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HIV Microbicides: Rethinking Research Priorities and Outcomes

The Challenge

Engineering is a field where—despite national and international efforts—women remain underrepresented. While many schemes exist to increase women's participation, few have considered how research foci, funding decisions, and project objectives impact women and men's proportional participation in research.

Method: Rethinking Research Priorities and Outcomes

This case study analyzes how a shift in research priorities in a particular mechanical engineering lab led to increased numbers of women working in the lab. Women were drawn to applied physicist Andrew Szeri's lab when research came to focus on the fluid mechanics of gels to deliver female-controlled HIV microbicides. Increasing women's participation in engineering may require reconceptualizing research to include methods of sex and gender analysis in creative and forward-looking ways.

Gendered Innovations:

    1. The proportion of women in one mechanical engineering lab was significantly increased when research priorities were changed to focus on projects with direct potential to improve human health. At the same time, this change in priorities expanded research in the field of fluid mechanics.

    2. Woman-controlled HIV protection is being developed in order to assist women in cultures where they may have less power to say "no" to sex or cannot rely on their partners to use condoms. This new technology represents an innovation that could help prevent the spread of HIV.

    3. Understanding how sexual practices differ across cultures is further refining developments in HIV prevention. These developments could further help sub-Saharan women and also men who have sex with men.

Go to Full Case Study
The Challenge
Gendered Innovation 1: Increasing Women’s Participation in Engineering by Changing Research Priorities
Method: Rethinking Research Priorities and Outcomes
Analyzing Academic Disciplines
Gendered Innovation 2: Woman-Controlled HIV Prevention
Method: Formulating Research Questions
Gendered Innovation 3: Analyzing Factors Intersecting with Gender to Improve Microbicides
Method: Analyzing Factors Intersecting with Sex and Gender
Conclusions
Next Steps
 

The Challenge

Over the last several decades, the European Union and U.S. have invested in increasing the number of women scientists and engineers (Marchetti et al., 2010; Rosser, 2008). Nonetheless, women's participation remains low in science, technology, engineering, and mathematics (STEM) fields. This suggests that increasing the number of women requires more than programs focused on removing subtle gender bias from hiring and promotion practices, stopping tenure clocks, leadership training, and the like; such interventions are necessary but not sufficient. Increasing the numbers of women may also require "changing the knowledge" or reconceptualizing research to include methods of sex and gender analysis in creative and forward-looking ways.

Gendered Innovation 1: Increasing Women's Participation in Engineering by Changing Research Priorities

Andrew Szeri, Professor of Mechanical Engineering and Dean of the Graduate Division at the University of California, Berkeley, increased the number of women in his mechanical engineering lab by shifting the research focus of his lab. Over the past decade, he switched his research topics from those focusing on applied physics to biomedical engineering and, in the process, his lab changed from a majority of men to a majority of women (see Method). As Szeri explains, "the mathematical methods (on which I rely heavily) haven't changed much at all. It is, rather, the goals of the projects which have. The goals of the research changed from understanding the physics of a problem to developing models that could be used to evaluate devices or treatments for medical conditions" (Szeri, 2009).

Method: Rethinking Research Priorities and Outcomes

In making choices about research priorities given limited resources, scientists and engineers will analyze who benefits from a particular project in terms of wealth and well-being, and who does not. What are the differential effects of this work on women and men of different social and cultural backgrounds?

The social origins and consequences of a particular research project may be one factor determining scientists' and engineers' interest in that project.

In changing the research focus of his lab, Szeri saw an unintended consequence: The proportion of women working in his lab increased. More research is needed on cases where changing research directions strongly influences who chooses to participate in that research.

