Some Makers, Vendors Drop N-9 Spermicide on HIV Risk

Scientists, public health advocates, gay rights groups and some women's organizations are launching a public awareness campaign next month to attack the popular spermicide Nonoxynol-9. "In the interest of public health, the safest thing to do is eliminate N-9 condoms and lubricants from the market," said campaign organizer Lori Heise of the Program for Appropriate Technology in Health.

Originally developed as a detergent, N-9 has been used for nearly 50 years as a vaginal cream that rapidly kills sperm cells. Cautions issued on N-9 for at least two years were reinforced over the summer, when the World Health Organization and the CDC issued warnings that N-9 has been found to be ineffective in stopping HIV and other STDs.

The campaigners intend to recommend that N-9 not be used during anal intercourse, by prostitutes, by anyone engaged in multiple acts of intercourse in one day, or to prevent STDs. The groups believe that N-9, which is present in many spermicides used with diaphragms and cervical caps, can be safely used by women not at risk for HIV. Researchers say that N-9 can break up or irritate the cell lining, or epithelium, of the rectum and vagina, making it easier for infecting organisms to invade. The danger with anal sex is especially significant, because the rectum only has a single-cell wall, while the vagina has a wall about 40 cells thick.

A study to be published in this week's Lancet reports that prostitutes using N-9 with multiple sex partners had more genital lesions and higher HIV rates than others using a placebo. And a small study by David Phillips of the Population Council of New York found that even low doses of N-9 caused heavy sloughing of the rectal epithelium. The epithelium regenerated itself in eight to 10 hours.

A Johnson & Johnson spokesperson said the company ceased production of its KY Plus with N-9 in July and will phase out N- 9-treated condoms, which are manufactured for sale in Brazil and Colombia, early next year. Also stopping sales of N-9 products are Planned Parenthood and fourth-largest US condom maker Mayer Laboratories Inc. But a spokesperson for the Advanced Medical Technology Association, which represents medical device makers, said the top three condom makers have no plans to pull their N-9 products. According to one person familiar with ongoing talks, the maker of No. 1-selling Trojan condoms is developing a new label that will say something like "for vaginal use only."

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