Microbicides promoted to stop spread of HIV, other STDs
According to World Health Organization estimates, somewhere between 5,000 and 7,000 women will be infected with HIV, the virus that causes AIDS, today.
Some of them will be infected because they couldn’t convince their partners to wear a condom.
“I’ve done research with all kinds of women, from low-income women to law students, and condom negotiation is always a tough one,” said Bethany Young Holt, an epidemiologist at UC Berkeley and director of the Sacramento-based California Microbicide Initiative. Holt’s specialty, microbicides, may help those women protect themselves from infection no matter what decisions their partners make.
Microbicides are products—gels, lotions, solutions—that are applied topically to either the vagina or rectum before sex in order to stop the transmission of infectious microbes. That means everything from viruses like HIV to the bacterium that causes gonorrhea to the spirochete that causes syphilis.
Put bluntly, microbicides kill the microbes—micro-organisms, or less precisely, “bugs.” Without the bugs, no disease.
“This is a new tool for prevention,” Holt told SN&R. “Microbicides are not the magic bullet—they won’t cure AIDS. Nothing probably will be a single magic bullet. But these will empower women to protect themselves from infection.”
In California, 45 percent of HIV infections in women come from heterosexual contact, more than any other source, including intravenous drug use. But for a variety of reasons, women may not feel they can protect themselves from possible HIV transmission. Holt has done studies in communities as disparate as Ethiopia and Oakland, and she said that the problem is pretty much the same.
“In a lot of communities, if a woman is married and she’s afraid that her husband is not safe, abstinence is not practical,” Holt said. “There are also situations where a lot of abuse is involved, so the ability to protect herself is paramount.” And that’s just where microbicides offer hope. Rather than convincing a partner to put on a condom, women—and for that matter, men who are having sex with men—can use the microbicide to prevent themselves from becoming infected.
Holt said that there are currently about 30 microbicides under development, with a number that have progressed to clinical trials. “There are all sorts of compounds and formulations,” she said. “Some are maintaining just normal vaginal flora”—that is, keeping the Ph of the vagina at its normal acidity so that HIV can’t thrive in semen. These particular microbicides offer a useful side effect, depending on your perspective: They can stop the transmission of HIV, but don’t affect conception. For women who wish to conceive without contracting or passing on HIV, microbicides like this would be, quite literally, life savers.
There are also products under development that function as both microbicides and spermicides, providing both protection from HIV transmission and contraception.
And in addition to preventing transmission of HIV, the microbicides can be effective against other sexually transmitted diseases, like Chlamydia, and infections such as bacterial vaginosis. “These infections are on the pathways—they make you more vulnerable—to HIV infection,” Holt said. “If we can be successful in developing microbicides for STDs and other infections like bacterial vaginosis, we can not only reduce these infections, but reduce the likelihood of HIV transmission.”
Holt’s organization, CAMI, is among many that have done studies of both the acceptability and cost-effectiveness of microbicides. According to Holt, “These studies show that the market for microbicides is there, and that they could save a lot of money in prevention, say, in preventing Chlamydia.”
But most research is being done by small companies, including some nonprofits. And research takes money. Among the legislative hopes for microbicidal research is the Microbicide Development Act, a federal bill aimed at directing HIV/AIDS prevention research funds for microbicides to the appropriate places. “The MDA isn’t asking for more money for microbicides,” Holt said. “It’s saying that we have this money, so let’s consolidate it for the best use.” The MDA has been introduced a number of times in Congress but has yet to pass. “It’s important to encourage California legislators to sign on for passage of the MDA,” Holt said.
In the meantime, some microbicides are already in clinical trials, and a number of area health providers—including Planned Parenthood Mar Monte, Kaiser Permanente and UC Davis Medical Center—have signed on with CAMI to assist in the trials. “We need to be very ethical with these trials,” said Holt. “While it’s important to get microbicides that work, they need to be safe, as well as effective.” She pointed out that both men and women will be using the microbicides in “very sensitive areas,” so it’s not enough to be effective; the products will need to be completely safe.
Katharyn McLearan, director of public affairs for Planned Parenthood Mar Monte, told SN&R that exploring new reproductive health advances is “core to our mission.” Planned Parenthood “is currently in Phase II testing of a microbicide,” she said. “The more options people have, the more likely they will be to find a method that works for them.” McLearan also told SN&R that starting this month all local Planned Parenthood clinics are providing rapid HIV tests, which will provide results within 20 minutes at low cost—in some cases, free.
People who are interested in participating in a microbicide trial should contact CAMI through their Web site at www.cami-health.com.
According to Holt, California is the perfect place to do microbicide research. “This is such a promising tool, and California is such an economic and cultural leader,” she said. “We should be able to step up and see that these things are developed safely.”