 

Analyzing Academic Disciplines

Science and engineering disciplines were established at a time when universities excluded women and the values ascribed to women (Schiebinger, 1989). Difference feminism holds that women are inherently more caring than men, and that "feminine" values may drive progressive change in science and engineering. Empirical evidence shows, however, that genders are multiple and fluid and cautions against essentializing gender in this way: Femininities and masculinities vary with time and place. Stereotyping women and men contributes to bias, even if the stereotypes are ostensibly positive ("women are nurturing", etc.). Accordingly, we should not expect a simplistic relationship between the participation of women in science and type of research pursued. The increased participation of women in science and engineering since the 1970s has been accompanied by changes in research priorities and disciplinary organization. More research is needed to understand the relevant interactions, but the following patterns have been observed:

    • The representation of women and men engineers differs by subfield. Biomedical, environmental, and agricultural engineering fields have the greatest proportions of women, while mechanical and electrical engineering have the greatest proportions of men—see charts for the EU and U.S. (NSF, 2011; EU-EGGE, 2009; Gibbons, 2009; PROMETEA, 2006). For the representation of women and men in science subfields and medical specialties, see disparities.

                  
     

    • In recent years, universities have become increasingly interdisciplinary. Women appear to be in the forefront of this development in so much as women hold appointments across traditional departments and fields more often than men. For example, among STEM faculty at the University of California, Berkeley, 26% of women professors hold joint appointments (or appointments in two separate departments or institutes) in comparison to 15% of men professors (National Academies, 2006). Available evidence shows that this pattern holds across the U.S. and Europe (Castaño et al., 2010; Rhoten et al., 2007; Beraud, 2003). We cannot know whether the influx of women into interdisciplinary fields is due to career choices or limited options in "traditional" fields.

    • Studies show that many girls and young women are dissuaded from pursuing engineering careers because both the image of engineers and the traditional offering of engineering education focus narrowly on mathematics and science—especially in cultures that heavily mark the technical as "masculine" and the social as "feminine" (Faulkner, 2000). This is at odds with the actual practice of engineering work, which demands social skills, such as teamwork and communication, as well as technical ones. There is a strong argument that more women (and arguably other men) would be attracted to engineering if engineering images and education foregrounded the social aspects of engineering alongside the technical (National Academy of Engineering, 2008; Sagebiel et al., 2008; Faulkner, 2007).

Gendered Innovation 2: Woman-Controlled HIV Prevention

Although the fluid mechanics research conducted in Szeri's lab has many applications, Szeri was particularly interested in contributing to the development of woman-controlled HIV microbicides.

About 33 million people are infected with HIV worldwide; some 68% of HIV infections and 72% of HIV-related deaths occur in sub-Saharan Africa, where the prevalence of HIV infection is about 6 times higher than the world average. Young women aged 15-24 in sub-Saharan Africa have particularly high HIV prevalence—about 8 times higher than age-matched men. HIV flourishes in regions where women's subordinate status makes it difficult to negotiate safe sex (Gilbert et al., 2010; Murray, 2008; UNAIDS, 2010). Currently, female condoms are the only woman-controlled HIV prevention option, but they are detectable and consequently require partner consent. They are also less available and more expensive than male condoms (Mack et al., 2010)—see Method.

Method: Formulating Research Questions

The greatest potential for creative innovation lies in asking new questions. Taking sex and gender into account, or examining assumptions about sex and gender, can prompt researchers to "see" new problems that open new questions. In turn, this can serve to bring to the fore areas of research that have been neglected and to open up new opportunities for development (Nieuwenhoven et al., 2010). In this case, an understanding of the reasons behind the high HIV incidence in some women led Szeri and his team to formulate research questions geared toward developing a woman-specific technology—a vaginal gel designed to deliver an HIV microbicide.

 

Szeri and his co-workers were interested in developing woman-controlled HIV microbicides in the hope of assisting women, especially in cultures where they cannot say "no" to sex or cannot rely on their partners to use condoms (Szeri, 2009). A large number of microbicides are under development; many are designed to prevent transmission of other infections in addition to HIV, and some are also intended to function as contraceptives (Harrison, 2003).

Szeri's lab is studying the transluminal flow of gels where the effectiveness of the microbicide depends on the completeness and durability of the vaginal coating. These properties depend on the physical characteristics (such as viscosity) of the gel carrying the microbicide (Szeri et al., 2008). Szeri's group seeks to create gels with desirable physical properties.

