Microbicides, the Future of HIV Prevention?

AIDS Survival Project has been a proud supporter of the Global Campaign for Microbicides since 1999. This open letter from campaign director, Lori Heise explains the excitement and the challenges presented at the year's International AIDS Conference.

Talk of microbicides was the pulse of the 2006 International AIDS conference this past week in Toronto, Canada. Microbicides moved from the sidelines to center stage, a paradigm shift of bold proportions. We should all feel a great sense of accomplishment. One of the main goals of our advocacy to date has been to get the world to recognize microbicides as an absolutely essential prevention tool. We have clearly achieved this goal within the HIV/AIDS world. All who have worked hard to articulate the need for user-controlled prevention should feel proud and savor this moment. Congratulations!

Reaching this tipping point also means that we now need to adjust our messages. For the past fifteen years, the microbicide movement has focused on building the enthusiasm and momentum necessary to gain the attention, respect, and commitment of world leaders. Having finally garnered substantial support and drive behind microbicides, it is time to shift focus. If we are concerned about the long term success of our enterprise, we must help individuals develop realistic expectations regarding what this new technology will mean to all of us. As advocates with advanced knowledge and training in the field, we have a critical role to play in shaping future discourse.

Our messages need to communicate a few key ideas; the primary one being that microbicides are not a magic bullet. The idea of a technological panacea is seductive and one we must discourage. Despite the swelling enthusiasm, it is important to remember that microbicides are a technology that cannot possibly make an impact without a concomitant investment in access and women's empowerment. As advocates we are responsible for keeping this larger agenda in focus.

The power structures that make microbicides essential are the very ones that also challenge microbicide development, use, and implementation. The first step was to gain the political commitment to develop safe, effective microbicides. Now that we have secured that commitment, the next step in microbicide activism is tackling the joint issues of access and use.

Access means nothing if people cannot successfully use the technology. This means working to empower women in their intimate relationships, addressing violence against women and expanding their economic opportunities. It also means working with men.

Now that we have garnered appropriate political will and support, the challenge for the microbicide field is to avoid unrealistic expectations. We need to firmly establish a realistic picture of microbicides as one tool that can help stem the increase of HIV incidence among women -- but only if we, collectively, work to assure social environments in which women can access and use them. If we fail to communicate this, we risk dashing the hope that this new technology offers and generating public disappointment and skepticism that eventually erodes continued financial and community support for the field.

We also have to encourage the media and advocates at all levels to be realistic about the complex nature of drug development. Public discussion of microbicides must be sensitive to the desperation and powerlessness that many women feel in the face of their current HIV risk and their lack of ability to protect themselves. In this environment, it is irresponsible and potentially exploitive to be overly optimistic about the characteristics and likely availability of microbicides.

What then are realistic, but inspiring, messages we can use to describe the potential for microbicides? And what other information must we incorporate in our advocacy and media work to help the wider public understand the realities of drug development?

This fact sheet contains several key messages that you can use to express clear and realistic expectations about microbicide in advocacy and outreach regarding:

• Timing of microbicide availability/drug development generally

• Nature of clinical trials

• Likely microbicide effectiveness

• Cost of a microbicide

• Attributes of a microbicide

• Current efforts to overcome barriers to making microbicides accessible.

The Toronto AIDS conference will always be remembered as a watershed event for microbicides. Let us celebrate our success, re-double our energy, and be thoughtful as we move forward in this new era.