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A Female Alternative to Condoms

George Spellwin

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By Jennifer Thomas
HealthScout Reporter
December 24, 2000


SATURDAY, Dec. 23 (HealthScout) -- A gel or a cream that a woman could apply to herself as protection from AIDS?
Just such a product could be available on your local drug store shelves in a few years.

Condoms generally are considered the best way for sexually active women to protect themselves from AIDS and other diseases, but there's one big problem with condoms: They require a man's cooperation.

So, researchers are trying to develop something that women could use on their own to halt the spread of HIV and other sexually transmitted diseases, like chlamydia and herpes.

Called microbicides, the products under development would be applied vaginally or rectally and would form a chemical barrier to prevent infection.

Microbicides are seen as one of the best hopes for combating the spread of AIDS in the near future, says Polly Harrison, director of the Alliance for Microbicide Development in Silver Spring, Md.

AIDS cases among women in the United States increased threefold between 1985 and 1996, making AIDS now the fourth-leading cause of death among American women age 25 to 44, according to the National Institute of Allergy and Infectious Diseases.

Of the 16,000 new HIV infections that occur every day worldwide, an estimated 90 percent stem from sexual contact -- 85 percent among heterosexuals and 5 percent among men who have sex with men, says the American Foundation for AIDS Research (amfAR), based in Washington, D.C.

"An HIV vaccine is still a long way away, but we have several microbicides that are showing promise and are ready to go forward into clinical [human] trials," Harrison says. Nearly 60 such products are in the research pipeline, although getting adequate funding to complete the tests continues to be a challenge, she says.

Giving women control

Jennifer Frost, a senior research associate at the Alan Guttmacher Institute, a New York City-based organization that supports research into contraceptives and the prevention of sexually transmitted diseases, says women now must rely on men to protect their own health.

"The key importance is that [microbicides] would give women some control over protection, and they would not have to depend on a man to use a condom," Frost says.

Getting men to use condoms can be difficult, or even dangerous, for women, says Megan Gottemoeller, program associate at the Center for Health and Gender Equity, a women's health and reproductive rights advocacy and research organization based in Takoma Park, Md.

In Africa, where AIDS cases are skyrocketing, women are considered among the most vulnerable.

Women now account for 45 percent of all adult HIV/AIDS cases worldwide. But in sub-Saharan Africa, 55 percent of all adults with HIV are women, according to amfAR.

"Internationally, in many cultures there's a perception associated with condoms that implies promiscuity or a lack of trust," Gottemoeller says. "And sometimes, the reaction to that is violent."

Prostitutes in Africa are sometimes paid more if condoms aren't used, and some are beaten if they refuse to provide sex without a condom, she says.

'Impediment to intimacy'

But negotiating condom use also can be difficult for U.S. women. Some people claim using condoms during sex decreases sensation. They're also seen as an impediment to intimacy, Gottemoeller says.

"As trust and intimacy grow and the relationship becomes exclusive, condom use drops off," she says.

Studies on condom use in the United States have found that condoms are used consistently by no more than 20 percent of couples, she says.

Microbicides -- which could come in gel, cream or suppository form -- could be used as a backup to condoms or as an option when a man refuses to use a condom, Harrison says. In some cases, they could be used without the man's knowledge.

Microbicides that are ready to be tested in women include:


BufferGel, which changes the natural environment of the vagina, making it more acidic than normal and inhospitable to invading cells.

PRO 2000, which has been shown to reduce the rate of infection by an AIDS-causing virus in monkeys when applied vaginally and which also has protected mice from genital herpes.

PC151, which uses carrageenan, a derivative of red seaweed that's used as a thickener in products such as salad dressing and cat food, to keep HIV from entering the host cell.
If things go well, these and other microbicides under development could be available within several years, Harrison says. They also might work as contraceptives, she says.

However, recently a microbicide that looked promising in the lab failed when tested in women. Trademarked the "Invisible Condom" by an enterprising researcher, the microbicide used nonoxynol-9, a substance found in conventional spermicides.

But a study of women in Africa found that nonoxynol-9 could irritate the vagina, possibly even leading to a higher rate of infection because of the small openings in the skin caused by abrasions.

As a result, most researchers have halted nonoxynol-9 research and are looking to other substances, says Henry Gabelnick, director of the contraceptive research and development program at the Eastern Virginia Medical School, in Arlington, Va.

What To Do

To read more about microbicides, visit the Web sites of the Alan Guttmacher Institute or the National Institute of Allergy and Infectious Diseases.

For information about AIDS, visit the American Foundation for AIDS Research online, or call the National AIDS Hotline at 1-800-342-2437 (Spanish-speakers should call 1-800-344-7432; the deaf and hearing impaired should call 1-800-243-7889).

Or, you may want to read previous HealthScout articles on microbicides and on AIDS.

Copyright © 2000 Rx Remedy, Inc.
 
Unfortunately viruses are continually mutating, and there is always the problem of harming our own cellular components. On the other hand, I think we will be able to control bacterial infections in the near future, both by restricting, limiting, and rotating antibiotic prescriptions and by reducing their use in agriculture. The whole condom issue is indeed a problem, I know first hand, so if a new product makes it easier, then I definitely think it is worthwhile.
 
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