Currently, no HIV microbicides are commercially available. Clinical trials of several microbicide formulations have shown limited efficacy and, in some cases, raised safety concerns (McCormack et al., 2010; McCoy et al., 2010).

Gendered Innovation 3: Analyzing Factors Intersecting with Gender to Improve Microbicides

While the potential benefits of woman-controlled methods of HIV prevention are clear, it does not follow that this technology will be appropriate for all women or inappropriate for all men. The diverse nature of gender suggests otherwise. In particular, addressing the diversity of sexual practices and HIV epidemiology is opening up new questions and new avenues for development (see Method).

Method: Analyzing Factors Intersecting with Sex and Gender

Engineers can improve products by systematically analyzing other social factors, such as geographic locations, socioeconomic status, sexual orientation, etc., that intersect with biological sex and socio-cultural gender relations. Most engineering work related to HIV microbicides takes place in developed countries, but the possible future users of such products are largely in developing countries (Ramjee et al., 2000).

 

Analyzing social factors that intersex with gender has revealed the following:

    1. Sexual Practices Differ Cross-Culturally. Studies are needed to investigate the acceptability of microbicidal gels in different cultural contexts (Moon et al., 2002). Gels can deliver microbicides and contraceptives, but also act as lubricants. In some areas of sub-Saharan Africa, dry sex practices—in which the vagina is dried through the use of herbs and traditional medicines—are prevalent. For example, a study of 812 women living in the Zambian capital city Lusaka showed that about 65% of women had used dry sex traditional medicines in their lifetimes, with about 50% reporting current use (Mbikusita-Lewanika et al., 2010). These practices correlate with low socioeconomic status and low education, and are most common among women whose partners prefer dry sex (Reddy et al., 2009). These drying practices can augment the risk of HIV transmission because of increased risk of tearing during sex (Feinstein et al., 2001; Gilbert et al., 2010). Interdisciplinary collaborations are needed to explore the intersection of cultural practices and biophysical functions for HIV prevention.

    2. HIV Epidemiology Differs Internationally.

    HIV infection rates vary internationally. A recent Center for Disease Control report on HIV incidence in the U.S., for example, shows that the rate of new infections for Black women is 14.7 times that for white women; Black men are also disproportionately affected.

    Moreover, in the U.S., about 57% of HIV infections result from sex between men, even though men who have sex with men (MSM) constitute only about 2% of the U.S. population (CDC, 2009a). HIV microbicides are also being tested in the rectum, which would create a barrier method for MSM—one that does not require partner consent or knowledge (Harrison et al., 2003).

Conclusions

Research priorities determine more than what will be studied and what products will be designed—they have a profound effect on who will perform research. In the case of HIV microbicides, research priorities related to improving women's and men's health increased the representation of women in Szeri's lab. These women had already chosen engineering careers, but it is possible that changing research priorities in engineering as a whole could increase the representation of women in the field overall.

Next Steps

Future research might investigate how shifts in research priorities relate to workforce participation, and vice versa.

    1. What data are available to answer such questions?

    2. What implications might this line of enquiry hold for future research funding?



Works Cited

Beraud, A. (2003). A European Research Study on Women and Engineering Education (2001-2002): Potentials of Interdisciplinary Courses in Engineering, Information Technology, Natural, and Socio-Economic Sciences in a Changing Society. European Journal of Engineering Education, 28 (4), 435-451.

Castaño, C., Müller, J., Gonzalez, A., & Palmen, R. (2010). Topic Report on Policy towards Gender Equity in Science and Research. Luxembourg: Publications Office of the European Union.

Centers for Disease Control (CDC). (2009a). Diagnoses of HIV Infection and AIDS in the United States and Dependant Areas, 2009. Washington, D.C.: Government Publishing Office (GPO).

European Commission Expert Group on Gender and Employment (EU-EGGE). (2009). Gender Segregation in the Labour Market: Root Causes, Implications, and Policy Responses in the European Union. Luxembourg: Publications Office of the European Union.

