Something good in the Pipeline. I hope.

No matter where she lives, who she is, or what she does - a woman should never need her partner's permission to save her own life. – Bill and Melinda Gates Foundation 

World AIDS Day was December 1. About 33 million people worldwide have HIV/AIDS and new infections keep coming. Unfortunately, the cities where I live (Baltimore) and work (Washington, DC) were rated number two and number one, respectively, in new HIV infections in 2006. Women, particularly young women, are hugely affected by the epidemic – it is the leading cause of death for black women ages 25 to 34. 

Also unfortunate is the lack of progress on an HIV vaccine. Merck stopped their trial in 2007; the government halted their trial in 2008.
 
So what comes next? Hopefully, microbicides.

Microbicides are agents (gels or creams, films, rings, or pills) that could be used topically (in the vagina or anus) or be taken orally to prevent the spread of HIV. They would be another tool in the arsenal of HIV-prevention. We have the ABC approach (Abstinence, Be monogamous, if you can’t be monogamous, use a Condom), we have drugs that greatly reduce the mother-to-child transmission in utero, and we have male circumcision. 

Why do we need microbicides if we have condoms, including the female condom? Well, for starters, have you ever seen or used a female condom? It isn’t exactly aesthetically pleasing, it can squeak or make noise during sex (although I am told that latex versions are less likely to do so), and it is expensive – about twice the price of male condoms. 

And both female and male condoms are contraceptive. What about serodiscordant couples (read: one partner has HIV, the other doesn't) who would like to expand their family?  Sperm washing is available...for a price, if you live in a developed nation with access to fertility specialists. 

Enter the microbicide. It could be used surreptitiously by women with partners who will not use a condom or who wish to conceive a child. (Please spare me the “she could just refuse” argument.   Sexual relations are complicated and wrapped up with trust, emotional and financial support, cultural norms, behavioral expectations and more.) 

The initial clinical trials of microbicides haven’t been overly promising (Nononxyl 9 increased the risk, the Carraguard trial ended in 2007 with poor results). But third generation trials are progressing with tenofovir and dapivirine (first round results on the former should be available in early 2009). 

What YOU can do to help: When the 111th Congress convenes in January, you can ask your legislators to support the Microbicide Development Act (last year’s versions here and here). President-elect Obama sponsored Senate version so we already have a friend in the White House. 

You can also learn more about microbicides and perhaps even seek out a clinical trial at the Alliance for Microbicide Development. You can read about scientific advances at the International Partnership for Microbicides. And you can get the word out by visiting the Global Partnership for Microbicides and ordering any of their wonderful materials.

Comments

[joanna womack]

A number of army wife's are torn apart about their husbands having affairs in the army.
I hope someone will look into how these men in the military treat your families who pray and support them. Soon this will come out in the press!! Maybe a special class on respecting themselves as well as their families. I have spoken to a lot of people about this. I will go to the highest level to expose this, if I have to. The American families are looking at the army in disgrace!

[joanna womack]

We talk about HIV what do you think is going on in the army. And bring this to their homes. But no one talk's about this. Take a look at a large number of the soilders, but I guess the "no tell" systems is in effect, It's time to TELL!! I have spoken to young wife's in a depressed state, don't know what to do, someone needs to step up, and yes TELL!

signed: Hurt and Mad.