HIV/AIDS Prevention

Preliminary results were released April 3 from a randomized clinical trial that studied the potential impact of the spermicide nonoxynol-9 (N-9) on the risk of male-to-female sexual transmission of HIV. The study was conducted by Family Health International (FHI), a nonprofit international health research organization, and the Cameroon Ministry of Health, with funding from the National Institutes of Health (NIH) and other agencies. Specifically, this study explored whether or not there is additional protection from male-to-female sexual transmission of HIV and other sexually transmitted diseases (STDs) when vaginal contraceptive film containing 70 mg of N-9 is provided in addition to male latex condoms.

The study participants, sex workers in Cameroon, were provided male latex condoms and either an N-9 film or a placebo film and were asked to use the film along with a condom for every act of intercourse. In addition, they were asked to reduce risky sexual behaviors and were tested and treated for STDs. This study found that when the N-9 film was used as part of a highly protective overall HIV/STD prevention program including counseling, condom promotion, and STD treatment, it provided no additional protection against HIV, gonorrhea, and chlamydia for the sex workers in the study.

CDC's recommendation for those who are sexually active with a partner whose HIV and STD status is unknown remains the same: consistent and correct use of male latex condoms, with or without the use of spermicide. If for some reason it is not possible to use male latex condoms, CDC recommends using female condoms. CDC does not recommend using spermicide alone to prevent HIV.

Individuals choosing to add spermicide when using male latex condoms should be aware that, although N-9 is still considered safe to use, the researchers did find a slight increase in genital ulcers among study participants who were provided N-9 film over those who were provided film containing a placebo. Other studies have shown that frequent use (daily or more) of other formulations of N-9 has been associated with genital irritation and inflammation. This is important because genital ulcers can increase a woman's susceptibility to becoming infected with HIV. The extent to which N-9-associated ulcers, irritation, and inflammation may increase susceptibility to becoming infected with HIV is unclear at this time. CDC will work closely with NIH and FHI investigators to determine how the findings of this study might apply to women with different characteristics than the sex workers in this study and to determine if current recommendations about use of N-9 spermicide for HIV/ STD prevention for U.S. women should be revised.

CDC and other public health agencies remain deeply committed to the development of safe and effective HIV/STD prevention methods that can be controlled by women, such as virus- and bacteria-killing products that women can apply before having sex.

There Is Good News

The good news about the Cameroon study is that, after the initiation of the intervention, there was a dramatic reduction in the rate of HIV infection from the rate that was previously estimated in this high-risk population. The HIV seroconversion rate in this study (6.7 per 100 person-years) is similar to rates seen among inconsistent condom users in discordant couple studies (see chart below). It is reasonable to assume that HIV infection rates could have been further reduced with 100 percent condom use.

If you have any questions about spermicides or condom use, call the CDC National AIDS Hotline toll free at 800-342-AIDS, or contact the CDC National AIDS Clearinghouse (see address, telephone number). For further information about this study, contact Mr. Nash Herndon at FHI, telephone 919-544-6979, extension 224.

Back | Next
Table of Contents