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World AIDS Day 2006: Progress on Microbicides

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As we recognize World AIDS Day, we can be encouraged that microbicides are finally receiving the serious attention they deserve as a new tool in the fight against HIV/AIDS.

Current HIV/AIDS prevention efforts that urge people to use condoms, be faithful, or abstain from sexual activity require women to rely on men in order to protect themselves from infection. But microbicides—topical compounds that could be applied vaginally to prevent the transmission of HIV/AIDS and other STDs—would give women a mechanism that they could use themselves.

Women’s rights activists have tried for many years to accelerate the development of microbicides. Yet no major pharmaceutical companies have been interested in pursuing the product despite the desperate need.

The 16th International AIDS Conference in Toronto this August was a turning point in raising public awareness about the urgent need for microbicides and other prevention measures for women. Close to 25,000 health workers, activists, scientists, and government representatives from 132 countries gathered at the conference to address the HIV/AIDS pandemic, and many keynote speakers used the opportunity to describe the promise of microbicides. In the opening session, Bill Gates forcefully argued why microbicides must be a priority:

Abstinence is often not an option for poor women and girls who have no choice but to marry at an early age. Being faithful will not protect a woman whose partner is not faithful. And using condoms is not a decision that a woman can make by herself; it depends on a man. We need to put the power to prevent HIV in the hands of women. This is true whether the woman is a faithful married mother of small children or a sex worker trying to scrape out a living in a slum. No matter where she lives or what she does, a woman should never need her partner’s permission to save her own life.

There are currently 30-40 microbicides in pre-clinical development, 14 in safety trials, and five in larger-scale clinical trials in the U.S., India, South Africa, and several other Sub-Saharan African countries. Almost all of this research is supported by public and/or philanthropic funding, and experts believe that the first partially-effective microbicide could be available by 2010—far sooner than any HIV vaccine.

Even a partially effective microbicide could have an enormous impact on women’s lives. Researchers at the London Institute of Tropical Hygiene have demonstrated that the introduction of a modestly effective microbicide in 73 low-income countries would prevent 2.5 million infections over three years.

Yet there are still obstacles to overcome. Funding for the research has increased with increased attention to the issue, but it is still insufficient. The infrastructure to carry out clinical trials is costly and difficult to establish, and the ethical questions are complex. What kinds of medical services should trial participants receive if they become HIV positive during a clinical trial? Does offering medical services to trial participants in settings where health care is almost non-existent constitute an undue inducement to participate? How do we test the safety and effectiveness of microbicides on women who are pregnant? Should men be informed when their partners are involved in a microbicide trial? And who gets to make decisions on questions like these—medical researchers, government agencies, or the local communities where trials take place?

Even when a safe and effective microbicide has been developed, marketing and distribution will present enormous challenges. How do we make sure that the first generation of microbicides, which will almost certainly provide a lower level of protection than condoms, doesn’t lead people to “migrate” away from condoms? How will we make sure that giving women a tool to prevent HIV/AIDS doesn’t undermine strategies to promote male responsibility? How do we ensure that the women who are at greatest risk—and those least likely to have access to any new technologies—get access to this one? And most importantly, how do we address the broader issues of inequality and violence against women that create their vulnerability to HIV/AIDS in the first place?

At the closing plenary of the Toronto Conference, Ambassador Stephen Lewis, UN Special Envoy for HIV/AIDS in Africa, made a clear and compelling call for action:

The growing excitement around a microbicide is entirely warranted. This is a preventive technology whose time has come. To be sure, there can be no flagging in the dogged quest for a vaccine, but it would appear that where preventive technologies are concerned, the microbicide is first in line. Now is the time to make certain, in advance, that when the discovery is made, it is instantly accessible and acceptable to the women of the world, wherever they may live.

As microbicides research and development proceeds, it is incumbent upon policy makers, and on all of us, to ensure that the women who will benefit most will be able to obtain and use them. Only then will we achieve real progress in combating the AIDS epidemic, and only then will we achieve true progress in improving women’s health and lives.

Shira Saperstein is a Senior Fellow at the Center for American Progress and the Deputy Director and Program Director for Women’s Rights and Reproductive Health at the Moriah Fund. She is also a member of the International Steering Committee of the Global Campaign for Microbicides.

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