A FRESH Look at HIV Prevention and Women’s Empowerment

Researchers at the Ragon Institute of Massachusetts General Hospital, MIT and Harvard recently published an editorial in Science Immunology detailing their efforts to combine basic science and social good to reduce the high rate of HIV infection in young South African women while simultaneously empowering them. Here is a brief summary.

Despite advances in treatment and the availability of new protective strategies, South Africa remains continues to be one of the hardest-hit regions by the HIV epidemic in the world, with young women being at the greatest risk for infection. For these women in South Africa, the high risk of contracting HIV is compounded by a lack of social and economic opportunities. An innovative new program launched by researchers at Mass General seeks to improve HIV prevention and treatment strategies while also providing a much-needed community support network.

The FRESH (Females Rising through Education, Support and Health) study was started by investigators from the Ragon Institute of Mass General, MIT and Harvard in 2012 at a shopping mall in KwaZulu-Natal, a South African province with one of the highest rates of infection in the world. The mall serves as a neutral location for women in the community, who are reluctant to visit clinics due to the stigma associated with HIV testing and treatment. Women visit the mall twice a week to participate in sessions covering a variety of areas, such as HIV prevention and treatment, self-esteem building, relationships and gender-based violence, and career development.

In addition to the group sessions, each woman undergoes an HIV test each visit, and receives blood and cervical tests every three months. Antiretroviral treatments are provided immediately upon detection of a positive HIV diagnosis. The women are also offered pre-exposure prophylaxis (PrEP) medication that can significantly reduce the risk of HIV infection. PrEP is not currently provided by the South African government.

The high rate of HIV infection among young South African woman has been linked to issues like gender inequality and economic dependence. Results from the FRESH study have shown that 85% of the over 1,000 women who have completed the program have been able to advance their professional careers through job placement, returning to school, or starting their own small business.

While the high rate of new infections continues to remain an issue, researchers have recognized that lasting change will require continuous improvement in career and educational opportunities and a shift in cultural norms.



Since FRESH has allowed for the study of HIV in the earliest stages of infection, researchers have also been able to gain insight on potentially curative therapies, but they do not measure their accomplishments based on the science alone. “We measure the success of this program both by these important scientific insights and by providing participants with a pathway out of poverty,” says Bruce Walker, MD, director of the Ragon Institute.

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