Faulkner, W. (2007). Nuts and Bolts and People: Gender-Troubled Engineering Identities. Social Studies of Science, 37 (3), 331-356.

Faulkner, W. (2000). The Power and the Pleasure? A Research Agenda for Making Gender Stick to Engineers. Science, Technology, and Human Values, 25 (1), 87-119

Feinstein, N., & Prentice, B. (2001). Gender and AIDS Almanac. Geneva: Joint United Nations Programme on HIV and AIDS (UNAIDS).

Gibbons, M. (2009). Engineering by the Numbers. In American Society for Engineering Education (ASEE) (Ed.), Profiles of Engineering and Engineering Technology Colleges, 2008, pp. 11-46. Washington, D.C.: ASEE.

Gilbert, L., & Selikow, A. (2010). HIV/AIDS and Gender. In Kuhlmann, E. & Annandale, E. (Eds.), The Palgrave Handbook of Gender and Healthcare., pp. 189-204. Basingstoke: Palgrave.

Harrison, P., Rosenberg, Z., & Bowcut, J. (2003). Topical Microbicides for Disease Prevention: Status and Challenges. Clinical Infectious Diseases, 36 (10), 1290-1294.

Joint United Nations Programme on HIV and AIDS (UNAIDS). (2008). Report on the Global AIDS Epidemic. Geneva: United Nations Publications.

Mack, N., Grey, T., Amsterdam, A., Williamson, N., & Matta, C. (2010). Introducing Female Condoms to Female Sex Workers in Central America. International Perspectives on Sexual and Reproductive Health, 36 (3), 149-156.

Marchetti, M. & Raudma, T. (Eds). (2010). Stocktaking: 10 Years of “Women in Science” Policy by the European Commission, 1999-2009. Luxembourg: Publications Office of the European Union.

Mbikusita-Lewanika, M., Stephen, H., & Thomas, J. (2009). The Prevalence of the Use of ‘Dry Sex’ Traditional Medicines among Zambian Women and the Profiles of the Users. Psychology, Health, and Medicine, 14 (2), 227-238.

McCormack, S., Ramjee, G., Kamali, A., Rees, H., Crook, A., Gafos, M., Jentsch, U., Pool, R., Chisembele, M., Kapiga, S., Mutemwa, R., Vallely, A., Palanee, T., Sookrajh, Y., Lacey, C., Darbyshire, J., Grosskurth, H., Profy, A., Nunn, A., Hayes, R., & Weber, J. (2010). PRO2000 Vaginal Gel for Prevention of HIV-1 Infection (Microbicides Development Programme 301): A Phase III, Randomised, Double-Blind, Parallel-Group Trial. The Lancet, 376 (9749), 1329-1337.

McCoy, S., Watts, C., & Padian, N. (2010). Preventing HIV Infection: Turning the Tide for Young Women. The Lancet, 376 (9749), 1281-1282.

Moon, M., Khumalo-Sakutukwa, G., Heiman, J., Mbizvo, M., & Padian, N. (2002). Vaginal Microbicides for HIV/STI Prevention in Zimbabwe: What Key Informants Say. Journal of Transcultural Nursing, 1 (13), 19-23.

Murray, A. (2008). From Outrage to Courage: Women Taking Action for Health and Justice. Monroe: Common Courage Press.

National Academies. (2006). Beyond Bias and Barriers: Fulfilling the Potential of Women in Academic Science and Engineering. Washington, D.C.: National Academics Press.

National Academy of Engineering. (2008). Changing the Conversation: Messages for Improving Public Understanding of Engineering. Washington, D. C.: National Academies Press.

National Science Foundation (NSF). (2011). Earned Science and Engineering (S&E) Doctoral Degrees in Selected Regions and Locations, by Sex and Field: 1999 or Most Recent Year. Washington, D.C.: Government Publishing Office (GPO).

Nieuwenhoven, L., & Klinge, I. (2010). Scientific Excellence in Applying Sex- and Gender-Sensitive Methods in Biomedical and Health Research. Journal of Women’s Health, 19 (2), 313-321.

