By Amy Littlefield
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.
Anna Forbes is former deputy director of the Global Campaign for Microbicides, an advocacy group with staff in Washington, D.C., South Africa, Zambia and Kenya. She said that understanding sexual pleasure is integral to public health because it affects real-world behavior, such as the refusal of some men to wear condoms.
"If you don't talk about what people do for pleasure and what people do sexually, you're cutting off your nose to spite your face in terms of HIV prevention," said Forbes.
For microbicides to catch on in a big way, Forbes said researchers may also have to persuade pharmaceutical companies--so far hesitant to invest--that microbicides are profitable. That could mean showing that U.S. women are willing to use microbicides--and pay for them.
Last year, researchers revealed that a vaginal gel containing the antiretroviral drug tenofovir reduced HIV incidence by 39 percent among women in South Africa who received it, compared to a placebo group. This CAPRISA 004 study was the first time researchers had shown a vaginal gel could reduce the spread of HIV. The gel also proved 51 percent effective in reducing the spread of genital herpes (HSV-2), which has been linked to a higher risk of HIV infection.
Women in the study were asked to insert the gel up to 12 hours before sex and as soon as possible within 12 hours after sex. The gel was more effective the more often it was used. Women who used it more than 80 percent of the time experienced a 54 percent reduction in HIV infection, versus 28 percent for women who used it less than half the time.
Male partners might be unaware, accepting or even excited about the product--in any case, their experiences must be considered, said Morrow. While some women might discuss microbicide use with a partner, others might not be able to do so.
Morrow began another National Institutes of Health-funded study, Project MIST, in 2011 to examine how heterosexual couples experience vaginal products. She hopes to collect data from 24 couples by the end of the year.
Participants in both studies have received compensation.
In multi-site studies, women's excitement over vaginal products has varied, depending on how real HIV is in their lives, Morrow said; the higher the sense of risk, the greater the motivation to try a vaginal gel.
While gel preferences may vary from place to place, the opinions of women in the United States who feel less at risk for HIV could help researchers develop optimum products for women in parts of the world where the disease risk is highest.
It could take years for a microbicide to become publicly available, but Morrow is dreaming of the day when her data might be an important part of the global anti-HIV solution.
"Can you imagine, 15 years from now, there's some big New York Times headline that says the incidence for HIV in South Africa has dropped by 50 percent thanks to X, Y and Z microbicides, and you can sit here in little old Providence, Rhode Island, and say I was a part of that?" she said.
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Amy Littlefield is a freelance reporter and founder of The Provider Project: Stories from the Abortion-Providing Community, online at theproviderproject.org. She lives in Providence, Rhode Island.
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