Philadelphia Inquirer Examines Developments, Ethics in Microbicide Research
March 24, 2009
The Philadelphia Inquirer on Monday examined issues surrounding microbicide research, including recent developments and ethical issues. The Inquirer reports that the use of microbicides to prevent the spread of HIV "seemed so simple" 15 years ago, when researchers thought they could provide a vaginal gel that would be applied prior to sex. The gel would be "cheap and nonprescription, provide contraception and prevent many sexually transmitted infections, not just HIV," the Inquirer reports, adding that women also would be able to control its use, making microbicides "popular in places where men did not like wearing condoms -- that is, everywhere."
Advocates for microbicides are "undaunted," and there is a "new hope" that antiretroviral drugs could be used to prevent transmission of the virus. Still, "no one believes it will be simple," and many experts say the "science behind many studies was weak, the ethical quandaries were underestimated, and the basic rule of product development -- find out what the consumer wants -- was ignored," the Inquirer reports. In addition, microbicide research is "full of ethical and real-world dilemmas," including the fact that "developers cannot knowingly increase HIV risk while seeking a way to reduce it," the Inquirer reports. Women therefore are provided with condoms and "strenuously counseled to persuade their partners to wear them," but for some women in low-income countries their "only leverage may be the nominal payment" they are given for participating in the study. Anna Forbes, deputy director of the Global Campaign for Microbicides, said that women "can sometimes get their partners to use condoms during the trial because they are making money" but that condom use ends after the trial is over. Forbes said it is a "gray area ethically."
The failures of previous studies have led researchers to "now realize they need to come up with products that are not just good for women, but that women feel good using," the Inquirer reports, adding that once-daily formulations and slow-release vaginal rings are "in the works." Sharon Hillier, head of the federal Microbicide Trials Network and a researcher at the University of Pittsburgh, said the past decade "showed us there's no magic bullet." She also said that successes in preventing mother-to-child transmission through antiretrovirals have led researchers to explore pre-exposure prophylaxis. The Inquirer reports that this is a "radical shift," as the drugs are "neither cheap nor nonprescription" and come with "the danger of unintended consequences." Forbes said, "In poor countries, what are the odds that prevention pills would be taken from a woman and given to a family member with HIV?" In addition, there is a concern that expanded use of antiretrovirals could led to drug resistance, "undermining treatment as well as prevention," the Inquirer reports (McCullough, Philadelphia Inquirer, 3/23).
This article was provided by Henry J. Kaiser Family Foundation. It is a part of the publication Kaiser Daily HIV/AIDS Report. Visit the Kaiser Family Foundation's website to find out more about their activities, publications and services.