Microbicides – female-controlled technology for HIV prevention

The East Bay Express (8 Mar 2006, A Fresh Front in the AIDS War“) presents a narrative on the development of microbicides as seen through the eyes of African and Californian residents and the work of Bethany Young Holt, a Cal-trained epidemiologist and former Peace Corps Volunteer. The article has several threads and makes some strong accusations but interesting story and implications for HIV prevention. Lemons as a potential household microbicide are described near the end.

In 1992, Bethany Young Holt was working in the refugee camps of southern Ethiopia, where thousands of people had fled to escape the civil war in Sudan. She was a master’s student from UC Berkeley’s School of Public Health, there for an internship with the Centers for Disease Control, which was rolling out an HIV prevention program. The camps seemed like an ideal place for it — while very few of the Sudanese refugees were HIV-positive, commercial sex workers from Ethiopian cities were flooding into the camps in search of clients, and their HIV prevalence was 42 percent. It should have been a chance to avert a disaster.

Holt’s job was to teach people to use condoms. “That was just a joke,” she quickly realized. “The women all wanted them and the men wouldn’t put them on for a hundred different reasons.”…

…Holt, currently a lecturer at Cal’s School of Public Health, believed there had to be a better way to protect women. So in the late ’90s, she joined with other public-health experts and researchers who had long envisioned the next best thing to a cure or effective AIDS vaccine: something new to prevent its transmission during sex. Ideally, it would be discreet and female-controlled. It would be cheap enough that clinics in the developing world could give it away, and people in industrialized nations could buy it for about the price of condoms. Most of all, it would have to work.

After twenty uphill years, it is almost here. It’s called a microbicide, a new class of experimental drugs that kill or block HIV on contact. Most are colorless, tasteless, odor-free, and could be applied as lubricating gels, foams, suppositories, or vaginal rings. They’ve been dubbed “invisible condoms” — most likely, a sexual partner wouldn’t even know they’re there. Some can also act as contraceptives; others can kill not only HIV but a broad spectrum of sexually transmitted diseases and common vaginal infections. There are fourteen microbicides now in clinical trials and another fifteen in laboratory development, which employ a range of disease-thwarting strategies (see sidebar “Halting a Killer”). And there is yet another option undergoing preliminary safety tests. If ultimately shown to be effective, it could prove the cheapest, lowest-tech solution imaginable for impoverished women around the world. It literally grows on trees. You probably bit into it the last time you took a tequila shot.

While these anti-HIV prospects have been a long time coming, their potential to slow the global AIDS epidemic could be truly awesome: A mathematical model produced by the London School of Hygiene and Tropical Medicine estimated that if just 20 percent of women in the world’s 73 poorest countries used microbicides half the time, and if those microbicides were only 60 percent effective, it would prevent more than 2.5 million new HIV infections every three years.

…the genius of microbicides is that they put the power in a woman’s hands. Microbicide advocates are sometimes reluctant to use words like “stealthy” to describe the drugs they’re promoting, although they’re well aware that not every woman can discuss her sexual health choices with her partner. But the rising number of HIV infections among women is clearly facilitated by the idea that certain truths — drug use, infidelity, past sexual experiences, HIV status — are unspeakable, even between people who love one another. That silence, and the resulting inability of women to protect themselves against infection, are making them exquisitely vulnerable. With so many secrets working against them, it is well past time for women to have a secret weapon of their own.

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2 Responses to “Microbicides – female-controlled technology for HIV prevention”

  1. Its good to know about the work done for the health of women, gives them some control for their own benefit.

  2. I agree with Denise its really good to know the work for women health gives them control…WoW