PROMETEA: Empowering Women Engineers in Industrial and Academic Research. (2006). Report on the State of the Art, Existing Quantitative Data, Identification of Gaps, and Methodological Overview. Luxembourg: Publications Office of the European Union.

Ramjee, G., Morar, N., Michela, A., Mukenge-Tshibaka, L., Vuylsteke, B., Ettiegne-Traore, V., Chandeying, V., Karim, S., & Van Damme, L. (2000). Challenges in the Conduct of Vaginal Microbicide Effectiveness Trials in the Developing World. Official Journal of the International AIDS Society, 14 (16), 2553-2557.

Reddy, P., Salerh-Onoya, D., Sifunda, S., Lang, D., Wingood, G., van den Borne, B., & Ruiter, R. (2009). Preference for Dry Sex, Condom Use, and Risk of Sexually-Transmitted Infection (STI) among HIV-Negative Black Women in the Western Cape Province, South Africa. South African Journal of Science, 105, 73-76.

Rhoten, D., & Pirfman, S. (2007). Women in Interdisciplinary Science: Exploring Preferences and Consequences. Research Policy, 36 (1), 56-75.

Rosser, S. (2008) Building Two-Way Streets to Implement Policies that Work for Gender and Science. In Schiebinger, L. (Ed.), Gendered Innovations in Science and Engineering, pp. 182-197. Stanford: Stanford University Press.

Sagebiel, F., Dahmen, J., Davidsson, B., Godfroy-Jenin, A., Rommes, E., Thaler, A., & Urbancikova, N. (2008). Motivations of Young People for Studying Science, Engineering, and Technology (SET): The Gender Perspective. Wuppertal: University of Wuppertal Press.

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Szeri, A., Park, S., Verguet, S., Weiss, A., & Katz, D. (2008). A Model of Transluminal Flow of Anti-HIV Microbicide Vehicle: Combined Elastic Squeezing and Gravitational Sliding. Physics of Fluids, 20 (8), 083101-083111.

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Governments, industries, funding agencies, and researchers themselves set priorities for future research. Research priorities respond to numerous social imperatives and background assumptions, such as intended markets, funding levels, lobbyists, and notions about gender—what men and women want, what they need, how sex functions biologically, how gender functions socially and culturally, and the like.

Gendered Innovations:

Andrew Szeri, Professor of Mechanical Engineering and Dean of the Graduate Division at University of California, Berkeley, shifted research priorities in his lab over the past decade from those focusing on applied physics to biomedical engineering. He does fluid mechanics.

This shift in research priorities led to two gendered innovations: the first has to do with participation, who does science, and the second has to do with outcomes, what science is produced. First, Szeri's change in research focus dramatically increased the number of women in his lab. Engineering is a field where—despite national and international efforts—women remain a minority—about 14% of engineering PhDs in the U.S. Szeri's change in research priorities resulted in about half his lab becoming women. He was delighted—and surprised. He had not shifted his priorities to attract women, but, in fact, he did.

Second, changing research priorities also expanded research in the field of fluid mechanics. Although the fluid mechanics research conducted in Szeri's lab has many applications, Szeri was particularly interested in contributing to woman-controlled HIV microbicides—especially in cultures where women cannot say "no" to sex or cannot rely on their partners to use condoms. Szeri's lab developed a vaginal gel to deliver microbicides. The physics of the problem is complex: the gel needs to coat the vagina completely and not fall out with the pull of gravity. These gels can also deliver birth control, if desired.

Engineers can improve products by also Analyzing Factors Intersecting with Sex and Gender, such as geographic locations, socioeconomic status, sexual orientation, etc. Gels can deliver microbicides and contraceptives, but they also act as lubricants. In some parts of sub-Saharan Africa, dry sex—in which the vagina is dried through the use of herbs and traditional medicines—is practiced. Interdisciplinary collaborations are needed to explore the intersection of cultural practices and biophysical functions for HIV prevention.

 

 

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