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Microbicides: The Forgotten Protection

By Atiya Jones

Condoms are good, but a lot of people don’t use them; mutual monogamy doesn’t always work; and, abstinence is somewhat of a joke. So, how else can someone protect themselves from HIV ? Microbicides might be just the thing. Similar in concept to spermicides, microbicides are a gel that when applied to the vagina or rectum, kill viruses before they can infect a person. Since the early 90s, researchers have been trying to develop microbicides to prevent HIV transmission. Along with adding another weapon to the war against HIV/AIDS, microbicides will be the first form of protection for women that   require a male partner’s cooperation.

What Are Microbicides?

A topical microbicide is any cream, gel, suppository, film, sponge or foam that, when applied or inserted into the vagina or rectum prior to sexual intercourse, prevents HIV or other sexually transmitted infections. Microbicides may even prevent pregnancy. There are no microbicides available yet but several are being tested on humans.

The “perfect” microbicide would have to be colorless, odorless, inexpensive, safe to use multiple times a day and for long periods of time, work against more than one STD, be available without a prescription, and be completely undetectable. It’s a tall order for a single product, but these demands are made for good biological, cultural and logistical reasons.

From a biological standpoint, women are physically more susceptible than men to HIV and other STDs. However, women must rely on their male partners to provide protection from these diseases. In some cultures, women simply do not have the power to insist that male partners use condoms, especially if its her husband. In addition, asking a male partner to use protection is sometimes equal to accusing him of having HIV or infidelity. For these cultural reasons, women must be able to use microbicides without detection.

What We Learned From Nonoxynol-9

Another advancement in microbicide design actually followed from the failure of spermicides in preventing HIV infection. The widely used spermicide nonoxynol-9 initially appeared to prevent HIV and other STDs in laboratory testing, but fell short once it was tested in women. In fact, nonoxynol-9 may actually increase HIV transmission because it causes small disruptions in the vaginal cells that may make it easier for the virus to enter. Among the lessons learned from nonoxynol-9 is that an effective microbicide would have to be easy on the cells in the vagina.

What’s in it for Men?

Women wouldn’t be the only ones benefiting from the development of microbicides. The Global Campaign for Microbicides also believes that a male would be protected if his female partner has HIV and uses a microbicide. There are also plans for a rectal microbicide (for use in the anus), which will help the gay community, especially men of color who have sex with men. Men of color now account for almost half of new HIV infections among MSM.

Clinical trials have been underway since the early 90s, but several different factors have conspired to keep an effective microbicide from reaching the market. First, many large pharmaceutical companies do not see microbicides as a profitable product. Without the financial and logistical muscle of Big Pharm, much of the development of microbicides has been left to academic institutions, nonprofit organizations, and small biotech companies.

While female-controlled forms of birth control have been around for many years, microbicides are the female-controlled forms of STD protection. While they are not a magic bullet for stopping the HIV/AIDS epidemic, microbicides promise to be an important weapon for women, who have been left unarmed in this battle.

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