If the recent lectures by Tina Rosenberg and Paul Farmer made one thing clear, it’s that our biggest weapon in the fight against AIDS is the ability to speak up. Amid this spirited climate, which was most recently present on AIDS Awareness Day on April 20, researchers and student activists are considering microbicides as an alternative method of prevention. The challenges they face extend beyond expressing support for the development of different options; they are working to encourage everyone else to do the same.
Microbicides are substances with the ability to prevent the sexual transmission of HIV and other sexually transmitted diseases (STDs). Although currently not approved by the government, scientists are confident that within five to seven years, microbicides will be perfected and ready for use. One reason for this optimism has been that many of the central ingredients in microbicides are already commonly used in over-the-counter products.
Until microbicides became a possibility, “ABC,” an acronym standing for Abstinence, Be Faithful, and Condom Use, was the only available preventative strategy. As proponents of microbicides point out, for many people this advice is difficult, if not impossible, to practice, especially in developing nations, who lack the social and economic power to insist on and pay for other preventative measures, such as condoms.
In particular, microbicides would provide protection to married women whose partners refuse to use condoms or who feel uncomfortable making this request of a spouse.
“This tool would be substantially different than condoms, in that it would be woman-initiated and unobtrusive, and thus empower a woman to take precautions when her partner is unwilling to use a condom, or when she feels unable to initiate this discussion,” said Dr. Thomas Moench, Medical Director of ReProtect, a research firm specializing in reproductive health.
The risk of infection is especially great for women whose husbands have been promiscuous (a reality for men in developing nations who must work at sites far from home, returning only at intervals). Because these women are unable to monitor their husbands’ sexual activity, their ability to intervene is hampered, and their vulnerability to infection increased.
According to Moench, an infected woman has a twenty-five percent chance of passing the infection to her infant at birth, and that this risk increases if she chooses to breast-feed. Currently, the use of antiretroviral drugs and birth by caesarean section can decrease the risk of transmission ten-fold. Microbicides also have the option of being contraceptive, making it more likely to decrease this transmission of AIDS through childbirth, as well as reduce the number of new infections annually.
“Unless preexisting condom use rates are very high, the net public health result of introducing a partially effective microbicide is a reduced transmission of HIV,” Moench said.
Moench warns, however, that microbicide research is not an attempt to render condoms obsolete.
Condoms are effective, safe, and inexpensive, and for those who are willing and able to use them, they will offer the best protection,“ Moench said.
But the fact remains that only six billion condoms are produced each year, a small number given that the world population is a number only slightly larger.
Although proponents of microbicides still advocate the use of condoms, they see an exclusive promotion of this method as a futile attempt to transform a country’s socio-economic landscape.
”There is a real acceptability problem with condoms,“ Moench said. ”More than two decades of education and condom promotion has not solved this, and probably never will solve it.“
”Yes, we’re perpetuating the social structure, but we’re not going to change society in ten years and the AIDS epidemic is only going to get worse,“ said Leah Katz ’07, Wesleyan’s Planned Parenthood intern who specializes in microbicides.
Some supporters say it will be years yet before the public can have access to these kinds of substances.
”They say ‘five to seven years’ but they said that five to seven years ago,“ Katz said.
Most of the activism in support of these substances focuses on raising public awareness and, consequently, funding to expedite the perfection of microbicides in the laboratory.
Moench and Katz agree that increased support for microbicides will only come through public awareness campaigns.
”This effort has been completely dependent on government and philanthropic support,“ Moench said. He encouraged people to show their support by contacting their representatives and asking them to support pending legislation to support microbicide research and development.
Katz, who did not know about microbicides before signing on as a Planned Parenthood intern, took action this year by starting the student group Students for Microbicides, abbreviated S4M.
So far, the group has worked together to bring relevant speakers, petition and write letters to governmental officials, register voters, and hold informational meetings.
Currently, the United States devotes two percent of its AIDS research budget to microbicides. Proponents of microbicides say this is not sufficient to make rapid progress.
To many microbicides supporters, the government’s paltry support is indicative of moral conservatism or a deep-seated alliance with pharmaceutical companies, who, as Katz pointed out, will not reap big profits from the development of microbicides.
”I think it is fair to say that the administration is also anti-sex, so they are not likely to go out on a limb to promote development of a product used during sex,“ Moench said. ”[It’s] far better to support a vaccine that is not so closely tied to intercourse.“
Moench, who describes microbicides as the ”poor stepchild“ of AIDS prevention research, attributes this apparent lack of support to fear of ”condom migration,“ a movement away from the promotion of condom use in favor of microbicides.
”[There is] a worry that a behavioral method will be hard to implement, as it requires widespread and sustained effort by individuals who are asked to make an intimate lifestyle change,“ Moench said.
In contrast, other areas of research, such as vaccine immunology appear to be more potentially effective.
”Microbicides are not ‘sexy’ in a scientific sense, despite being all too sexy in a political sense,“ Moench said.
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