The Scandal of Nonoxynol-9
Last summer the Centers for Disease Control (CDC) issued a warning about nonoxynol-9, the spermicide commonly used in condoms and lubricants. Helene Gayle, M.D, Director of the National Center for HIV, STD, and TB Prevention at the CDC, wrote: "N-9 has now been proven ineffective against HIV transmission -- the possibility of risk, with no benefit, indicates that N-9 should not be recommended as an effective means of HIV prevention."
So how did the CDC finally reach this conclusion? Research, of course. Seems that from 1996 until May 2000, UNAIDS (United Nations Programme on AIDS) sponsored a study of the effectiveness of a gel which contained 52.5 milligrams of nonoxynol-9 compared to an inactive placebo gel. The study was conducted in several locations in Africa. Nearly 1,000 HIV-negative, female, commercial sex workers were enrolled in the trial, and all women were counseled to use condoms consistently and correctly. In addition to condom use, the women were asked to use a vaginal gel each time they had intercourse. Half of the women were provided a placebo gel and half of the women received an N-9 gel. None of the women, or the researchers, knew which product each woman received, and all of the women were informed of the possible risks, benefits, and unknowns involved in the study.
By the end of the trial, researchers found that the women who used N-9 gel had become infected with HIV at about a 50% higher rate than women who used the placebo gel. Worse, the more frequently women used only N-9 gel without a condom to protect themselves, the higher their risk of becoming infected. Nonoxynol-9 did not protect the women from HIV infection and may have caused more transmission. Women who used N-9 also had more vaginal lesions, which probably increased the chances of HIV transmission.
On the heels of that trial comes unnerving data from another study. In New York City, researchers for the Population Council recruited four volunteers (three men and a woman) for a small rectal study of nonoxynol-9. The four participants were injected rectally (yes, up the butt) with 50 to 100 milligrams of an N-9-containing lubricant, a measurement typically found in lube tubes and packets. Placebos without N-9 were also used for comparison. The discovery? Lubes containing N-9 stripped away much of the protective rectal lining in all four people -- something that took hours to heal -- but the lining remained intact with the placebos. A larger study is planned, but for now, researchers are advising against the use of N-9 when having buttsex.
Rest assured that all this scientific evidence will be reevaluated again, even though these aren't the first studies to imply that nonoxynol-9 is useless as an HIV prevention strategy. Nonoxynol-9 is one of those appalling, creepy American products masquerading as something beneficial, when in fact it is snake oil. The debate over the merits of nonoxynol-9 has raged for over a decade. This substance, a detergent-like solution developed over 30 years ago as a kind of contraceptive spermicide for women, is the product of junk science. Nonoxynol-9 is the Frankenstein monster of laboratory lubes. It has never been FDA-approved for use against HIV infection, yet it was added to condoms and lubricants at the height of AIDS hysteria back in the 1980s based on nothing more than some lame animal experiments and questionable test tube results.
Yes, nonoxynol-9 kills HIV in a test tube. Vaginas and rectums are not test tubes. Controlled, laboratory experiments have little in common with real-world, human sexual interaction. Still, various companies were able to plant the idea that nonoxynol-9 kills HIV, STDs and sperm with very little scrutiny and went on to make a lot of money off our need to alleviate fears about disease and pregnancy. While cosmetic, pharmaceutical and condom companies added nonoxynol-9 to commercial sexual products, the Food and Drug Administration looked the other way and unsuspecting consumers like you and me bought into this deceitfulness and quackery.
I haven't promoted this N-9 crap since I first became a safer sex educator in 1994. Nonoxynol-9 always gave me a rash and irritated my skin. I knew that couldn't be a good thing. My male safer sex workshop participants reported similar results. I talked to women who privately disclosed their own dissatisfaction with N-9 because of vaginal lesions and irritation. It's bad enough that we've been duped and put at risk, but worse than that is the fact that the hype surrounding nonoxynol-9 was so effective that it ultimately undermined further, better research into spermicides and microbicides that really might effectively kill HIV and other STDs. Someone ought to be held accountable for this sham, because the truth is we have every right to be angry and unforgiving towards all the companies who developed, sold and falsely marketed this fraudulent substance.
Remember when we all found out that those guys from Milli Vanilli were lip-synching their songs? Okay, that was a surprising, but harmless turn of events. Nobody ever got hurt by deceptive pop music. This nonoxynol-9 business is a real scandal with real victims. We have been grievously misled by the shameful marketing of a product so bogus and ill-conceived that it can actually increase the risk of HIV and STD transmission. How is this any less abominable than big tobacco companies secretly mixing harmful additives into cigarettes and lying about it? It's not. Big tobacco eventually got busted. Public condemnation and aggressive litigation against the manufacturers and marketers of nonoxynol-9 is long overdue. There is no evidence to date that N-9 provides protection against HIV in real-life sexual situations. Let's bust them, too, because this is not one of those situations where we can say that nonoxynol-9 is better than nothing; it's good for nothing.