Violence and HIV -- both are potentially deadly and both have persistent negative effects on health and well-being. Multiple factors put women in violent relationships at increased risk of becoming infected with HIV and other sexually transmitted infections (STIs), including:

Biological factors:

• Forced sex can increase risk of infection. Bleeding or tearing of the vaginal or rectal area creates passageways for HIV to enter the bloodstream, thus facilitating infection.
• Women are already at least twice as likely as men to contract HIV from unprotected sex, in part because semen carries more HIV than vaginal secretions.
• Vaginal membranes are exposed to infectious fluids for hours after sex. Younger women are at highest risk because the immature cervix is more vulnerable to damage.
• STIs often go undetected, and therefore untreated, in women. Untreated, they increase women's vulnerability to HIV and can lead to infertility, ectopic (tubal) pregnancy, infant mortality, and cervical cancer.

Economical factors:

• Lack of access to fair-wage jobs, minimal work experience or education, isolation, discrimination, deprivation of property rights, etc. are just some of the factors that can render women economically dependent on their partners.
• The power imbalance created by economic dependency and violence can leave women unable to "negotiate" condom use or to leave partners who put them at risk.

Cultural factors:

• Many societies around the world expect women to be faithful even when men are not. A woman's partner puts her at higher risk of HIV when he has multiple sex partners.
• In many cultures, girls are discouraged from learning about their bodies and sex and are taught to regard their bodies as the property of men (fathers, boyfriends or husbands). Under culturally enforced ignorance, powerlessness and the threat of violence, women experience little or no control over when and how sex happens in their lives and may see sexual decision-making -- including condom use -- as the domain of men.

What Are Microbicides?

Microbicides: (mi-KRO'-bi-sidz) are products being developed to prevent the sexual transmission of HIV and other STIs when applied in the vagina or rectum. They are likely to come in a variety of forms such as a gel or cream inserted with an applicator, a sponge or time-released suppository, or an intra-vaginal ring that could potentially be used for months at a time.

Will Microbicides Also Work as Birth Control?

Some of the microbicides being investigated will prevent pregnancy and some will not. "Dual-action" contraceptive microbicides could provide both pregnancy and disease prevention to women wishing to meet both needs with one product. They would also offer a much-needed alternative to women choosing not to use hormonal birth control methods like pills or patches.

But we also need non-contraceptive microbicides. With condoms, women have to choose between childbearing and HIV prevention. Access to a non-contraceptive microbicide would give women a third option -- one that blocks infection but still allows pregnancy to occur.

Will They Protect Against All STIs?

Although protection against HIV is the primary goal, each microbicide under development is tested against a range of common STIs. Several products appear capable of reducing risk of at least one or two other STIs, in addition to HIV. No one microbicide will be effective against all possible infections. But it is very likely that "broad-spectrum" microbicides, capable of preventing HIV and least a handful of other STIs, can be developed.

Will a Woman Be Able to Use a Microbicide Without Her Partner Knowing About It?

The first microbicides will probably come in gels or creams -- products that will increase vaginal lubrication somewhat. This may make using them secretly a bit of a problem for women in long-term partnerships. Second- and third-generation microbicides, however, are being formulated in ways that may minimise this effect. A flexible, microbicide-loaded vaginal ring, for example, could provide time-released protection with minimal lubrication change, thus meeting the needs of women who can't or don't want to discuss the issue of protection with their male partners.

A woman who can't safely raise the topic of HIV or STI risk with her partner may choose to claim that she is using the product for hygiene or sexual enhancement rather than for disease prevention. The substantial market for "vaginal cosmetics" of all types (such as douches and deodorant sprays) is problematic from a health standpoint. But it does show products are used in all parts of the world already and, hence, offer a ready excuse to the woman in need of a pretext for her microbicide use.

Why Aren't Microbicides Available Now?

Scientists have identified over 50 potential microbicides and are testing them to find out which ones could be safe and effective for regular use. Unfortunately, not enough public funding is available to move their research along efficiently. Getting a microbicide on the shelves in the near future doesn't depend as much on the speed of scientific progress as it does on increasing the level of funding to support research, development and access. If we want microbicides, we have to demand sufficient governmental funding to develop them without delay.

Microbicides and Safety Planning

With microbicides, women could reduce infection and unwanted pregnancy risk, even in the context of forced unprotected sex. Women living with HIV could lower their risk of re-infection and minimise their already heightened vulnerability to STIs and vaginal infections. For HIV negative women, microbicides offer the hope of leaving an abusive relationship still uninfected. Women living with domestic violence struggle every day to regain control over their own bodies and futures. Microbicides could become one more tool for achieving that goal.