have misquoted the doctor who ran the previous study among men who have sex with men — a doctor who will therefore remain unnamed here), artfully positioned quotation marks around phrases to end up with this comment about the current study: “it’s difficult to understand why they did not see protection” but blood samples may tell more about whether it’s related to how faithfully women took the pills, said Dr….
That’s right — blood samples that have not yet been examined. Innocent until proven “faithless.”
TIME Magazine wove these bits together to craft a “quote,” making it appear that Dr. Anthony Fauci, the Director of the US National Institute of Allergy and Infectious Diseases, naturally suspects that all sex workers lie. After noting that he had declared that it’s still too early to draw any conclusions about the study in women, TIME went on to say (erroneously) that the “trial focused on commercial sex workers, who are at increased risk of acquiring HIV, and, says Fauci, may not be reporting their adherence to the drug regimen accurately.” (Later in the piece, the reporter attributes a more Fauci-like opinion to Fauci — that is, the suggestion that further study is needed; that we may find that there are differences we don’t yet know about, which can cause Truvada to react in men and women differently; that it could be that documentation of adherence to the medication was a missing component in the trial involving women. If, as one suspects, those last comments reflect a more accurate account of what Dr. Fauci said, he was one of the rare experts who fairly assumed that if a lack of adherence were to be found among thousands of female participants in a study, that would point to a shortcoming in the study, not in women. The International Partnership on Microbicides — perhaps not coincidentally, led by a female scientist who is both respectful toward and deeply grateful to women who volunteer for HIV trials — released the only statement AIDS-Free World could find that avoided speculation unworthy of science, and still managed to convey the details of the disappointing news as clearly as anyone else had — all without a hint of blame.
TIME, on the other hand, after going on to “report” that pregnancies that occurred during the trial among participants on birth control might suggest “discrepancy between the reported and actual use of the anti-HIV drugs,” added (as if there were one dark-horse contender among much stronger possibilities): “Aside from reporting issues, there could also be a biological explanation of why the protective effect found among gay men was not seen in women.”
Aside from reporting issues? The jury of journalists, unencumbered by evidence, appears to have beaten scientists to a verdict. Their judgment has a familiar ring to it, one we’ve heard repeatedly throughout the 30-year history of the AIDS pandemic: if women end up infected with HIV, assume it’s their own fault.