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.
Because the majority of HIV cases occur in developing countries—with little to no purchasing power—there is little chance for companies to make large profits. Investment is also risky.
“There is every reason to think that a microbicide is possible. But because microbicides represent a new product class, with undefined development costs and market potential, they remain unattractive to private investors,” adds Joelle.
