Illinois: Microbicide Advocates Stress Options

Between fiscal years 1999 and 2008, the US Agency for International Development increased research and development funding for microbicides by nearly 20-fold. But while support and interest in vaginal microbicides to prevent HIV have increased, support for rectal microbicides is not as strong.

Microbicides for both anatomic sites should be developed, say AIDS advocates. Gay men are not the only ones having anal sex, and most heterosexuals engaging in anal sex are not using protection, according to advocates. The rectum provides a "perfect storm" of susceptibility to HIV infection, said Jim Pickett, chair of International Rectal Microbicides Advocates and director of advocacy for AIDS Foundation of Chicago (AFC).

Chicago is a center for microbicide activism, said Jessica Terlikowski, AFC's policy manager. A new clinical trial of a vaginal microbicide gel will soon take place in Chicago, most likely launching this summer, she said.

Advocates are optimistic the federal government will also support rectal microbicide research and development. "We don't have to deny behavior and pretend gay people don't exist" to get federal support any longer, or conduct rectal microbicide research quietly for fear of losing such support, Pickett said. A large proportion of rectal microbicide funding comes from the National Institutes of Health.

The University of California-Los Angeles recently conducted the first rectal microbicide safety trial, and several more Phase I safety trials are either ongoing or planned. Rectal safety trials of vaginal microbicides have also been conducted.

"They won't replace condoms," Terlikowski said. "Condoms still serve as the gold standard."

But for people who refuse to use condoms, microbicides might someday provide one more barrier to infection, Pickett said. "If you aren't using a condom, you have no protection," he said. "Wouldn't something that's even 60 percent effective be great in comparison?"

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