When my friend describes his work at the Women’s Global Health Imperative, he usually remains concise.
“I do HIV research.”
I always want to bolster this explanation, adding that he is helping develop a product that could revolutionize the way women protect themselves from HIV and other sexually transmitted infections (STIs). The product is a microbicide, and if proven safe and effective, will give women the ability to have safer sex on their terms, not his.
My friend’s brevity is understandable; few Americans have heard of microbicides, and their applicability in the United States is small compared to their global potential. In developing countries, women’s low social and economic status leaves them with little control over whether their partner uses a condom or not.
“Gender inequality and poverty trap millions of women in economic dependence on male partners, and expose them to violence and sexual aggression—all of which compromise their ability to shield themselves from sexually transmitted infections, including HIV,” notes Professor Joelle Brown, PhD, an epidemiologist at the University of California, Los Angeles.
Violence has contributed to situations like the one in Sub-Saharan Africa, where seventy-six percent of young people living with HIV are girls. In Rwanda, women have become infected with HIV after being gang raped by men in militias. In some parts of Africa, some believe that men can rid their HIV infection by having sex with a virgin. According to the Global Campaign for Microbicides, even suggesting the use of a condom may put a woman in danger, because it implies she has been unfaithful. It can also imply that she does not trust him or suspects that he has a sexually transmitted disease.
Microbicides are diverse groups of products that prevent infection from STIs, including HIV. Some provide a physical barrier that stops a virus from entering or attaching to host cells, and other microbicides are chemical agents that kill a virus or bacteria before it enters a healthy cell. Formulated as a gel, cream, suppository, or vaginal ring, women could insert the compounds into their vagina before having sex. Microbicides could also be used by men and by individuals (already infected with HIV or a STI) who want to minimize the risk of spreading it to their uninfected partners.
Current prevention methods for HIV and STI transmission are male and female condoms, abstinence, and monogamy. Although all these methods are valid and widely used, microbicides could be used in situations where women are not able to negotiate condom use or cannot ensure partner fidelity. Although some work as contraceptives, others are being developed so that women who want to get pregnant can, while still protecting themselves from HIV.
Many women may want or need to disclose microbicide use to their partners, but will be able to initiate the protection themselves. According to the World Health Organization, when women are in control of contraception, it is used more effectively. Advocates see a similar role for microbicides.
“The birth control pill revolutionized reproductive health by giving women power to regulate their fertility without requiring partner involvement,” notes Bindiya Patel, a representative from the Global Campaign for Microbicides. “It is our hope that microbicides will eventually fill that same role in terms of disease prevention—giving women more power over AIDS and other STDs.”
Despite their huge potential, the future of microbicides remains precarious. They are still being researched and developed. Two large-scale trials of microbicides were recently halted due to safety concerns. Of the sixty or so remaining compounds, about ten have progressed to clinical trials in humans. Costs of running such trials can run into the tens of millions of dollars. Although all drugs have to go through these lengthy regulatory and safety processes, large pharmaceutical companies usually foot the bill. This is not the case with microbicides.
“Thus far, no big pharmaceutical companies have invested significantly in microbicides research; we rely completely on government and philanthropic sources,” says Bindiya.
