Removing Barriers to HIV Prevention
Yet millions of people do not use condoms and continue to put themselves at risk every time they have sex. This knowledge/behavior disconnect is reflected in recent increases in infection rates of HIV and other STDs such as syphilis, gonorrhea and chlamydia. A recent estimate of HIV infection in young, gay black men is a startling 30%.
Why, armed with condoms and information, do people continue to put themselves at risk? The reasons are many. Some of them are:
Prevention methods based on condom use, monogamy, and abstinence have failed to keep millions of people from becoming infected with HIV and other sexually transmitted diseases. Each day sees as many as 16,000 new HIV infections globally. There are 34 million people in the world living with HIV/AIDS and 95% of infections occur in developing countries. More than 90% of these HIV infections are transmitted through unprotected sex and at least 5% of those infections are transmitted through anal sex. Adding to this bleak picture, UNAIDS reports (as it has every year for at least the last 5 years) that it will be 10 years or longer before an effective preventative vaccine is ready for use.
Most of the microbicides being developed will probably also have some contraceptive effect -- because it's hard to make something that neutralizes viruses and bacteria but doesn't affect sperm.
Some scientists are also working on products that may be microbicidal without being contraceptive. These will be useful to couples who want to conceive a child while still protecting themselves from infection. Non-contraceptive microbicides may also offer acceptable protection for those who choose not to use contraceptives for religious or cultural reasons.
It is hoped that some of the microbicides approved for distribution will be able to protect against multiple STDs, in addition to HIV.
Two or more of these approaches may be combined with a number of active ingredients to develop a successful microbicide. Right now there are no proven microbicides on the market, although there are at least 60 topical microbicides in development and 23 microbicidal products being tested in people. This is a promising increase compared to the dozen compounds that were being developed in 1994.
Some have also suggested that a mouthwash-type product would also be useful for protection during oral sex. (The inside of the mouth is made up of the same type of mucosal cells as the vagina, so this isn't as far-fetched as it may seem.)
Microbicides may also help prevent HIV transmission from mother to baby during delivery by reducing the amount of HIV in an HIV-positive woman's vagina right before she gives birth. This might be especially important in very poor countries where women do not have access to anti-HIV therapy.
Because they are not actual physical barriers, microbicides will never be as good at stopping the transmission of STDs as a condom. However, the success of any method of prevention is a function of not only how effective it is, but how often it is correctly used. Because microbicides may be used more consistently than condoms, they may be more effective in the long run.
Some products may be able to help HIV-positive women become pregnant without exposing her partner to HIV.
It might also be possible to develop products that would help an HIV-positive man to conceive a baby sexually, without infecting his partner if she were HIV-negative.
The second reason is that heterosexism has inhibited a broader discussion of anal sex practices and rectal microbicides. Dr. Connie Celum at the University of Washington is responsible for the only research of rectal microbicides on human subjects. She addresses the anal stigma of science, saying "Most of the researchers in this field aren't just homophobic, they are erotophobic." Slowly, more interest and research has focused on finding a product that can be used both vaginally and rectally, although differences in the anatomy and environment may hinder such a formulation, making it necessary to create different products for vaginal versus anal sex. The open-ended rectal cavity makes it difficult to thoroughly coat and the acidity levels and bacterium ecology differ from those of the vagina. Unfortunately, these considerations are being ignored by many researchers, and funding of rectal microbicides is often being suppressed by conservative activists.
New drug development is usually funded primarily by major pharmaceutical companies that have the money to invest in large clinical trials. Unfortunately, none of the largest corporations are investing in microbicide research. They are reluctant for a variety of reasons. Their main concern, however, is that microbicides may not be profitable enough to justify the cost of developing them. Those who need the product the most are the least able to afford it. According to Alliance for Microbicide Development, it costs about $20 million to get one product from discovery through Phase II trials of safety. It can then cost up to $20 to $30 million more to get it through the huge Phase III efficacy trials, which can involve as many as 3,000 to 4,000 participants per product. Right now, about $35 million per year, at most, is being spent globally on microbicide research. The U.S. government is providing about $26 million of that. Without additional funding, the money just isn't there to move potential microbicides efficiently through the research pipeline. Unless industrialized counties, including the United States, make microbicide research a higher priority, research will be delayed and even more lives will be lost during the wait for effective products. Effective microbicides might transform the HIV epidemic from a raging wildfire to a more controlled burn.
The Global Campaign for Microbicides is a broad-based, world-wide coalition of organizations working to engage individuals, community-based organizations and institutions in the advocacy needed to make microbicides a reality soon.
In addition to generating media coverage, speaking at conferences and lobbying legislatures, Global Campaign is collecting signatures in over 80 countries on a petition for greater investment in microbicides.
The goal is to amass 250,000 signatures calling for increased funding from the U.S. government, the European Union and other public donors. Global Campaign will present the completed petition at the 2002 international AIDS conference.
Global Campaign has also helped Maryland Representative Connie Morella write the Microbicide Development Act. If passed, the Act would increase federal microbicide research funding at the NIH to $50 million in 2001, $75 million in 2002, and $100 million in 2003 -- enough to get the first products through the research pipeline.
More information on microbicide development is available at the Web site http://www.microbicide.org. You can help get safe, effective microbicides onto our drugstore shelves and into the hands of people who need them all around the world. Everyone who supports this issue may call their representatives and senators and ask them to sign on as a co-sponsor of the Microbicide Development Act as soon as it is re-introduced in congress. Congressional contact information is available, by state, on the Web site www.congress.org.
This article was provided by Seattle Treatment Education Project. It is a part of the publication STEP Perspective.