Sexual Pleasure Called Key to HIV-Gel Efficacy

Wednesday, September 7, 2011

After decades of research, vaginal microbicides that prevent HIV infection are on the horizon. To fulfill their medical promise, a Rhode Island researcher says users' sexual pleasure must be considered.

PROVIDENCE, Rhode, Island (WOMENSENEWS)--Participants in Kate Morrow's recent study may not have felt like they were fighting the global HIV epidemic.

In fact, what they were literally feeling were gels of various consistencies inside their vaginas.

The women in Morrow's Project LINK answered questions after handling the gels, inserting them vaginally, walking around and simulating intercourse with a fake phallus. Did the gel leak out? Did it inhibit the experience . . . or did they actually enjoy it?

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Morrow has developed a set of scales to show the range of sensations and experiences women reported. Her goal now is to connect those sensations to data about which gels women would use to prevent HIV. Do they prefer gels that are smooth, thin or thick like hair gel? The answers to those questions could help lead to a microbicide that women will tolerate--and perhaps even enjoy.

For decades, women's health advocates have known that women need a way to protect themselves from HIV that is not dependent on a male partner. Vaginal microbicide gels are among an array of options--including pills, rectal microbicides and vaginal rings--that may one day help. Advocates hope microbicides could even be combined with birth control and help prevent other sexually-transmitted illnesses.

That call is urgent today, with women worldwide making up just over half of new HIV infections among people over 15 in 2009, according to the most recent data from UNAIDS.

In the United States, 23 percent of people newly infected with HIV in 2009 were women. Black women were disproportionately affected, becoming infected at 15 times the rate of white women, and more than three times that of Hispanic/Latina women, according to the Centers for Disease Control and Prevention.

In sub-Saharan Africa, 60 percent of people living with HIV are women and girls, and young women ages 15-24 are as many as eight times more likely to be HIV positive than men, according to UNAIDS. Of those living with HIV worldwide in 2009, 34 percent lived in 10 countries in southern Africa.

Acceptability a Must

Researchers knew when they began creating microbicide gels that women could insert vaginally to prevent HIV that acceptability was a key question. If women weren't willing to use them, the products wouldn't work.

So Morrow, a staff psychologist at the Miriam Hospital here and an associate professor of research at the Alpert Medical School of Brown University, has been studying the nitty-gritty aspects of acceptability.

Funded by a grant from the National Institutes of Health, Project LINK began in 2006 and has examined about 350 women's experiences of vaginal gels--none of which actually contained drugs. Data collection is complete and Morrow hopes to have results in the next year.

Those results could help determine what properties would make women willing--or even eager--to use a vaginal microbicide.

But there is no simple answer. Women's responses to the gel could depend on how old they are, where they are in their menstrual cycles or whether they are bothered by things like leakage and stickiness.

"How do I make this product feel good enough--or not feel like anything--such that women can use it without interrupting their normal day-to-day sexual lives? Or could it actually make their sexual lives better?" asked Morrow.

Studying pleasure is not something Morrow does for fun. She sees it as a "medical necessity" for preventing the spread of HIV. Even a partially-effective microbicide that is pleasant enough to gain wide use could dramatically reduce new infections. And a highly effective microbicide that women refuse to use won't work at all.

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