A New Lifeline

In the coming decade, microbicides may become the most surefire way of preventing AIDS, says Seema Chowdhry Sharma

Lata is a sex worker, whose daily meal comes in only if she is able to find a customer. Sure, she has heard about condoms and how they can help prevent the dreaded disease AIDS, but when she broaches the subject of condoms with some customers, they threaten to look for another sex worker. Even though Lata would like to say 'no' to these men all the time, she ends up having sex with them because she knows what it is like to be hungry.

Lata is not alone. As we celebrate World AIDS Day, millions of women across India face the hazard of acquiring AIDS for no fault of theirs. "Married women have it worse, because unlike a sex worker who can insist on condoms being used, these women are at the mercy of their husbands. In fact, it has been has found that marriage can be a major factor in HIV transmission in women in India," says Dr N Kumaraswamy, chief medical officer, YRG Care, Chennai. For women in this country, the concept of insisting that their husband uses a condom just does not exist. While most are unaware about AIDS, those who are aware seldom have the choice or the chance to take steps to protect themselves against this killer virus since the current method of protection - condoms - has a huge drawback: Their use requires the man's agreement. In societies like ours where women have little power, getting men to wear one is next to impossible.

A New Approach

In 2002, almost 50 per cent of those infected with HIV globally were women, says a report on the International Family Health, UK website. Their husbands or sole sexual partner infected many of them. For these women, often expected to bear children, there are virtually no options available as they seek to protect themselves against this disease. Till now, the effort to get the AIDS pandemic under control is focused on the "safer sex" approach, which entreats people to use condoms and limit their sexual partners. This approach frequently referred to as the ABC of prevention - Abstain, Be Monogamous and Use a Condom - assumes that women have control over their reproductive and sexual health, which is not the case for millions of women in our country. Women who have no say in patriarchal societies like ours are left with no means to protect themselves. "The need of the hour is to reach out and develop strategies that will help women take control of their sexual wellbeing and reduce the chances of acquiring the virus," says Dr Kumaraswamy. Hence, we need a completely different approach to AIDS prevention, one in which the woman can be in charge. Scientists in several countries are investigating the possibility of develop vaginal medications, called microbicides, that can prevent the transmission of HIV during sex. So what are microbicides? These are biological substances which when applied topically, can protect people against infection by microbes, such as viruses or bacteria, by directly killing them or physically preventing them from entering the body.

Empowering Women

"The best thing about microbicides is that their use will be in the hands of women," says Dr Kumaraswamy. They will give women the option of taking action themselves, if necessary without their partners' agreement or even knowledge. As a potentially woman-controlled technology, they can fill an important prevention gap for those who are unable to successfully negotiate safer sex. A microbicide could be the first method of HIV and STD prevention that enables women to control their HIV and STD risks in the same way that men, via condoms, already can. These products - vaginal gels, foams, creams, pessaries, suppositories and impregnated sponges - will be largely undetectable, with no odour, colour or taste that are likely to reduce pleasure and at the same time, will accord the much-needed protection. Instead, some products might even be promoted as "sex enhancers", emphasising positive attributes such as lubrication. And an added advantage of these products will be that they would protect men against HIV infection too.

A Slow Ascent

Researchers have developed a mathematical model that shows that if even a small proportion of women in lower income countries used a 60 per cent efficacious microbicide in half the sexual encounters where condoms are not used, 2.5 million HIV infections could be averted over three years. In spite of such staggering statistics to support their cause, microbicides are still at a developmental stage, and no proven safe and effective products are currently available. Shortage of funds and a lack of interest in this area from large pharmaceutical companies are believed to be the prime cause of this delay. However, scientists are seriously pursuing almost 60 product leads that can help protect against HIV and/or other STDs, including at least 11 that have been proven safe and effective in animals and are now being tested in people. If one of these leads proves successful and investment is sufficient, a microbicide could be available in five to seven years. "However, at this time, there is no scientific evidence to prove the efficacy of microbicides in preventing HIV transmission. Clinical trials are going on but there is no concrete evidence yet. At YRG care, we will shortly be starting clinical trials using 'cellulose sulphate' to test the efficacy of this product in preventing HIV transmission as well as find out if the product is user friendly for women," cautions Dr Kumaraswamy. "It takes minimum two years of trial to yield any kind of results." Currently the need of the hour is to create awareness and step up the efforts to overcome challenges, which are a result of lack of awareness and shortage of funds. Not too far away lies the possibility of safe and effective microbicides being made available as a lifeline to some of the poorest and most powerless women in the world to protect them against HIV.

Condom Catch

F you think that a microbicide will eliminate the need for condoms, you are way off the mark. When used consistently and correctly, male or female condoms are likely to provide better protection against HIV and STDs than microbicides, so they will still be the preferred option. But for people who cannot or will not use condoms, and particularly for women whose partners refuse condoms, using microbicides can save lives and have a substantial impact on the HIV epidemic. The idea is not to replace one with the other. In our fight against the pandemic AIDS, the more methods we have for prevention, the better control we will have over stopping this virus in its tracks.

Source: www.global-campaign.org

Better Safe Than Sorry

YOUR body makes the best natural defence mechanisms available to you, but you need to take care of your body in order for these to be effective. A healthy vagina can help fight HIV and other STDs if you avoid practices that disrupt the natural vaginal ecology. Steer clear of douching, using substances to dry or tighten the vagina, such as herbs or astringents, using products described as vaginal deodorants or vaginal cleansers or inserting objects or sex toys that have not been cleaned with soap and water. Women can also help protect themselves by seeking prompt treatment for all reproductive tract infections, since the risk of getting or transmitting HIV is higher if the individual has another STD. So if you have any itching, burning sensations, painful urination, an unusual amount of discharge or a bad odour south-of-the-border, consult your gynaecologist immediately.

Source: www.global-campaign.org