Microbicide advocates stress options - Researchers hope microbicides are the next step in the fight against HIV/AIDS.

Microbicide advocates stress options - Researchers hope microbicides are the next step in the fight against HIV/AIDS.
By Amy Wooten
Copyright by The Chicago Free Press
March 25, 2009
http://www.chicagofreepress.com/node/3299


With over 33 million people living with HIV/AIDS across the globe, advocates stress that more prevention options are needed, and a product currently in development—microbicides—could potentially save millions of people from infection.

Microbicides have for years been in development to reduce HIV transmission, and some even aim to prevent other STDs, as well. But since the rectum and vagina are biologically very different, safe and effective microbicides for both areas need to be developed.

The rectum is what AIDS Foundation of Chicago (AFC) Director of Advocacy and International Rectal Microbicides Advocates (IRMA) chair Jim Pickett describes as “the perfect storm” for HIV infection. Although women will primarily use vaginal microbicides, safety trials are being conducted to determine if they are safe for anal use. Both men and women will ideally utilize rectal microbicides.

According to AFC policy manager Jessica Terlikowski, Chicago has been a hub for microbicide activism.

“This is the city where microbicide advocacy has been taking place for the last 10 years,” Terlikowski said.

That is why advocates are ecstatic that an upcoming clinical trial of a vaginal microbicide gel will take place in Chicago, as well as other cities. Terlikowski said that the trial would most likely be launched this summer and added that support for microbicide research and development is on the rise.

“There has been a groundswell of both intellectual and monetary investments,” according to Terlikowski.

Between fiscal year 1999 and fiscal year 2008, the USA Agency for International Development’s funding for such research and development has increased nearly 20-fold.

The Obama White House is supportive of microbicide research and development as well, and included it in the White House agenda. In fact, while a U.S. senator, President Barack Obama introduced the Microbicide Development Act.

Pickett said the support from the top leaves advocates feeling very optimistic.

“We don’t have to deny behavior and pretend gay people don’t exist” to get government dollars,” he said, adding that under the Bush regime scientists had to quietly conduct rectal microbicide research for fear of getting their funding pulled.

This increased attention has allowed scientists to make headway. New research suggests that a vaginal gel called Pro 2000 lessened the risk of infection. Pickett said the initial study’s results, while not statistically significant, still “offer the first glimmer of hope” for the field. A much larger study of Pro 2000 is now taking place.

While interest and support of vaginal microbicides has increased over the years, support for rectal microbicides—which could greatly impact the gay community—is not as strong.

According to Pickett, the rectal microbicide field is “significantly behind” for various reasons. For one, funding is hard to come by, and the current economic crisis won’t make things easier. Data on sexual behavior, even today, is spotty. Also, anal sex is an issue still not widely discussed because of the stigma attached to it and homophobia.

“This is typical of anything that has to do with anal sex or gay men,” Pickett said. “We need to take away the moral component and the judgment and focus on saving lives.”

Regardless, headway has been made. UCLA recently conducted the world’s first rectal microbicide safety trial, and several more Phase 1 safety trials are already planned or underway. Safety trials of vaginal microbicides used rectally have taken place, as well.

International Rectal Microbicides Advocates, an organization created in 2005 by a handful of individuals that now boasts nearly 900 members, calls for rectal microbicide funding to increase five-fold by 2010, from $7 million in U.S. funding per year to $35 million. A large bulk of current rectal microbicide funding comes from the NIH, which accounts for over half of federal microbicide (rectal and vaginal) research dollars.

Advocates emphasize that gay men aren’t the only ones having anal sex. Between 10-35 percent of straight women and up to 40 percent of men in the U.S. practice anal sex. Studies also show that more straight women than gay men in the U.S. practice receptive anal sex, and that heterosexual anal sex is largely practiced unprotected.

According to IRMA, even a 60 percent effective microbicide used by 20 percent of sexually active people in over 70 low-income countries could prevent 2.5 million HIV infections over the course of three years.

Advocates additionally point out that condom use will not disappear with the eventual availability of microbicides, and that they will continue to stress condom use, which is believed to be 98 percent effective. Advocates say microbicides will, rather, become a part of a comprehensive prevention strategy.

“They won’t replace condoms,” Terlikowski said. “Condoms still serve as the gold standard.”

Microbicides additionally can be useful for those who don’t use condoms at all. Vaginal microbicides are particularly important for women who can’t negotiate condom use in a relationship for fear of physical abuse, which is often the case in poorer countries. In sub-Saharan Africa, where 60 percent of those with HIV are women, less than 7 percent of women reported using a condom the last time they had sex with their primary partner. A vaginal gel, however, can be applied secretly.

There are also no options for those who simply don’t want to use condoms. And although many gay men have lessoned their risk over the years by methods like serosorting, microbicides could further reduce their risk. While some believe that advocating alternatives to the condom equates advocating unprotected sex, microbicide advocates like Pickett quip that something is far better than nothing.

“It’s a false argument,” he said. “If you aren’t using a condom, you have no protection. Wouldn’t something that’s even 60 percent effective be great in comparison?”

Terlikowski, who is also a strong female condom advocate, feels that in order to reduce infection rates, people need a variety of affordable and accessible choices. She said that doing female condom advocacy “helped lay the groundwork for microbicides.”

“I find it absolutely ridiculous we’ve been so satisfied with one option,” Pickett said. “After all, we’re a consumer culture. We don’t accept that in any other aspect of our lives.”